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      Quality of life after amputation in patients with advanced complex regional pain syndrome: a systematic review

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          Abstract

          • The majority of included studies (8 out of 11, n = 54) supported the concept of considering amputation for selected, unresponsive cases of complex regional pain syndrome (CRPS) as a justifiable alternative to an unsuccessful multimodality nonoperative option.

          • Of patients who underwent amputation, 66% experienced improvement in quality of life (QOL) and 37% were able to use a prosthesis, 16% had an obvious decline in QOL and for 12% of patients, no clear details were given, although it was suggested by authors that these patients also encountered deterioration after amputation.

          • Complications of phantom limb pain, recurrence of CRPS and stump pain were predominant risks and were noticed in 65%, 45% and 30% of cases after amputation, respectively and two-thirds of patients were satisfied.

          • Amputation can be considered by clinicians and patients as an option to improve QOL and to relieve agonizing, excruciating pain of severe, resistant CRPS at a specialized centre after multidisclipinary involvement but it must be acknowledged that evidence is limited, and the there are risks of aggravating or recurrence of CRPS, phantom pain and unpredictable consequences of rehabilitation.

          • Amputation, if considered for resistant CRPS, should be carried out at specialist centres and after MDT involvement before and after surgery. It should only be considered if requested by patients with poor quality of life who have failed to improve after multiple treatment modalities.

          • Further high quality and comprehensive research is needed to understand the severe form of CRPS which behaves differently form less severe stages.

          Cite this article: EFORT Open Rev 2019;4:533-540. DOI: 10.1302/2058-5241.4.190008

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          Proposed new diagnostic criteria for complex regional pain syndrome.

          R Harden, Stephen Bruehl, Michael Stanton-Hicks … (2007)
          This topical update reports recent progress in the international effort to develop a more accurate and valid diagnostic criteria for complex regional pain syndrome (CRPS). The diagnostic entity of CRPS (published in the International Association for the Study of Pain's Taxonomy monograph in 1994; International Association for the Study of Pain [IASP]) was intended to be descriptive, general, and not imply etiopathology, and had the potential to lead to improved clinical communication and greater generalizability across research samples. Unfortunately, realization of this potential has been limited by the fact that these criteria were based solely on consensus and utilization of the criteria in the literature has been sporadic at best. As a consequence, the full potential benefits of the IASP criteria have not been realized. Consensus-derived criteria that are not subsequently validated may lead to over- or underdiagnosis, and will reduce the ability to provide timely and optimal treatment. Results of validation studies to date suggest that the IASP/CRPS diagnostic criteria are adequately sensitive; however, both internal and external validation research suggests that utilization of these criteria causes problems of overdiagnosis due to poor specificity. This update summarizes the latest international consensus group's action in Budapest, Hungary to approve and codify empirically validated, statistically derived revisions of the IASP criteria for CRPS.
          Article 0 comments Cited 187 times – based on 0 reviews     Review now
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            The harvest plot: A method for synthesising evidence about the differential effects of interventions

            David Ogilvie, Debra Fayter, Mark Petticrew … (2008)
            Background One attraction of meta-analysis is the forest plot, a compact overview of the essential data included in a systematic review and the overall 'result'. However, meta-analysis is not always suitable for synthesising evidence about the effects of interventions which may influence the wider determinants of health. As part of a systematic review of the effects of population-level tobacco control interventions on social inequalities in smoking, we designed a novel approach to synthesis intended to bring aspects of the graphical directness of a forest plot to bear on the problem of synthesising evidence from a complex and diverse group of studies. Methods We coded the included studies (n = 85) on two methodological dimensions (suitability of study design and quality of execution) and extracted data on effects stratified by up to six different dimensions of inequality (income, occupation, education, gender, race or ethnicity, and age), distinguishing between 'hard' (behavioural) and 'intermediate' (process or attitudinal) outcomes. Adopting a hypothesis-testing approach, we then assessed which of three competing hypotheses (positive social gradient, negative social gradient, or no gradient) was best supported by each study for each dimension of inequality. Results We plotted the results on a matrix ('harvest plot') for each category of intervention, weighting studies by the methodological criteria and distributing them between the competing hypotheses. These matrices formed part of the analytical process and helped to encapsulate the output, for example by drawing attention to the finding that increasing the price of tobacco products may be more effective in discouraging smoking among people with lower incomes and in lower occupational groups. Conclusion The harvest plot is a novel and useful method for synthesising evidence about the differential effects of population-level interventions. It contributes to the challenge of making best use of all available evidence by incorporating all relevant data. The visual display assists both the process of synthesis and the assimilation of the findings. The method is suitable for adaptation to a variety of questions in evidence synthesis and may be particularly useful for systematic reviews addressing the broader type of research question which may be most relevant to policymakers.
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              Signs and symptoms of reflex sympathetic dystrophy: prospective study of 829 patients.

              P H Veldman, I E Arntz, H Reynen … (1993)
              The pathogenesis of reflex sympathetic dystrophy--variously known as Sudeck's atrophy, causalgia, algodystrophy, and peripheral trophoneurosis--is not yet understood, and diagnosing and treating patients is difficult. We have prospectively studied 829 patients, paying particular attention to early signs and symptoms. In its early phase, reflex sympathetic dystrophy is characterised by regional inflammation, which increases after muscular exercise. Pain was present in 93% of patients, and hypoaesthesia and hyperpathy were present in 69% and 75% respectively. With time, tissue atrophy may occur as well as involuntary movements, muscle spasms, or pseudoparalysis. Tremor was found in 49% and muscular incoordination in 54% of patients. Sympathetic signs such as hyperhidrosis are infrequent and therefore have no diagnostic value. We found no evidence consistent with the presence of three consecutive phases of the disease. Early symptoms are those of an inflammatory reaction and not of a disturbance of the sympathetic nervous system. These data support the concept of an exaggerated regional inflammatory response to injury or operation in reflex sympathetic dystrophy.
              Article 0 comments Cited 66 times – based on 0 reviews     Review now
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                Author and article information

                Journal
                Journal ID (nlm-ta): EFORT Open Rev
                Journal ID (iso-abbrev): EFORT Open Rev
                Title: EFORT Open Reviews
                Publisher: British Editorial Society of Bone and Joint Surgery
                ISSN (Electronic): 2058-5241
                Publication date Collection: September 2019
                Publication date (Electronic): 3 September 2019
                Volume: 4
                Issue: 9
                Pages: 533-540
                Affiliations
                [1 ]Department of Orthopaedics, Blackpool Teaching Hospitals NHS Trust, Blackpool, UK
                [2 ]Edge Hill University, Ormskirk, UK
                Author notes
                [*]Brijesh Ayyaswamy, Department of Orthopaedics, Blackpool Teaching Hospitals NHS Trust, Whinney heys Road, Blackpool, Lancashire, FY3 8NR, UK. Email: brijeshayyaswami@ 123456gmail.com
                Article
                Publisher ID: 10.1302_2058-5241.4.190008
                DOI: 10.1302/2058-5241.4.190008
                PMC ID: 6771076
                PubMed ID: 31598331
                SO-VID: 17782174-c353-4410-b1f8-6826938e2162
                Copyright © © 2019 The author(s)
                License:

                This article is distributed under the terms of the Creative Commons Attribution-Non Commercial 4.0 International (CC BY-NC 4.0) licence ( https://creativecommons.org/licenses/by-nc/4.0/) which permits non-commercial use, reproduction and distribution of the work without further permission provided the original work is attributed.

                History
                Categories
                Subject: General Orthopaedics
                Subject: 10
                Subject: Amputation
                Subject: Complications
                Subject: Criteria
                Subject: Crps
                Subject: Pain
                Subject: Phantom Pain
                Subject: Quality of Life

                Keywords: amputation,complications,criteria,crps,pain,phantom pain,quality of life
                Data availability:
                Keywords: amputation, complications, criteria, crps, pain, phantom pain, quality of life

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