Psychogenic regional pain

Psychogenic regional pain develops in association with emotional stress. This article suggests that the role of the liaison psychiatrist is to encourage other clinicians to evaluate emotional factors, restrict excessive investigation and provide appropriate reassurance and treatment for such problems.     

Intravenous regional anaesthesia

The technique of intravenous regional anaesthesia (IVRA) has failed to gain general acceptance among anaesthetists, who are divided into those who never use it, preferring more specific local anaesthetic blocks, and those who would recommend it as the technique of choice for some procedures. Numerous large series have been published, attesting to its general safety, but intermittent accounts of serious side effects and more recent reports of fatalities have called the technique into question, so that a reassessment seems timely.     

Intravenous regional block with phentolamine in the treatment of complex regional pain syndrome

Complex regional pain syndrome (CRPS) is a variety of painful conditions following injury which appears regionally having a distal predominance of abnormal findings. This study, evaluate the use of phentolamine for sympathetic block and regional anesthesia in treatment of CRPS related pain. In this study, 68 patients with CRPS who were referred to pain clinics of Imam Hossein and Akhtar Hospitals and Gandy Center of Surgery between 2003-2008 were evaluated. Forty three of 87 patients finally undertaken intravenous regional sympatholytic block according to therapeutic protocol. 37 patients (86%) received one block, 2 of them (4.75%) received 2 repetitions of blocks and finally repeated block for three times occurred in 4 patients (9.3%). A week after block pain relief outcomes was recorded as following; excellent in 7 patients (16.3%), good in the 32 patients (74.4%) and moderate in the 4 patients (9.3%). After a month, 8 patients (18.5%) showed excellent relief and it was good and moderate in 32 (78%) and one case (2.4%), respectively. Pain relief after three months was excellent, good and moderate in the 13 patients (31.7%), 25 patients (61%) and 3 patients (7.3%), respectively. In this study level of pain relief was significant in various intervals and it showed significant difference in relief three months after block (P=0.04). CRPS due to SMP(sympathetically maintained pain) is thought to be alleviated by phentolamine. Intravenous phentolamine infusion is potentially a new significant option for the therapy of CRPS.