Department of Rehabilitation Medicine, University of Groningen, University Medical Center Groningen, Hanzeplein 1, PO Box 30.001, 9700 RB Groningen, The Netherlands.
Department of Rehabilitation Medicine, University of Groningen, University Medical Center Groningen, Hanzeplein 1, PO Box 30.001, 9700 RB Groningen, The Netherlands; Department of Oral and Maxillofacial Surgery, University of Groningen, University Medical Center Groningen, Hanzeplein 1, PO Box 30.001, 9700 RB Groningen, The Netherlands.
Med Hypotheses. 2018 Dec;121:15-20. doi: 10.1016/j.mehy.2018.08.026. Epub 2018 Aug 29.
Deciding for an amputation in case of complex regional pain syndrome type I (CRPS-I) is controversial. Evidence for favorable or adverse effects of an amputation is weak. We therefore follow a careful and well-structured decision making process. After referral of the patient with the request to amputate the affected limb, it is checked if the diagnosis CRPS-I is correct, duration of complaints is more than 1 year, all treatments described in the Dutch guidelines have been tried and if consequences of an amputation have been well considered by the patient. Thereafter the patient is assessed by a multidisciplinary team (psychologist, physical therapist, anesthesiologist-pain specialist, physiatrist and vascular surgeon). During a multidisciplinary meeting professionals summarize their assessment. Pros and cons of an amputation are discussed, taking into account level of amputation and expectations about post amputation functioning of patient and team. Based on assessments and discussion a consensus based decision is formulated and the patient is informed. If it is decided that an amputation is to be performed, the amputation will follow shortly. If it is decided not to amputate, the decision is extensively explained to the patient. Incidence of patients suffering from therapy resistant CRPS-I referred for amputation is low and because referred patients are strongly in favor of an amputation, a randomized controlled trial will be difficult to perform. Hence level of evidence in favor or against an amputation will remain low. We therefore report our decision making process to facilitate discussion about this difficult and delicate matter.
对于复杂性区域疼痛综合征 I 型 (CRPS-I) 患者进行截肢的决策存在争议。截肢对 CRPS-I 患者的影响尚无明确证据。因此，我们遵循仔细且结构化的决策过程。在接到患者要求截肢的转诊后，我们会检查 CRPS-I 的诊断是否正确，症状持续时间是否超过 1 年，是否尝试了荷兰指南中描述的所有治疗方法，以及患者是否充分考虑了截肢的后果。然后，患者会由多学科团队（心理学家、物理治疗师、麻醉师-疼痛专家、物理治疗师和血管外科医生）进行评估。在多学科会议上，专业人员会总结他们的评估结果。考虑到截肢的水平以及患者和团队对截肢后功能的期望，会讨论截肢的利弊。基于评估和讨论，制定基于共识的决策，并告知患者。如果决定进行截肢，将尽快进行。如果决定不截肢，会向患者详细解释原因。因治疗抵抗的 CRPS-I 而转诊要求截肢的患者发病率较低，由于转诊患者强烈要求截肢，因此很难进行随机对照试验。因此，支持或反对截肢的证据水平仍然较低。因此，我们报告我们的决策过程，以促进对这一困难和微妙问题的讨论。
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