Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
Meta-Analysis
. 2016 Jul 28;7(7):CD004598.
doi: 10.1002/14651858.CD004598.pub4.

Local anaesthetic sympathetic blockade for complex regional pain syndrome

Neil E O'Connell  1 , Benedict M Wand, William Gibson, Daniel B Carr, Frank Birklein, Tasha R Stanton
Affiliations
Meta-Analysis

Local anaesthetic sympathetic blockade for complex regional pain syndrome

Neil E O'Connell et al. Cochrane Database Syst Rev. .

Abstract

Background: This review is an update of a previously published review in the Cochrane Database of Systematic Reviews, 2005, Issue 4 (and last updated in the Cochrane Database of Systematic Reviews, 2013 issue 8), on local anaesthetic blockade (LASB) of the sympathetic chain to treat people with complex regional pain syndrome (CRPS).

Objectives: To assess the efficacy of LASB for the treatment of pain in CRPS and to evaluate the incidence of adverse effects of the procedure.

Search methods: For this update we searched the Cochrane Central Register of Controlled Trials (CENTRAL) (2015, Issue 9), MEDLINE (Ovid), EMBASE (Ovid), LILACS (Birme), conference abstracts of the World Congresses of the International Association for the Study of Pain, and various clinical trial registers up to September 2015. We also searched bibliographies from retrieved articles for additional studies.

Selection criteria: We considered randomised controlled trials (RCTs) that evaluated the effect of sympathetic blockade with local anaesthetics in children or adults with CRPS compared to placebo, no treatment, or alternative treatments.

Data collection and analysis: We used standard methodological procedures expected by Cochrane. The outcomes of interest were reduction in pain intensity, the proportion who achieved moderate or substantial pain relief, the duration of pain relief, and the presence of adverse effects in each treatment arm. We assessed the evidence using GRADE (Grading of Recommendations Assessment, Development and Evaluation) and created a 'Summary of findings' table.

Main results: We included an additional four studies (N = 154) in this update. For this update, we excluded studies that did not follow up patients for more than 48 hours. As a result, we excluded four studies from the previous review in this update. Overall we included 12 studies (N = 461), all of which we judged to be at high or unclear risk of bias. Overall, the quality of evidence was low to very low, downgraded due to limitations, inconsistency, imprecision, indirectness, or a combination of these.Two small studies compared LASB to placebo/sham (N = 32). They did not demonstrate significant short-term benefit for LASB for pain intensity (moderate quality evidence).One small study (N = 36) at high risk of bias compared thoracic sympathetic block with corticosteroid and local anaesthetic versus injection of the same agents into the subcutaneous space, reporting statistically significant and clinically important differences in pain intensity at one-year follow-up but not at short term follow-up (very low quality evidence).Of two studies that investigated LASB as an addition to rehabilitation treatment, the only study that reported pain outcomes demonstrated no additional benefit from LASB (very low quality evidence).Eight small randomised studies compared sympathetic blockade to various other active interventions. Most studies found no difference in pain outcomes between sympathetic block versus other active treatments (low to very low quality evidence).One small study compared ultrasound-guided LASB with non-guided LASB and found no clinically important difference in pain outcomes (very low quality evidence).Six studies reported adverse events, all with minor effects reported.

Authors' conclusions: This update's results are similar to the previous versions of this systematic review, and the main conclusions are unchanged. There remains a scarcity of published evidence and a lack of high quality evidence to support or refute the use of local anaesthetic sympathetic blockade for CRPS. From the existing evidence, it is not possible to draw firm conclusions regarding the efficacy or safety of this intervention, but the limited data available do not suggest that LASB is effective for reducing pain in CRPS.

PubMed Disclaimer

Conflict of interest statement

NEO: none known.

BMW: none known.

WG: none known.

DBC: none known; DBC practiced anesthesiology and pain medicine in busy academic medical centers from 1986‐2005, directly treating patients with CRPS, but has not treated people with CRPS since 2005.

FB: none known; FB is a practicing neurologist and pain treatment specialist who treats patients with CRPS.

TRS: none known.

Figures

1
1
#Study flow diagram for updated searches
2
2
Risk of bias summary: review authors' judgements about each risk of bias item for each included study.
3
3
Risk of bias graph: review authors' judgements about each risk of bias item presented as percentages across all included studies.
See this image and copyright information in PMC

Update of

References

References to studies included in this review

Aydemir 2006 {published data only}
    1. Aydemir K, Taskaynatan MA, Yazicloglu K, Ozgul A. The effects of stellate ganglion block with lidocaine and ultrasound in complex regional pain syndrome: A randomized, double blind, placebo controlled study. Journal of Rheumatology and Medical Rehabilitation 2006;17(3):193-200.
Bonelli 1983 {published data only}
    1. Bonelli S, Conoscente F, Movilia PG, Restelli L, Francucci B, Grossi E. Regional intravenous guanethidine vs. stellate ganglion block in reflex sympathetic dystrophies: a randomized trial. Pain 1983;16(3):297-307. - PubMed
Carroll 2009 {published data only}
    1. Carroll I, Clark JD, Mackey S. Sympathetic block with botulinum toxin to treat complex regional pain syndrome. Annals of Neurology 2009;65(3):348-51. - PMC - PubMed
Freitas 2013 {published data only}
    1. Freitas TS, Deusdara R, Kessler I. Pulsed radiofrequency of sympathetic lumbar plexus versus sympathetic block in the management of lower limb complex regional pain syndrome type. Stereotactic and functional neurosurgery 2013;91:107.
Lim 2007 {published data only}
    1. Lim K B, Lee H J, Joo S J, Kim J Y, Lim S S. The Comparision of Effects between Stellate Ganglion Block and Oral Corticosteroid Therapy in Post-stroke Complex Regional Pain Syndrome. Journal of Korean Academy of Rehabilitation Medicine 2007;31(4):417-22.
Nascimento 2010 {published data only}
    1. Nascimento MSA, Klamt JG, Prado WA. Intravenous regional block is similar to sympathetic ganglion block for pain management in patients with complex regional pain syndrome type I. Brazilian Journal of Medical and Biological Research 2010;43(12):1239-44. - PubMed
Price 1998 {published data only}
    1. Price DD, Long S, Wilsey B, Rafii A. Analysis of peak magnitude and duration of analgesia produced by local anesthetics injected into sympathetic ganglia of complex regional pain syndrome patients. Clinical Journal of Pain 1998;14(3):216-26. - PubMed
Rocha 2014 {published data only}
    1. Rocha RDO, Teixeira MJ, Yeng LT, Cantara MG, Faria VG, Liggieri V et al. Thoracic sympathetic block for the treatment of complex regional pain syndrome type I: a double-blind randomized controlled study. Pain 2014;155(11):2274-81. - PubMed
Rodriguez 2005 {published data only}
    1. Rodriguez RF, Bravo LE, Tovar MA, Castro F, Ramos GE, Mendez F. Determination of the analgesic efficacy of the stellate ganglion blockade in the alleviation of pain mediated by the sympathetic nervous system in patients with Complex Regional Pain Syndrome [Determinacion de la eficacia analgesica de los bloqueos del ganglio estrellado en el alivio del dolor mediado por el sistema nervioso simpatico, en pacientes con sindrome doloroso regional complejo del miembro superior]. Revista Colombiana de Anestesiología 2005;33(3):153-9.
Toshniwal 2012 {published data only}
    1. Toshniwal G, Sunder R, Thomas R, Dureja GP. Management of complex regional pain syndrome type I in upper extremity - Evaluation of continuous stellate ganglion block and continuous infraclavicular brachial plexus block: a pilot study. Pain Medicine 2012;13(1):96-106. - PubMed
Yoo 2012 {published data only}
    1. Yoo SD, Jung SS, Kim HS, Yun DH, Kim DH, Chon J. Efficacy of ultrasonography guided stellate ganglion blockade in the stroke patients with complex regional pain syndrome. Annals of Rehabilitation Medicine 2012;36(5):633-9. - PMC - PubMed
Zeng 2003 {published data only}
    1. Zeng X, Chen S, Guan C, Jiang L, Wang L. Block of ganglion stellatum on improving edema and range of movement in shoulder-hand syndrome. Chinese Journal of Clinical Rehabilitation 2003;7(7):1194-5.

References to studies excluded from this review

Ackerman 2006 {published data only}
    1. Ackerman WE, Zhang JM. Efficacy of stellate ganglion blockade for the management of type 1 complex regional pain syndrome. Southern Medical Journal 2006;99(10):1084-8. - PubMed
Arias 1989 {published data only}
    1. Arias LM, Bartkowski R, Grossman KL, Schwartzman RJ, Tom CM. Sufentanil stellate ganglion injection in the treatment of refractory reflex sympathetic dystrophy. Regional Anesthesia 1989;14(2):90-2. - PubMed
Catala 1994 {published data only}
    1. Catala E, Ferrandiz M, Aliaga L, Serra R, Castro MA, Villar JM. Intravenous lidocaine compared with sympathetic blocks as treatment for post-herpetic neuralgia. A 1-year survey. The Pain Clinic 1994;7(3):205-10.
Dellemijn 1994 {published data only}
    1. Dellemijn PL, Fields HL, Allen RR, McKay WR, Rowbotham MC. The interpretation of pain relief and sensory changes following sympathetic blockade. Brain 1994;117(6):1475-87. - PubMed
Erickson 1993 {published data only}
    1. Erickson SJ, Hogan QH. CT-guided injection of the stellate ganglion: description of technique and efficacy of sympathetic blockade. Radiology 1993;188(3):707-9. - PubMed
Farcot 1990 {published data only}
    1. Farcot JM, Grasser C, Foucher G, Marin Braun F, Ehrler S, Demangeat JL, et al. Local intravenous treatment of algodystrophy of the hand: buflomedil versus guanethidine, long term follow-up [Traitements locaux intra-veineux des algodystrophies de la main: buflomédil versus guanéthidine, suivi à long terme]. Annales de Chirurgie de la Main et du Membre Supérieur: Organe Officiel des Sociétés de Chirurgie de la Main 1990;9(4):296-304. - PubMed
Fukusaki 1995 {published data only}
    1. Fukusaki M, Matsumoto M, Yamaguchi K, Nakamura H, Sumiwaka K. The role of nerve blocks to deal with pain associated with cervical radiculopathy. The Pain Clinic 1995;8(3):219-25.
Garrido 2005 {published data only}
    1. Garrido B, Fernandez-Suarez L, Bosch F, Rabi MC, Hernandez-Arteaga M. Complex regional pain syndrome type I. Management with sympathetic blockade and other therapies [Síndrome doloroso regional complejo tipo 1.Tratamiento mediante bloqueos simpáticos y más]. Revista de la Sociedad Española del Dolor 2005;12(7):417-24.
Glynn 1993 {published data only}
    1. Glynn C, Casale R. Morphine injected around the stellate ganglion does not modulate the sympathetic nervous system nor does it provide pain relief. Pain 1993;53(33):37. - PubMed
Hartrick 2004 {published data only}
    1. Hartrick CT, Kovan JP, Naismith P. Outcome prediction following sympathetic block for complex regional pain syndrome. Pain Practice 2004;4(3):222-8. - PubMed
ISRCTN71968956 {published data only}
    1. ISRCTN71968956. Percutaneous sympathetic blockade in complex regional pain syndrome type 1: a prospective clinical investigation on predictors of sympatheticaly (sic) maintained pain ID - 7. http://www.isrctn.com/ISRCTN71968956 (accessed 15 October 2015).
Kastler 2013 {published data only}
    1. Kastler A, Aubry S, Sailley N, Michalakis D, Siliman G, Gory G, et al. CT-guided stellate ganglion blockade vs. radiofrequency neurolysis in the management of refractory type I complex regional pain syndrome of the upper limb. European Radiology 2013;25(5):1316-22. - PubMed
Linson 1983 {published data only}
    1. Linson MA, Leffert R, Todd DP. The treatment of upper extremity reflex sympathetic dystrophy with prolonged continuous stellate ganglion blockade. Journal of Hand Surgery 1983;8(2):153-9. - PubMed
Malmqvist 1992 {published data only}
    1. Malmqvist ELA, Bengtsson M, Sorensen J. Efficacy of stellate ganglion block: a clinical study with bupivacaine. Regional Anesthesia 1992;17(6):340-7. - PubMed
Meier 2009 {published data only}
    1. Meier PM, Zurakowski D, Berde CB, Sethna NF. Lumbar sympathetic blockade in children with complex regional pain syndromes: a double blind placebo-controlled crossover trial. Anesthesiology 2009;111(2):372-80. - PMC - PubMed
Perrigot 1982 {published data only}
    1. Perrigot M, Bergego C, Hocini A, Pierrot Deseilligny E. Algodystrophic syndrome in hemiplegia. Clinical and therapeutic study [Le syndrome algodystrophique chez l'hémiplégique. Etude clinique et thérapeutique]. Annales de Médecine Interne 1982;133(8):544-8. - PubMed
Quevedo 2005 {published data only}
    1. Quevedo JP, Purgavie K, Platt H, Strax TE. Complex regional pain syndrome involving the lower extremity: a report of 2 cases of sphenopalatine block as a treatment option. Archives of Physical Medicine and Rehabilitation 2005;86(2):335-7. - PubMed
Raja 1991 {published data only}
    1. Raja SN, Treede RD, Davis KD, Campbell JN. Systemic alpha-adrenergic blockade with phentolamine: a diagnostic test for sympathetically maintained pain. Anesthesiology 1991;74(4):691-8. - PubMed
Schurmann 2001 {published data only}
    1. Schurmann M, Gradl G, Wizgal I, Tutic M, Moser C, Azad S, et al. Clinical and physiologic evaluation of stellate ganglion blockade for complex regional pain syndrome type I. Clinical Journal of Pain 2001;17(1):94-100. - PubMed
Steinbrocker 1953 {published data only}
    1. Steinbrocker O, Neustadt D, Lapin L. Shoulder-hand syndrome:sSympathetic block compared with corticotropin and cortisone therapy. JAMA 1953;153(9):788-91. - PubMed
Tran 2000 {published data only}
    1. Tran KM, Frank SM, Raja SN, El Rahmany HK, Kim LJ, Vu B. Lumbar sympathetic block for sympathetically maintained pain: changes in cutaneous temperatures and pain perception. Anesthesia and Analgesia 2000;90(6):1396-401. - PubMed
Verdugo 1995 {published data only}
    1. Verdugo RJ, Moya MF, Cea JG, Salinas HA, Bilbeny CJ. Stellate ganglion block in reflex sympathetic dystrophy: a double-blind crossover study. In: Program & Abstracts of the 1st Scientific Meeting of the European Federation of IASP Chapters; 1995 May 18-21; Verona (Italy). Diegum (Belgium): European Federation of IASP Chapters (EFIC), 1995:52.
Wang 1985 {published data only}
    1. Wang JK, Erickson RP, Ilstrup DM. Repeated stellate ganglion blocks for upper-extremity reflex sympathetic dystrophy. Regional Anesthesia 1985;10(3):125-8.
Wehnert 2002 {published data only}
    1. Wehnert Y, Müller B, Larsen B, Kohn D. Sympathetically maintained pain (SMP): phentolamine test vs sympathetic nerve blockade. Comparison of two diagnostic methods [Sympathisch unterhaltener Schmerz (SMP) – Phentolamintest vs. Sympathikusblockade Vergleich zweier diagnostischer Methoden]. Der Orthopäde 2002;31(11):1076-83. - PubMed
Yucel 2009 {published data only}
    1. Yucel I, Demiraran Y, Ozturan K, Degirmenci E. Complex regional pain syndrome type I: efficacy of stellate ganglion blockade. Journal of Orthopaedic Traumatology 2009;10(4):179-83. - PMC - PubMed

References to studies awaiting assessment

Kostadinova 2012 {published data only}
    1. Kostadinova M, Blaise G, Homsy A, De Gagne N, Del Pino S F. The effect of stellar ganglion block with bupivacaine combined or not with neostigmine on the pain relief in patients with complex regional pain syndrome (1343376). In: Canadian Journal of Anesthesia. Proceedings of the Canadian Anesthesiologists' Society Annual Meeting; 2012 June 15-18; Quebec City (Canada). Toronto (Canada): Canadian Anesthesiologists' Society, 2012; Supplement 1:1-90.
Rodriguez 2006 {published data only}
    1. Rodriguez RF, Bravo LE, Tovar MA, Castro F, Ramos GE, Daza P. Study of the analgesic efficacy of stellate ganglion blockade in the management of the complex regional pain syndrome in patients with pain mediated by sympathetic nervous system: preliminary study [Determinación de la eficacia analgésica de los bloqueosdel ganglio estrellado en el síndrome doloroso regionalcomplejo con dolor mediado por el sistema nerviososimpático: estudio preliminar]. Revista de la Sociedad Española del Dolor 2006;13(4):230-7.
Rodriguez 2008 {published data only}
    1. Rodriguez RF, Bravo LE, Tovar MA, Ramos GE. Sympathetic blockades in sympathetic mediated pain. In: The 12th World Congress of PainAbstract viewer; 2008 Aug 17-22; Glasgow (Scotland). Washington (DC): International Association for the Study of Pain (IASP), 2008:PM 349.
Salinas Cerda 1997 {published data only}
    1. Salinas Cerda, H. Reflex sympathetic dystrophy: long-term control of sympatic block with guanethidine [Distrofia simpática refleja: control a largo plazo del bloqueo simpático con guanetidina]. Dolor 1997;5:17-22.

Additional references

Albrecht 2006
    1. Albrecht PJ, Hines S, Eisenberg E, Pud D, Finlay DR, Davar G et al. Pathologic alterations of cutaneous innervation and vasculature in affected limbs from patients with complex regional pain syndrome. Pain 2006;120(3):244-66. - PubMed
Ali 2000
    1. Ali Z, Raja SN, Wesselmann U, Fuchs PN, Meyer RA, Campbell JN. Intradermal injection of norepinephrine evokes pain in patients with sympathetically maintained pain. Pain 2000;88(2):161-8. - PubMed
Altman 2012
    1. Altman DG, Moher D, Schultz KF. Improving the reporting of randomised trials: The CONSORT statement and beyond. Statistics in Medicine 2012;31(25):2985-97. - PubMed
Balshem 2011
    1. Balshem H, Helfand M, Schünemann HJ, Oxman AD, Kunz R, Brozek J et al. GRADE guidelines: 3. Rating the quality of evidence. Journal of Clinical Epidemiology 2011;64(4):401-6. - PubMed
Binder 2009
    1. Binder A, Baron R. Complex regional pain syndrome, including applications of neural blockade. In: Cousins MJ, Carr DB, Horlocker TT, Bridenbaugh PO, editors(s). Cousins & Bridenbaugh's Neural Blockade in Clinical Anesthesia and Management of Pain. 4th edition. Philadelphia: Lippincott Williams & Wilkins, 2009:1154-68.
Birklein 2000
    1. Birklein F, Weber M, Neundörfer B. Increased skin lactate in complex regional pain syndrome: evidence for tissue hypoxia? Neurology 2000;55(8):1213-5. - PubMed
Birklein 2001
    1. Birklein F, Schmelz M, Schifter S, Weber M. The important role of neuropeptides in complex regional pain syndrome. Neurology 2001;57(12):2179-84. - PubMed
Birklein 2014
    1. Birklein F, Drummond PD, Li W, Schlereth T, Albrecht N, Finch PM et al. Activation of cutaneous immune responses in complex regional pain syndrome. Journal of Pain 2014;15(5):485-95. - PMC - PubMed
Breivik 2009
    1. Breivik H, Cousins MJ. Sympathetic neural blockade of upper and lower extremity. In: Cousins MJ, Carr DB, Horlocker TT, Bridenbaugh PO, editors(s). Cousins & Bridenbaugh's Neural Blockade in Clinical Anesthesia and Management of Pain. 4th edition. Philadelphia: Lippincott Williams & Wilkins, 2009:848-85.
Bruehl 1999
    1. Bruehl S, Harden RN, Galer BS, Saltz S, Bertram M, Backonja M et al. External validation of IASP diagnostic criteria for Complex Regional Pain Syndrome and proposed research diagnostic criteria. Pain 1999;81(1-2):147-54. - PubMed
Bruehl 2010
    1. Bruehl S. An update on the pathophysiology of complex regional pain syndrome. Anesthesiology 2010;113(3):713-25. - PubMed
Busse 2015
    1. Busse JW, Bartlett SJ, Dougados M, Johnston BC, Guyatt GH, Kirwan JR et al. Optimal strategies for reporting pain in clinical trials and systematic reviews: recommendations from an OMERACT 12 workshop. Journal of Rheumatology 2015;42(10):1962-1970. - PubMed
Campbell 1996
    1. Campbell JN. Complex regional pain syndrome and the sympathetic nervous system. Pain 1996;68:89-96.
Carr 2011
    1. Carr DB. Local anesthetic blockade for neuralgias: “Why is the sky blue, daddy?”. Anesthesia and Analgesia 2011;112(6):1285. - PubMed
De Mos 2007
    1. De Mos M, De Bruijn AGJ, Huygen FJPM, Dieleman JP, Stricker BHC, Sturkenboom MCJM. The incidence of complex regional pain syndrome: a population-based study. Pain 2007;129(1-2):12-20. - PubMed
De Mos 2008
    1. De Mos M, Huygen FJPM, Dieleman JP, Koopman JSHA, Stricker BHC, Sturkenboom MCJM. Medical history and the onset of complex regional pain syndrome (CRPS). Pain 2008;139(2):458-66. - PubMed
De Mos 2009
    1. De Mos, Sturkenboom MCJM, Huygen FJPM. Current understandings on complex regional pain syndrome. Pain Practice 2009;9(2):86-99. - PubMed
Drummond 2001
    1. Drummond PD, Finch PM, Skipworth S, Blockey P. Pain increases during sympathetic arousal in patients with complex regional pain syndrome. Neurology 2001;57(7):1296-303. - PubMed
Drummond 2004
    1. Drummond PD, Finch PM. Persistence of pain induced by startle and forehead cooling after sympathetic blockade in patients with complex regional pain syndrome. Journal of Neurology, Neurosurgery and Psychiatry 2004;75(1):98-102. - PMC - PubMed
Dworkin 2008
    1. Dworkin RH, Turk DC, Wyrwich KW, Beaton D, Cleeland CS, Farrar JT et al. Interpreting the clinical importance of treatment outcomes in chronic pain clinical trials: IMMPACT recommendations. Journal of Pain 2008;9(2):105-21. - PubMed
Dworkin 2009
    1. Dworkin RH, Turk DC, McDermott MP, Peirce-Sandner S, Burke LB, Cowan P et al. Interpreting the clinical importance of group differences in chronic pain clinical trials: IMMPACT recommendations. Pain 2009;146(3):238-44. - PubMed
Dworkin 2010
    1. Dworkin RH, Turk DC, Peirce-Sandner S, Baron R, Bellamy N, Burke LB et al. Research design considerations for confirmatory chronic pain clinical trials: IMMPACT recommendations. Pain 2010;149(2):177-93. - PubMed
Fine 1994
    1. Fine PG, Roberts WJ, Gillette RG, Child TR. Slowly developing placebo responses confound tests of intravenous phentolamine to determine mechanisms underlying idiopathic chronic low back pain. Pain 1994;56(2):235-42. - PubMed
Forouzanfar 2002
    1. Forouzanfar T, Koke AJ, Van Kleef M, Weber WE. Treatment of complex regional pain syndrome type I. European Journal of Pain 2002;6(2):105-22. - PubMed
Geha 2008
    1. Geha PY, Baliki MN, Harden RN, Bauer WR, Parrish TB, Apkarian AV. The brain in chronic CRPS pain: abnormal gray-white matter interactions in emotional and autonomic regions. Neuron 2008;60(4):570-81. - PMC - PubMed
Guyatt 2011a
    1. Guyatt GH, Oxman AD, Vist G, Kunz R, Brozek J, Alonso-Coello P et al. GRADE guidelines: 4. Rating the quality of evidence - study limitations (risk of bias). Journal of Clinical Epidemiology 2011;64(4):407-15. - PubMed
Guyatt 2011b
    1. Guyatt G, Oxman AD, Akl EA, Kunz R, Vist G, Brozek J et al. GRADE guidelines: 1. Introduction - GRADE evidence profiles and summary of findings table. Clinical Journal of Clinical Epidemiology 2011a;64(4):383-94. - PubMed
Harden 2006
    1. Harden RN, Bruehl S. Introduction and diagnostic considerations. In: Harden RN, editors(s). Complex Regional Pain Syndrome: Treatment Guidelines. Reflex Sympathetic Dystrophy Syndrome Association, 2006.
Harden 2010
    1. Harden RN, Bruehl S, Perez RS, Birklein F, Marinus J, Maihofner C et al. Validation of proposed diagnostic criteria for complex regional pain syndrome. Pain 2010;150(2):268-74. - PMC - PubMed
Harden 2013
    1. Harden RN, Oaklander AL, Burton AW, Perez RS, Richardson K, Swan M et al. Complex regional pain syndrome: practical diagnostic and treatment guidelines, 4th edition. Pain Medicine 2013;14(2):180-229. - PubMed
Higgins 2003
    1. Higgins JPT, Thompson SG, Deeks JJ, Altman DG. Measuring inconsistency in meta-analyses. BMJ 2003;327:557. - PMC - PubMed
Higgins 2011
    1. Higgins JPT, Green S (editors). Cochrane Handbook of Systematic Reviews of Interventions Version 5.1.0 [updated March 2011]. The Cochrane Collaboration, 2011. Available from: www.cochrane-handbook.org.
Hogan 1997
    1. Hogan QH, Abram SE. Neural blockade for diagnosis and prognosis. A review. Anesthesiology 1997;86(1):216-41. - PubMed
Jadad 1995
    1. Jadad AR, Carroll D, Glynn CJ, McQuay HJ. Intravenous regional sympathetic blockade for pain relief in reflex sympathetic dystrophy: a systematic review and a randomized, double blind crossover study. Journal of Pain and Symptom Management 1995;10(1):13-20. - PubMed
Jänig 2003
    1. Jänig W, Baron R. Complex regional pain syndrome: mystery explained? The Lancet Neurology 2003;2(11):687-97. - PubMed
Koban 2003
    1. Koban M, Leis S, Schultze-Mosgau S, Birklein F. Tissue hypoxia in complex regional pain syndrome. Plastic and Reconstructive Surgery 2003;104(1-2):149-57. - PubMed
Lewis 2007
    1. Lewis JS, Kersten P, Mccabe CS, Mcpherson KM, Blake DR. Body perception disturbance: a contribution to pain in complex regional pain syndrome (CRPS). Pain 2007;133(1-3):111-9. - PubMed
Lotze 2007
    1. Lotze M, Moseley GL. Role of distorted body image in pain. Current Rheumatology Reports 2007;9(6):488-96. - PubMed
Maihöfner 2004
    1. Maihöfner C, Handwerker HO, Neundörfer B, Birklein F. Cortical reorganization during recovery from complex regional pain syndrome. Neurology 2004;63(4):693-701. - PubMed
Marinus 2011
    1. Marinus J, Moseley GL, Birklein F, Baron R, Maihofner C, Kingery WS et al. Clinical features and pathophysiology of complex regional pain syndrome. The Lancet Neurology 2011;10(7):637-48. - PMC - PubMed
McQuay 1997
    1. McQuay HJ, Moore RA, Eccleston C, Morley S, Williams AC. Systematic review of outpatient services for chronic pain control. Health Technology Assessment 1997;1(6):1-135. - PubMed
Merskey 1994
    1. Merskey H, Bogduk N. Classification of Chronic Pain: Descriptions of Chronic Pain Syndromes and Definitions of Pain Terms. 2nd edition. Seattle: IASP Press, 1994.
Moore 2008
    1. Moore RA, Barden J, Derry S, McQuay HJ. Managing potential publication bias. In: McQuay HJ, Kalso E, Moore RA, editors(s). Systematic Reviews in Pain research: Methodology Refined. Seattle: IASP Press, 2008:15-23.
Moore 2010
    1. Moore RA, Eccleston C, Derry S, Wiffen P, Bell RF, Straube S et al. "Evidence" in chronic pain--establishing best practice in the reporting of systematic reviews. Pain 2010;150(3):386-9. - PubMed
Moseley 2006
    1. Moseley GL. Why do people with complex regional pain syndrome take longer to recognize their affected hand? Neurology 2006;62(12):2182-6. - PubMed
Nelson 2006
    1. Nelson DV, Stacey BR. Interventional therapies in the management of complex regional pain syndrome. Clinical Journal of Pain 2006;22(5):438-42. - PubMed
Niehof 2006
    1. Niehof SP, Huygen FJPM, Van der Weerd RWP, Westra M, Zijlstra FJ. Thermography imaging during static and controlled thermoregulation in complex regional pain syndrome type 1: diagnostic value and involvement of the central sympathetic system. BioMedical Engineering Online 2006;5:30. - PMC - PubMed
Nüesch 2010
    1. Nüesch E, Trelle S, Reichenbach S, Rutjes AWS, Tschannen B, Altman DG et al. Small study effects in meta-analyses of osteoarthritis trials: meta-epidemiological study. BMJ 2010;341(7766):241. - PMC - PubMed
O'Connell 2013
    1. O'Connell NE, Wand BM, McAuley J, Marston L, Moseley GL. Interventions for treating pain and disability in adults with complex regional pain syndrome- an overview of systematic reviews. Cochrane Database of Systematic Reviews 2013, Issue 4. Art. No: CD009416. [DOI: 10.1002/14651858.CD009416.pub2] - DOI - PMC - PubMed
Ochoa 1995
    1. Ochoa JL, Verdugo RJ. Reflex sympathetic dystrophy. A common clinical avenue for somatoform expression. Neurologic Clinics 1995;13(2):351-63. - PubMed
Perez 2010
    1. Perez RS, Zollinger PE, Dijkstra PU, Thomassen-Hilgersom IL, Zuurmond WW, Rosenbrand KCJ et al. Evidence-based guidelines for complex regional pain syndrome type 1. BMC Neurology 2010;10:20. - PMC - PubMed
Pleger 2006
    1. Pleger B, Ragert P, Schwenkreis P, Forster AF, Wilimzig C, Dinse H et al. Patterns of cortical reorganization parallel impaired tactile discrimination and pain intensity in complex regional pain syndrome. Neuroimage 2006;32(2):503-10. - PubMed
Reinders 2002
    1. Reinders MF, Geertzen JHB, Dijkstra PU. Complex Regional Pain Syndrome: Use of the International Association for the Study of Pain Diagnostic Criteria Defined in 1994. Clinical Journal of Pain 2002;18(4):207-15. - PubMed
RevMan 2012 [Computer program]
    1. The Nordic Cochrane Centre, The Cochrane Collaboration Review Manager (RevMan). Version 5.2. Copenhagen: The Nordic Cochrane Centre, The Cochrane Collaboration, 2012.
Sandroni 2003
    1. Sandroni P, Benrud-Larson LM, McClelland RL, Low PA. Complex regional pain syndrome type I: incidence and prevalence in Olmsted county, a population-based study. Pain 2003;103(1-2):199-207. - PubMed
Schinkel 2006
    1. Schinkel C, Gaertner A, Zaspel J, Zedler S, Faist E, Schuermann M. Inflammatory mediators are altered in the acute phase of posttraumatic complex regional pain syndrome. Clinical Journal of Pain 2006;22(3):235-9. - PubMed
Schmelz 2001
    1. Schmelz M, Weber M, Birklein F, Neundo B. Facilitated neurogenic inflammation in complex regional pain syndrome. Pain 2001;91(3):251-7. - PubMed
Schott 1995
    1. Schott GD. An unsympathetic view of pain. The Lancet 1995;345(8950):634-6. - PubMed
Schulz 1995
    1. Schulz KF, Chalmers I, Hayes RJ, Altman DG. Empirical evidence of bias. Dimensions of methodological quality associated with estimates of treatment effects in controlled trials. JAMA 1995;273(5):408-12. - PubMed
Schwenkreis 2003
    1. Schwenkreis P, Janssen F, Rommel O, Pleger B, Volker B, Hosbach I, et al. Bilateral motor cortex disinhibition in complex regional pain syndrome (CRPS) type I of the hand. Neurology 2003;61(4):515-9. - PubMed
Sethna 2012
    1. Sethna NF. Sympathetic nerve blocks, pragmatic trials and responder analysis. Anesthesiology 2012;116(1):12-4. - PubMed
Shipton 2009
    1. Shipton EA. Complex regional pain syndrome: mechanisms, diagnosis, and management. Current Anaesthesia and Critical Care 2009;20(5-6):209-14.
Stanton‐Hicks 1995
    1. Stanton-Hicks 1995. Reflex sympathetic dystrophy: changing concepts and taxonomy. Pain 1995;63(1):127-33. - PubMed
Stanton‐Hicks 2002
    1. Stanton-Hicks MD, Burton AW, Bruehl SP, Carr DB, Harden RN, Hassenbusch SJ et al. An updated interdisciplinary clinical pathway for CRPS: report of an expert panel. Pain Practice 2002;2(1):1-16. - PubMed
Swart 2009
    1. Swart CMA, Stins JF, Beek PJ. Cortical changes in complex regional pain syndrome (CRPS). European Journal of Pain 2009;13(9):902-7. - PubMed
Tan 2005
    1. Tan ECTH, Oyen WJG, Goris RJA. Leukocytes in complex regional pain syndrome type I. Inflammation 2005;29(4-6):182-6. - PubMed
Tran 2010
    1. Tran DQH, Duong S, Bertini P, Finlayson R. Treatment of complex regional pain syndrome: a review of the evidence. Canadian Journal of Anesthesia 2010;57(2):149-66. - PubMed
Turk 2008a
    1. Turk DC, Dworkin RH, Revicki D, Harding G, Burke LB, Cella D et al. Identifying important outcome domains for chronic pain clinical trials: An IMMPACT survey of people with pain. Pain 2008;137(2):276-85. - PubMed
Turk 2008b
    1. Turk DC, Dworkin RH, McDermott MP, Bellamy N, Burke LB, Chandler JM et al. Analyzing multiple endpoints in clinical trials of pain treatments: IMMPACT recommendations. Pain 2008;139(3):485-93. - PubMed
Van Eijs 2011
    1. Van Eijs F, Stanton-Hicks M, Van Zundert J, Faber CG, Lubenow TR, Mekhail N et al. Evidence-based interventional pain medicine according to clinical diagnoses. 16. Complex regional pain syndrome. Pain Practice 2011;11(5):70-87. - PubMed
Van Rijn 2011
    1. Van Rihn MA, Marinus J, Putter H, Bosselaar SRJ, Moseley GL, Van Hilten JJ. Spreading of complex regional pain syndrome: not a random process. Journal of Neural Transmission 2011;118(9):1301-9. - PMC - PubMed
Verdugo 1994a
    1. Verdugo RJ, Ochoa JL. Sympathetically maintained pain I. Phentolamine block questions the concept. Neurology 1994;44(6):1003-10. - PubMed
Verdugo 1994b
    1. Verdugo RJ, Campero M, Ochoa JL. Phentolamine sympathetic block in painful polyneuropathies. II. Further questioning of the concept of "sympathetically maintained pain". Neurology 1994;44(6):1010-14. - PubMed
Wood 2008
    1. Wood L, Egger M, Gluud LL, Schulz KF, Juni P, Altman DG et al. Empirical evidence of bias in treatment effect estimates with different interventions and outcomes: meta-epidemiological study. BMJ 2008;336:601-5. - PMC - PubMed

References to other published versions of this review

Cepeda 2002
    1. Cepeda MS, Lau J, Carr DB. Defining the therapeutic role of local anesthetic sympathetic blockade in complex regional pain syndrome: a narrative and systematic review. Clinical Journal of Pain 2002;18(4):216-33. - PubMed
Cepeda 2005
    1. Cepeda S, Carr D. Local anesthetic sympathetic blockade for complex regional pain syndrome. Cochrane Database of Systematic Reviews 2005, Issue 4. Art. No: CD004598. [DOI: 10.1002/14651858.CD004598] - DOI - PubMed
Cepeda 2010
    1. Cepeda MS, Carr DB, Lau J. Local anaesthetic sympathetic blockade for complex regional pain syndrome. Cochrane Database of Systematic Reviews 2010, Issue 1. Art. No: CD004598. [DOI: 10.1002/14651858.CD004598.pub2] - DOI - PubMed
Stanton 2013
    1. Stanton TR, Wand BM, Carr DB, Birklein F, Wasner GL, O'Connell NE. Local anaesthetic sympathetic blockade for complex regional pain syndrome. Cochrane Database of Systematic Reviews 2013, Issue 8. Art. No: CD004598. [DOI: 10.1002/14651858.CD004598.pub3] - DOI - PubMed

Publication types

Substances