[Reflex sympathetic algodystrophies. Preventive and therapeutic aspects].

Deafferentation syndromes have in common the existence of a physical injury and/or of a functional impairment of a nerve, either somatosensory afferent (Phantom Limb Pain) and/or sympathetic efferent (Reflex Sympathetic Dystrophy). These progressively debilitating syndromes are the witness of the absence of self-limitation of neuronal sensitization, which is normally the evolution of any painful stimulation of spinal cord neurons. To some extent deafferentation syndromes could be defined as a maladaptive neuronal plasticity. The lack of complete understanding of underlying pathophysiological mechanisms gives account of the wide variety of proposed treatments and of their unpredictable and variable efficacy. This fact is also due in part to the lack of controlled studies of most of the therapeutic propositions, whose purported efficacy is usually based on anecdotal reports. Finally, the role of prevention must be strongly emphasized, focusing, if those syndromes are likely to occur following surgery, on the importance of pre- and postoperative efficient analgesia, and also, possibly, on the preemptive role of regional anaesthetic techniques.