Referral and treatment patterns for complex regional pain syndrome in the Netherlands

Background: Patients with complex regional pain syndrome (CRPS) are seen and treated by a variety of physicians. The present study aims to describe referral and treatment patterns for CRPS patients in the Netherlands. Methods: Patients, who were selected (1996–2005) from an electronic general practi...

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Bibliographic Details
Published in:Acta anaesthesiologica Scandinavica 2009-07, Vol.53 (6), p.816-825
Main Authors: DE MOS, M., HUYGEN, F. J. P. M., VAN DER HOEVEN-BORGMAN, M., DIELEMAN, J. P., STRICKER, B. H. CH, STURKENBOOM, M. C. J. M.
Format: Article
Language:English
Subjects:
Adolescent
Adult
Aged
Aged, 80 and over
Analgesics - therapeutic use
Anesthesia
Anesthesia. Intensive care medicine. Transfusions. Cell therapy and gene therapy
Biological and medical sciences
Child
Complex Regional Pain Syndromes - diagnosis
Complex Regional Pain Syndromes - epidemiology
Complex Regional Pain Syndromes - therapy
Databases, Factual
Drug Utilization
Female
Humans
Longitudinal Studies
Male
Medical sciences
Middle Aged
Nerve Block
Netherlands - epidemiology
Pharmacies - statistics & numerical data
Physical Therapy Modalities
Referral and Consultation - statistics & numerical data
Surveys and Questionnaires
Young Adult
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Summary:Background: Patients with complex regional pain syndrome (CRPS) are seen and treated by a variety of physicians. The present study aims to describe referral and treatment patterns for CRPS patients in the Netherlands. Methods: Patients, who were selected (1996–2005) from an electronic general practice (GP) database (Integrated Primary Care Information Project), were invited for study participation, involving diagnosis verification (International Association for the Study of Pain criteria) and assessment of referrals and treatment through information retrieved from GP journals, patients' questionnaires, pharmacy dispensing lists and specialist letters if available. Results: One hundred and two patients were included. Sixty‐one percent had presented first at the GP, while 80% subsequently consulted one or more medical specialists, most frequently an anesthetist (55% of the cases) or a specialist in rehabilitation medicine (41%). Over 90% of the patients received oral or topical pharmacotherapy, 45% received intravenous therapy, 89% received non‐invasive therapy (i.e. physiotherapy) and 18% received nerve blocks. Analgesics and free radical scavengers were administered early during CRPS, while vasodilating drugs and drugs against neuropathic pain (antidepressants and anti‐epileptics) were administered later on. Pharmacotherapy was usually initiated by a medical specialist. Conclusion: The Dutch treatment guidelines, issued in 2006, recommend free radical scavenger prescription (plus physiotherapy) as the initial treatment step for CRPS. Until 2005 only half of the patients received a scavenger within 3 months after disease onset, and the majority presents first at the GP, in particular GPs may be encouraged to initiate treatment with scavengers, while waiting for the results of further specialist consultation.
ISSN:0001-5172
1399-6576
DOI:10.1111/j.1399-6576.2009.01927.x