{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,2]],"date-time":"2026-06-02T12:23:06Z","timestamp":1780402986736,"version":"3.54.1"},"reference-count":55,"publisher":"Wiley","issue":"1","license":[{"start":{"date-parts":[[2024,9,30]],"date-time":"2024-09-30T00:00:00Z","timestamp":1727654400000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc-nd\/4.0\/"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Pain Practice"],"published-print":{"date-parts":[[2025,1]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec><jats:title>Introduction<\/jats:title><jats:p>Peripheral artery diseases (PAD) and Raynaud's syndrome are associated with substantial morbidity. PAD, through the restriction of blood flow to the extremities, may lead to critical limb ischemia with symptoms of pain at rest which may eventually progress to severe limb ischemia with gangrene. This serious and painful clinical condition requires extensive medical care, is limb\u2010threatening and, in case of delayed or unsuccessful treatment, is associated with a high mortality rate. In Raynaud's syndrome, the blood supply to certain parts of the body, usually the fingers and toes and less frequently the nose or ears, is restricted because of vasculopathy of the smaller vessels at acral sites. Under certain circumstances, with cold as the most well\u2010known provoking factor, blood flow restriction occurs, leading to demarcated color changes and symptoms such as pain, paresthesia, and numbness. In severe cases of Raynaud syndrome tissue ischemia may lead to necrosis and the need for amputation of the affected area.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>In this narrative review, the literature on the diagnosis and interventional pain treatment of PAD and Raynaud's syndrome was updated and summarized.<\/jats:p><\/jats:sec><jats:sec><jats:title>Objectives<\/jats:title><jats:p>This review focused on interventional pain treatment. In PAD, the effects of the intervention on limb salvage, ulcer healing, and ischemic pain were summarized. Additionally, results with respect to skin microcirculation and quality of life were reported if available. In Raynaud's syndrome, we focused on the effect of the intervention on peripheral blood flow metrics and pain intensity during attacks.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>In PAD, prevention and treatment of risk factors are important. Initially, conservative treatment and pharmacological therapy are preferred first\u2010line therapies. However, when disease progression occurs, interventional management may be considered. The literature search yielded conflicting evidence for sympathectomy as a treatment for PAD. Spinal cord stimulation (SCS) as a treatment modality for advanced PAD had high\u2010quality evidence for limb salvage in subgroups of patients but conflicting evidence for other outcome measures such as pain, wound healing, and quality of life. The literature search for interventional pain management in Raynaud's syndrome was limited to only one randomized controlled trial (RCT) studying the effect of thoracic sympathectomy. This study had several limitations and hence the level of evidence for this interventional treatment is very low. No RCTs studying SCS in patients with Raynaud's syndrome were found.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>In both PAD and Raynaud's syndrome, additional RCTs are needed to substantiate interventional (pain) management and bolster the evidence base for sympathectomy and SCS as treatment options.<\/jats:p><\/jats:sec>","DOI":"10.1111\/papr.13421","type":"journal-article","created":{"date-parts":[[2024,10,1]],"date-time":"2024-10-01T06:05:12Z","timestamp":1727762712000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":6,"title":["12. Vascular pain: Ischemic pain in the extremities and Raynaud's syndrome"],"prefix":"10.1111","volume":"25","author":[{"given":"Antal","family":"van der Gaag","sequence":"first","affiliation":[{"name":"Anesthesiology and Pain Medicine Catharina Ziekenhuis  Eindhoven The Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Steven P.","family":"Cohen","sequence":"additional","affiliation":[{"name":"Anesthesiology, Neurology, Physical Medicine &amp; Rehabilitation and Psychiatry and Behavioral Sciences Northwestern University Feinberg School of Medicine  Chicago Illinois USA"},{"name":"Anesthesiology and Physical Medicine &amp; Rehabilitation, Walter Reed National Military Medical Center Uniformed Services University of the Health Sciences  Bethesda Maryland USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Milan P.","family":"Stojanovic","sequence":"additional","affiliation":[{"name":"Department of Anesthesiology Critical Care and Pain Medicine Service, VA Boston Healthcare System  Boston Massachusetts USA"},{"name":"VA Bedford Healthcare System Harvard Medical School  Boston Massachusetts USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Frank J. P. M.","family":"Huygen","sequence":"additional","affiliation":[{"name":"Department of Anesthesiology and Pain Management Erasmus Medical Centre  Rotterdam The Netherlands"},{"name":"Department of Anesthesiology and Pain Management University Medical Center Utrecht  Utrecht The Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jan Willem","family":"Kallewaard","sequence":"additional","affiliation":[{"name":"Anesthesiology and Pain Medicine Rijnstate Ziekenhuis  Elst The Netherlands"},{"name":"Anesthesiology and Pain Medicine Amsterdam University Medical Centers  Amsterdam The Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2024,9,30]]},"reference":[{"key":"e_1_2_15_2_1","first-page":"483","article-title":"Ischemic pain in the extremities and Raynaud's phenomenon","volume":"11","author":"Devulder J","year":"2011","journal-title":"Evidence\u2010Based Interventional Pain Medicine: According to Clinical Diagnoses"},{"key":"e_1_2_15_3_1","first-page":"3","article-title":"Clinical presentation of lower extremity arterial disease (LEAD)","volume":"16","author":"Diaconu CC","year":"2018","journal-title":"E\u2010Journal of Cardio Pract"},{"key":"e_1_2_15_4_1","doi-asserted-by":"publisher","DOI":"10.1016\/S2214-109X(19)30255-4"},{"key":"e_1_2_15_5_1","doi-asserted-by":"publisher","DOI":"10.1007\/s11886-015-0611-y"},{"key":"e_1_2_15_6_1","doi-asserted-by":"publisher","DOI":"10.1001\/jamasurg.2016.2018"},{"key":"e_1_2_15_7_1","doi-asserted-by":"publisher","DOI":"10.1161\/CIRCRESAHA.121.320702"},{"key":"e_1_2_15_8_1","first-page":"798","article-title":"Recent advances in the workup and management of Raynaud phenomenon","volume":"129","author":"Lis\u2010\u015awi\u0119ty A","year":"2019","journal-title":"Pol Arch Intern Med"},{"key":"e_1_2_15_9_1","doi-asserted-by":"publisher","DOI":"10.1136\/bmjopen-2014-006389"},{"key":"e_1_2_15_10_1","first-page":"123","article-title":"A review of Raynaud's disease","volume":"113","author":"Temprano KK","year":"2016","journal-title":"Mo Med"},{"key":"e_1_2_15_11_1","doi-asserted-by":"publisher","DOI":"10.1111\/papr.12786"},{"key":"e_1_2_15_12_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.cjca.2022.02.029"},{"key":"e_1_2_15_13_1","doi-asserted-by":"publisher","DOI":"10.1053\/j.tvir.2014.08.003"},{"key":"e_1_2_15_14_1","doi-asserted-by":"publisher","DOI":"10.1177\/1358863X20909433"},{"key":"e_1_2_15_15_1","doi-asserted-by":"publisher","DOI":"10.1177\/000331979604700605"},{"key":"e_1_2_15_16_1","doi-asserted-by":"publisher","DOI":"10.1159\/000008185"},{"key":"e_1_2_15_17_1","doi-asserted-by":"publisher","DOI":"10.1016\/S1474-4422(13)70236-9"},{"key":"e_1_2_15_18_1","doi-asserted-by":"publisher","DOI":"10.2147\/JPR.S37589"},{"key":"e_1_2_15_19_1","doi-asserted-by":"publisher","DOI":"10.3389\/fcvm.2023.1154708"},{"key":"e_1_2_15_20_1","doi-asserted-by":"publisher","DOI":"10.1177\/1358863X221082702"},{"key":"e_1_2_15_21_1","doi-asserted-by":"publisher","DOI":"10.1001\/jama.2022.3391"},{"key":"e_1_2_15_22_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jvs.2021.11.036"},{"key":"e_1_2_15_23_1","first-page":"CD002000","article-title":"Bypass surgery for chronic lower limb ischaemia","volume":"4","author":"Antoniou GA","year":"2017","journal-title":"Cochrane Database Syst Rev"},{"key":"e_1_2_15_24_1","article-title":"Lumbar sympathectomy techniques for critical lower limb ischaemia due to non\u2010reconstructable peripheral arterial disease","volume":"2016","author":"Karanth VK","year":"2016","journal-title":"Cochrane Database Syst Rev"},{"key":"e_1_2_15_25_1","doi-asserted-by":"publisher","DOI":"10.1002\/bjs.1800620116"},{"key":"e_1_2_15_26_1","doi-asserted-by":"publisher","DOI":"10.1016\/0002-9610(85)90075-3"},{"key":"e_1_2_15_27_1","doi-asserted-by":"publisher","DOI":"10.1001\/archsurg.1977.01370110059006"},{"key":"e_1_2_15_28_1","first-page":"1","article-title":"Spinal cord stimulation for non\u2010reconstructable chronic critical leg ischaemia","volume":"2013","author":"Ubbink DT","year":"2013","journal-title":"Cochrane Database Syst Rev"},{"key":"e_1_2_15_29_1","doi-asserted-by":"publisher","DOI":"10.1007\/978-3-642-48441-4_21"},{"key":"e_1_2_15_30_1","doi-asserted-by":"publisher","DOI":"10.1016\/S1078-5884(05)80010-3"},{"key":"e_1_2_15_31_1","first-page":"344","article-title":"Transcutaneous oxygen pressure as predictive parameter for ulcer healing in endstage vascular patients treated with spinal cord stimulation","volume":"15","author":"Claeys L","year":"1996","journal-title":"International Angiology: A Journal of the International Union of Angiology"},{"key":"e_1_2_15_32_1","doi-asserted-by":"publisher","DOI":"10.1016\/S0741-5214(99)70133-3"},{"key":"e_1_2_15_33_1","doi-asserted-by":"publisher","DOI":"10.1016\/S0140-6736(98)05069-7"},{"key":"e_1_2_15_34_1","doi-asserted-by":"publisher","DOI":"10.1053\/eujp.2000.0170"},{"key":"e_1_2_15_35_1","doi-asserted-by":"publisher","DOI":"10.1002\/bjs.4629"},{"key":"e_1_2_15_36_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.avsg.2008.08.016"},{"key":"e_1_2_15_37_1","doi-asserted-by":"publisher","DOI":"10.1080\/02688697.2021.1884189"},{"key":"e_1_2_15_38_1","doi-asserted-by":"publisher","DOI":"10.1053\/ejvs.2002.1876"},{"key":"e_1_2_15_39_1","first-page":"325","article-title":"Complications of spinal cord stimulation and peripheral nerve stimulation techniques: a review of the literature","volume":"17","author":"Eldabe S","year":"2016","journal-title":"Pain Med"},{"key":"e_1_2_15_40_1","article-title":"Raynaud's phenomenon: reviewing the pathophysiology and management strategies","volume":"1","author":"Nawaz I","year":"2022","journal-title":"Cureus"},{"key":"e_1_2_15_41_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jaad.2022.06.1199"},{"key":"e_1_2_15_42_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jaad.2022.05.067"},{"key":"e_1_2_15_43_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.ejvs.2021.02.048"},{"key":"e_1_2_15_44_1","article-title":"Vasodilators for primary Raynaud's phenomenon","volume":"5","author":"Su KY","year":"2021","journal-title":"Cochrane Database Syst Rev"},{"key":"e_1_2_15_45_1","doi-asserted-by":"publisher","DOI":"10.1080\/1744666X.2017.1279052"},{"key":"e_1_2_15_46_1","doi-asserted-by":"publisher","DOI":"10.1097\/ALN.0000000000004084"},{"key":"e_1_2_15_47_1","doi-asserted-by":"publisher","DOI":"10.1002\/ana.21601"},{"key":"e_1_2_15_48_1","doi-asserted-by":"publisher","DOI":"10.1097\/AAP.0b013e3181b48f9a"},{"key":"e_1_2_15_49_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.semarthrit.2022.152065"},{"key":"e_1_2_15_50_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jvs.2011.01.069"},{"key":"e_1_2_15_51_1","doi-asserted-by":"publisher","DOI":"10.1089\/lap.2017.0634"},{"key":"e_1_2_15_52_1","first-page":"316","article-title":"Spinal cord stimulator for the treatment of ischemic pain\u2010Burger's disease and Raynaud's disease: a report of two cases and literature review","volume":"34","author":"Ertilav E","year":"2022","journal-title":"Agri"},{"key":"e_1_2_15_53_1","doi-asserted-by":"publisher","DOI":"10.3109\/02688699409002949"},{"key":"e_1_2_15_54_1","doi-asserted-by":"publisher","DOI":"10.1177\/000313480106701113"},{"key":"e_1_2_15_55_1","doi-asserted-by":"publisher","DOI":"10.1111\/j.1533-2500.2007.00122.x"},{"key":"e_1_2_15_56_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.neurom.2021.10.015"}],"container-title":["Pain Practice"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1111\/papr.13421","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,1,16]],"date-time":"2025-01-16T13:28:34Z","timestamp":1737034114000},"score":1,"resource":{"primary":{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/10.1111\/papr.13421"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2024,9,30]]},"references-count":55,"journal-issue":{"issue":"1","published-print":{"date-parts":[[2025,1]]}},"alternative-id":["10.1111\/papr.13421"],"URL":"https:\/\/doi.org\/10.1111\/papr.13421","archive":["Portico"],"relation":{},"ISSN":["1530-7085","1533-2500"],"issn-type":[{"value":"1530-7085","type":"print"},{"value":"1533-2500","type":"electronic"}],"subject":[],"published":{"date-parts":[[2024,9,30]]},"assertion":[{"value":"2024-09-30","order":3,"name":"published","label":"Published","group":{"name":"publication_history","label":"Publication History"}}],"article-number":"e13421"}}