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25. Ischemic Pain in the Extremities and Raynaud’s Phenomenon
Author(s) -
Devulder Jacques,
van Suijlekom Hans,
van Dongen Robert,
Diwan Sudhir,
Mekhail Nagy,
van Kleef Maarten,
Huygen Frank
Publication year - 2011
Publication title -
pain practice
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.899
H-Index - 58
eISSN - 1533-2500
pISSN - 1530-7085
DOI - 10.1111/j.1533-2500.2011.00460.x
Subject(s) - medicine and health sciences , evidence based medicine , ischemic pain , raynaud's phenomenon , spinal cord stimulation , controlled clinical trial , critical limb ischemia , term follow up , lumbar sympathectomy , disease , scs
Two important groups of disorders result from an insufficient blood supply to the extremities: critical vascular disease and the Raynaud’s phenomenon. The latter can be subdivided into a primary and a secondary type. Critical ischemic disease is often caused by arteriosclerosis due to hypertension or diabetes. Primary Raynaud’s is idiopathic and will be diagnosed as such if underlying systemic pathology has been excluded. Secondary Raynaud’s is often a manifestation of a systemic disease. It is essential to try to establish a diagnosis as soon as possible in order to influence the evolution of the disease. A sympathetic nerve block can be considered in patients with critical ischemic vascular disease after extensive conservative treatment, preferably in the context of a study (2B±). If this has insufficient effect, spinal cord stimulation can be considered in a selected patient group (2B±). In view of the degree of invasiveness and the costs involved, this treatment should preferably be applied in the context of a study and with the use of transcutaneous pO 2 measurements. In case of primary Raynaud’s , life style changes are the first step. Sympathectomy can be considered as a treatment of Raynaud’s phenomenon (2C+), but only after multidisciplinary evaluation of the patient and in close consultation with the patient’s rheumatologist, vascular surgeon or internist.