[Chronic, refractory algodystrophy]

Among the patients suffered form algodystrophy, a subgroup characterized as refractory can be selected. This subgroup consists of exclusively young women, in whom the syndrome develops as a consequence of relatively minor trauma and frequently the course is associated with neurological symptoms and signs. The main problem in these patients is to control a severe, spontaneous pain of the affected limb, while impaired function of the hand is of less importance; in almost all cases the disease leads to almost total disability of the affected limb. The cause of the progressive course of the algodystrophy and resistance to the treatment in these patients remains obscure. We present a series of 9 women in the mean age of 33 years, with chronic, refractory algodystrophy of the upper limb lasting mean of 13 months at presentation. The diagnosis of the syndrome was based on clinical grounds, and the treatment included the following methods: mannitol combined with dexamethasone, regional intravenous blocks with methylprednosolone, regional intravenous blocks with phentolamine, phenoxybenzamine, sympathectomy, salmon calcitonin, continuous brachial plexus anaesthesia with bupivacaine, amitryptyline, gabapentin, thaildomid and botulin toxin. Four of the nine patients responded partially to the treatment, one underwent amputation of the affected hand, two are still under control after implantation of the catheter for continuous brachial plexus anaesthesia, and in remaining two patients the long lasting treatments totally failed.