Medication Summary
In patients with reflex sympathetic dystrophy, the goals of pharmacotherapy are to reduce morbidity and prevent complications.
Sympatholytic drugs
Class Summary
Suppress sympathetic nerve function / noradrenaline inhibitor.
Reserpine (Serpalan)
Inhibits vesicular uptake of noradrenaline and thus stops excitation of sympathetic nervous system; inhibits beta-hydroxylation of dopamine to noradrenaline.
Lewis et al reported good results in 90% of patients at 18 months, with 93% of patients experiencing pain relief.
Alpha-adrenergic blocking agents
Class Summary
May exert effect by causing blockade of postganglionic synapses.
Phenoxybenzamine (Dibenzyline)
May have effect through long-lasting noncompetitive alpha-adrenergic blockade of the postganglionic synapses in smooth muscle.
Phentolamine (Regitine)
Alpha-1 and alpha-2 adrenergic blocking agent that blocks circulating epinephrine and norepinephrine action.
Alpha-adrenergic agonists
Class Summary
May act to decrease muscle tone.
Clonidine (Catapres)
Stimulates alpha2-adrenoreceptors in brain stem, activating an inhibitory neuron, which in turn results in reduced sympathetic outflow.
Guanethidine (Ismelin)
Acts on postganglionic fibers at the presynaptic level, releasing noradrenaline and inhibiting reuptake and rerelease. Fiscat et al reported good results in 63% of cases; Bensigner et al reported good results in 58.6% of cases.
For administration, IV access is gained as close as possible to the involved part. A BP cuff is tied well above the site of pain and inflated above the systolic pressure; a second BP cuff is tied below the first cuff as in a Bier block. Pressure is maintained for 20 min, the limb manipulated, and pressure is reduced while alternating between the 2 cuffs.
Six blocks are performed on alternate days with rigorous rehabilitation; repeated blocks even if the first block fails.
Calcium channel blockers
Class Summary
Inhibit calcium ions from entering slow channels; select voltage-sensitive areas, or vascular smooth muscle.
Nifedipine (Adalat, Procardia)
May have a relaxant effect on certain muscles. Inhibits transmembrane influx of calcium ions into smooth muscle, which, in turn, inhibits contraction of the muscle fibers.
Amlodipine (Norvasc)
May have a relaxant effect on certain muscles. Inhibits transmembrane influx of calcium ions into smooth muscle, which, in turn, inhibits contraction of the muscle fibers.
Corticosteroids
Class Summary
Have anti-inflammatory properties and cause profound and varied metabolic effects. Corticosteroids modify the body's immune response to diverse stimuli.
Prednisolone (Articulose-50, Delta-Cortef, Pediapred)
Decreases inflammation by suppressing migration of polymorphonuclear leukocytes and reducing capillary permeability.
Anesthetics
Class Summary
Local anesthetics stabilize the neuronal membrane and prevent the initiation and transmission of nerve impulses.
Lidocaine (Anestacon, Dermaflex, Lidoderm, Zilactin-L)
Decreases permeability to sodium ions in neuronal membranes. This results in the inhibition of depolarization, blocking the transmission of nerve impulses.
Tricyclic antidepressants
Class Summary
A complex group of drugs that have central and peripheral anticholinergic effects and sedative effects. They have central effects on pain transmission. They block the active reuptake of norepinephrine and serotonin.
Amitriptyline (Elavil)
Analgesic for certain chronic and neuropathic pain.
Analgesics
Class Summary
Pain control is essential to quality patient care. Analgesics ensure patient comfort, promote pulmonary toilet, and have sedating properties, which are beneficial for patients who experience pain.
Codeine
Binds to opiate receptors in CNS, causing inhibition of ascending pain pathways, altering perception and response to pain.
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Reflex sympathetic dystrophy following surgery for Dupuytren contracture.
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Radiograph of affected extremity, depicting regional osteopenia contrasted with normal radiographic appearance of the opposite extremity.
