This is the fourth edition of diagnostic and treatment guidelines for complex regional pain syndrome (CRPS; aka reflex sympathetic dystrophy).

Expert practitioners in each discipline traditionally utilized in the treatment of CRPS systematically reviewed the available and relevant literature; due to the paucity of levels 1 and 2 studies, less rigorous, preliminary research reports were included. The literature review was supplemented with knowledge gained from extensive empirical clinical experience, particularly in areas where high-quality evidence to guide therapy is lacking.

The research quality, clinical relevance, and "state of the art" of diagnostic criteria or treatment modalities are discussed, sometimes in considerable detail with an eye to the expert practitioner in each therapeutic area. Levels of evidence are mentioned when available, so that the practitioner can better assess and analyze the modality under discussion, and if desired, to personally consider the citations. Tables provide details on characteristics of studies in different subject domains described in the literature.

Oxytocin treatment: A key contributing factor to duration of mastitis is the frequency and completeness of milk removal from the infected quarter. In some cases, cows are stripped between normal milking times, sometimes with injection of oxytocin to stimulate an effective milk let down. Clearly removal of the primary growth medium of the bacteria, the milk, more often should enhance rate of recovery from infection.

Non-responding cases: Inspite of the natural resistance mechanisms of the cow, antibiotic treatment to help her fight bacterial infection, and other methods such as frequently stripping out the milk, some cows are unable to elimiate the infection. These are often considered to be chronically infected cows, typically with Staph. aureus , and remain a constant source of infection for other cows. Culling of chronically infected cows sometimes is the only way to effectively control spread of mastitis in the herd.

Awareness of the economic losses associated with mastitis is resulting in a desire for mastitis control programs. Control programs are focused on detection of mastitis (by the above methods), identification of the causative agent(s) and prevention of transmission by removing the source of the agent (milk contaminated fomites, bedding, persistently infected cows, etc.). Knowledge of mammary anatomy and physiology, mammary defense mechanism, microbial habitats, microbial virulence factors, milking machine function, and antibiotics/germicides is important in achieving effective mastitis control.

This is the fourth edition of diagnostic and treatment guidelines for complex regional pain syndrome (CRPS; aka reflex sympathetic dystrophy).

Expert practitioners in each discipline traditionally utilized in the treatment of CRPS systematically reviewed the available and relevant literature; due to the paucity of levels 1 and 2 studies, less rigorous, preliminary research reports were included. The literature review was supplemented with knowledge gained from extensive empirical clinical experience, particularly in areas where high-quality evidence to guide therapy is lacking.

The research quality, clinical relevance, and "state of the art" of diagnostic criteria or treatment modalities are discussed, sometimes in considerable detail with an eye to the expert practitioner in each therapeutic area. Levels of evidence are mentioned when available, so that the practitioner can better assess and analyze the modality under discussion, and if desired, to personally consider the citations. Tables provide details on characteristics of studies in different subject domains described in the literature.

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