Surgery
Spinal cord stimulators
Spinal cord stimulator appears to be an effective therapy in the management of patients with CRPS type I (level A evidence) and type II (level D evidence). While they improve pain and quality of life, evidence is unclear regarding effects on mental health and general functioning.Dorsal root ganglion stimulation is type of neurostimulation that is effective in the management of focal neuropathic pain. The FDA approved its use in February 2016. The ACCURATE Study demonstrated superiority of dorsal root ganglion stimulation over spinal (dorsal column) stimulation in the management of CRPS and causalgia. Sympathectomy
Surgical, chemical, or radiofrequency sympathectomy — interruption of the affected portion of the sympathetic nervous system — can be used as a last resort in patients with impending tissue loss, edema, recurrent infection, or ischemic necrosis. However,  little evidence supports these permanent interventions to alter the pain symptoms of the affected patients, and in addition to the normal risks of surgery, such as bleeding and infection, sympathectomy has several specific risks, such as adverse changes in how nerves function. Amputation
No randomized study in medical literature has studied the response with amputation of patients who have failed the above-mentioned therapies and who continue to be miserable. Nonetheless,  on average, about half of the patients will have resolution of their pain, while half will develop phantom limb pain and/or pain at the amputation site.
Drug induced pigmentation may take on many different appearances, one of the most common being a change in the color, or pigmentation, of the skin. Presentation
Cause
Drug-induced pigmentation of the skin may occur as a consequence of drug administration, and the mechanism may be postinflammatory hyperpigmentation in some cases, but frequently is related to actual deposition of the offending drug in the skin. : 125–6 The incidence of this change varies, and depends on the type of medication involved. Some of the most common drugs involved are NSAIDs, antimalarials, psychotropic drugs, Amiodarone, cytotoxic drugs, tetracyclines, and heavy metals such as silver and gold (which must be ingested, not just worn). Pathophysiology
There are 4 possible mechanisms to how this change may occur:
Accumulation of melanin, the skin pigment
Accumulation of drug or one of its products under any layer of the skin (usually the dermis or epidermis)
Accumulation of iron throughout the dermis from drug-induced post-inflammatory changes
The synthesis of special pigments, under direct influence of the drug

See also
Skin lesion

References


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