Akupunktur versus Guanethidin (Ismelin)-Blockade zur Behandlung der sympathischen Reflexdystrophie - Drei Kasuistiken |
Author(s): , , ,
Journal/Book: Deutsche Zeitschrift für Akupunktur. 1995; 38/3: 71-76.
Abstract: The term "reflex sympathetic dystrophy" (RSD) includes many syndromes. At present RSD can be defined as: following an injury, irrespective of the type and location, a triad of mostly acute autonomic (sympathetic), motor and sensory disorders develop in a generalised form in the distal region of an affected extremity. If not treated RSD, as a rule, remains more or less unchanged. After a longer period there are more frequent occurrences of spontaneous pain as well as restriction of passive movement. Finally contractions and atrophy of the skin and musculature develop. The aim of therapy for RSD is, in the first place, to reduce or remove the pain and swelling since this is the only way to improve the motor disorder. An invasive sympathicolytic therapy should be carried out as soon as possible. Various methods of sympathetic blocking are available. Blocking of the stellate ganglion and the lumbar sympathetic trunk as well as the use of guanethidine (thus, Ismelin). In all cases, regular physiotherapy should also be carried out. Since sympathetic vasomotor changes have been reported under acupuncture analgesie, the aim of our investigation was to compare the efficacy of acupuncture versus guanethidine blockade in the treatment of RSD. So far 3 patients with RSD have been subjected to acupuncture followed by guanethidine blockade after an one week interval. Immediately before, after and 30 minutes after treatment a thermovision was performed. Simultaneously, pain evaluation was made using a visual analogue scale (VAS). Interestingly, an unexpected fall in skin temperature of the affected hand was observed in 2 patients after guanethidine blockade. In contrast, no decrease in skin temperature could be observed after acupuncture. A reduction of pain was noted in two out of three patients irrespective of the applied therapeutic method. Although therapy of RSD with guanethidine blockade is considered a "gold standard", it was not effective in all patients presented here. Acupuncture was equally effective or even superior in improving perfusion of the affected extremity. Thus our finding support the presumption that the activity of the sympathetic nervous system is negatively influenced by acupuncture and that this effect can be successfuly used for the treatment of RSD patients.
Keyword(s): Akupunktur, sympathische Reflexdystrophie, Ismelin-Blockaden.
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