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Ischemic pain in the extremities and Raynaud's phenomenon

(2011) PAIN PRACTICE. 11(5). p.483-491
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Organization
Abstract
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.
Keywords
evidence-based medicine, ischemic pain, Raynaud's phenomenon, SPINAL-CORD STIMULATION, CONTROLLED CLINICAL-TRIAL, CRITICAL LIMB ISCHEMIA, TERM-FOLLOW-UP, LUMBAR SYMPATHECTOMY, DISEASE, SCS

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Chicago
Devulder, Jacques, Hans van Suijlekom, Robert van Dongen, Sudhir Diwan, Nagy Mekhail, Maarten van Kleef, and Frank Huygen. 2011. “Ischemic Pain in the Extremities and Raynaud’s Phenomenon.” Pain Practice 11 (5): 483–491.
APA
Devulder, J., van Suijlekom, H., van Dongen, R., Diwan, S., Mekhail, N., van Kleef, M., & Huygen, F. (2011). Ischemic pain in the extremities and Raynaud’s phenomenon. PAIN PRACTICE, 11(5), 483–491.
Vancouver
1.
Devulder J, van Suijlekom H, van Dongen R, Diwan S, Mekhail N, van Kleef M, et al. Ischemic pain in the extremities and Raynaud’s phenomenon. PAIN PRACTICE. 2011;11(5):483–91.
MLA
Devulder, Jacques, Hans van Suijlekom, Robert van Dongen, et al. “Ischemic Pain in the Extremities and Raynaud’s Phenomenon.” PAIN PRACTICE 11.5 (2011): 483–491. Print.
@article{1210266,
  abstract     = {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.},
  author       = {Devulder, Jacques and van Suijlekom, Hans and van Dongen, Robert  and Diwan, Sudhir and Mekhail, Nagy and van Kleef, Maarten and Huygen, Frank },
  issn         = {1530-7085},
  journal      = {PAIN PRACTICE},
  keyword      = {evidence-based medicine,ischemic pain,Raynaud's phenomenon,SPINAL-CORD STIMULATION,CONTROLLED CLINICAL-TRIAL,CRITICAL LIMB ISCHEMIA,TERM-FOLLOW-UP,LUMBAR SYMPATHECTOMY,DISEASE,SCS},
  language     = {eng},
  number       = {5},
  pages        = {483--491},
  title        = {Ischemic pain in the extremities and Raynaud's phenomenon},
  url          = {http://dx.doi.org/10.1111/j.1533-2500.2011.00460.x},
  volume       = {11},
  year         = {2011},
}

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