PMID: 9188029Apr 1, 1997Paper

Medical and pharmacologic management of upper extremity neuropathic pain syndromes

Journal of Hand Therapy : Official Journal of the American Society of Hand Therapists
G A Mackin

Abstract

Written from a neurologic and therapeutically conservative perspective, this review advocates fundamentally medical and pharmacologic management of upper extremity neuropathic pain syndromes, including chronic regional pain syndromes, formerly classified reflex sympathetic dystrophy (RSD) and causalgia. Mandatory steps include, first, a prompt serious attempt to localize the nerve lesion whenever possible using complete, sophisticated neurologic examinations, then thoughtfully selected conventional neurophysiologic and radiologic tests. Strongly discouraged are promiscuous use of "RSD" to describe all neuropathic pains, and diagnostic reliance upon thermography and uncontrolled sympathetic blocks. Conservative multidisciplinary diagnostic and treatment teams should often possess a nucleus of neurologist and hand therapist, plus additional consultants including psychiatric. Every physician and therapist managing neuropathic pain must consider psychologic and wellness issues within their responsibilities. Prompt referral to an experienced surgeon is crucial for decompression or repair of relevant, significant, objectively proven (ideally neurophysiologically) nerve and root lesions. Ambiguous professional colloquialisms, "central...Continue Reading

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Apr 25, 2000·Journal of Clinical Anesthesia·F R ManekshaP J Poppers
Mar 15, 2011·The Journal of Pain : Official Journal of the American Pain Society·Lori Reisner
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