Interrupting the sympathetic outflow in causalgia and reflex sympathetic dystrophy

BMJ 1998;317:752 ( 12 September )

Letters

Interrupting the sympathetic outflow in causalgia and reflex sympathetic dystrophy

Terminology is outdated $---$ 1994 taxonomy should be used

Intravenous regional guanethidine blockade is a safe and effective treatment

Author's reply

Stellate ganglion blockade: clinics take precautions, but few follow guidelines

Terminology is outdated $---$ 1994 taxonomy should be used

The first 150 words of the full text of this article appear below.

EDITOR $---$ Schott's editorial questions the value of interrupting the sympathetic outflow in causalgia and reflex sympatheticdystrophy when clinical studies and meta-analyses fail to provebenefit.¹ Continued use of terms such as "reflex sympatheticdystrophy" merely serve to perpetuate the misconception that sympatheticblock should always be therapeutic. A consensus workshop in 1993recommended a new taxonomy $---$ accepted by the International Associationfor the Study of Pain $---$ in which "complex regional pain syndrome"types I and II replace the terms reflex sympathetic dystrophyand causalgia respectively.² Reclassification has significantadvantages in the establishment of clinical criteria for diagnosis,which should lead to reduced use of numerous synonyms and differenttreatments. Clinically, the triad of autonomic, motor, and sensorysymptoms and signs are variable, and laboratory investigations(thermography, skin blood flow, sudomotor function, and galvanicskin and ice response) are beyond the capability of many hospitals.³The three phase bone . . . [Full text of this article]