BACKGROUND: Amputation for the treatment of long-standing, therapy-resistant complex regional @entity158 ( @entity6866 -I) is controversial. An evidence-based decision regarding whether or not to amputate is not possible on the basis of current guidelines. The aim of the current study was to systematically review the literature and summarize the beneficial and adverse effects of an amputation for the treatment of long-standing, therapy-resistant @entity6866 -I. METHODS: A literature search, using MeSH terms and free text words, was performed with use of PubMed and EMBASE. Original studies published prior to January 2010 describing @entity6866 -I as a reason for amputation were included. The reference lists of the identified studies were also searched for additional relevant studies. Studies were assessed with regard to the criteria used to diagnose @entity6866 -I, level of amputation, amputation technique, rationale for the level of amputation, reason for amputation, recurrence of @entity6866 -I after the amputation, phantom @entity158 , prosthesis fitting and use, and @entity1 functional ability, satisfaction, and quality of life. RESULTS: One hundred and sixty articles were identified, and twenty-six studies with Level-IV evidence (involving 111 amputations in 107 @entity1 ) were included. Four studies applied @entity6866 -I diagnostic criteria proposed by the International Association for the Study of @entity158 , Bruehl et al., or Veldman et al. Thirteen studies described symptoms without noting whether the @entity1 met diagnostic criteria for @entity6866 -I, and nine studies stated the diagnosis only. The primary reasons cited for amputation were @entity158 (80%) and a dysfunctional limb (72%). Recurrence of @entity6866 -I in the stump occurred in thirty-one of sixty-five @entity1 , and phantom @entity158 occurred in fifteen @entity1 . Thirty-six of forty-nine @entity1 were fitted with a prosthesis, and fourteen of these @entity1 used the prosthesis. Thirteen of forty-three @entity1 had paid employment after the amputation. @entity1 satisfaction was reported in eight studies, but the nature of the satisfaction was often not clearly indicated. Changes in @entity1 quality of life were reported in three studies (fifteen @entity1 ); quality of life improved in five @entity1 and the joy of life improved in another six @entity1 . CONCLUSIONS: The previously published studies regarding @entity6866 -I as a reason for amputation all represent Level-IV evidence, and they do not clearly delineate the beneficial and adverse affects of an amputation performed for this diagnosis. Whether to amputate or not in order to treat long-standing, therapy-resistant @entity6866 -I remains an unanswered question.

Therapy-resistant complex regional XXXX : to amputate or not?

@entity1 :: ('9606', 'Species') :: ['patients', 'patient', 'Patient'] @entity6866 :: ('MESH:D002422', 'Disease') :: ['CRPS'] @entity158 :: ('MESH:D010146', 'Disease') :: ['pain syndrome type I', 'Pain', 'pain']
@entity158 :: (MESH:D010146,Disease) :: ['pain syndrome type I']
