[Sympathetic reflex dystrophy and phantom pain. Diagnosis, therapy and prognosis]

The incidence of phantom limb pain has been significantly underestimated for many years. However, studies published during the recent decade indicate that the real incidence of phantom limb pain may be between 60% and 90%. Reflex sympathetic dystrophy (RSD) occurs with an incidence of about 15.000 new cases every year in Germany. Both diseases show early centralisation and chronification. Hence, only early diagnosis and onset of correct therapy in time provide significant pain reduction. When therapy is started too late, prognosis in regard to sufficient pain reduction is poor. Phantom limb pain can be prevented by proper anaesthesia. Several studies could show the benefit of perioperative continuous regional anaesthesia . None of the patients treated with a combination of local anaesthetics and low dose morphine developed phantom limb pain. Therapy of choice for RSD is the sympathetic blockade. The most suitable method is intravenous regional sympathetic blockade (IVRSB) with guanethidine (2).