1/6. Management of post-traumatic pain syndromes (causalgia).A number of post-traumatic pain syndromes may be grouped under the two headings: causalgia and mimocausalgia states. Our concern is the early recognition of patients whose complaints have a real organic basis but whose physical signs are not of sufficient degree to make this fact readily apparent. These patients are all too often mismanaged or neglected for sufficiently long periods of time to permit the underlying pathologic physiology to secure supremacy over normal function. Recognized and treated properly by means of sympathetic ablation, either medical or surgical, the vast majority can be relieved of their symptoms. The extremities can then be rehabilitated by appropriate measures.- - - - - - - - - - ranking = 1keywords = physical (Clic here for more details about this article) |
2/6. Complex regional pain syndrome.A previously well fifty-five year-old female household helper developed complex regional pain syndrome Type II (reflex sympathetic dystrophy) following a minor injury to her left hand. She had marked hyperaesthesia and allodynia and was unable to perform her household work and to participate in the required physiotherapy. Following a series of stellate ganglion block, neurostimulation as well as physical therapy, there was a dramatic improvement in her condition and she was able to return to normal function.- - - - - - - - - - ranking = 1keywords = physical (Clic here for more details about this article) |
3/6. Psychophysical observations on patients with neuropathic pain relieved by a sympathetic block.patients with sympathetically maintained pain (SMP) were tested with noxious heat pulses, innocuous mechanical stimuli, and transcutaneous electrical nerve stimulation before and during local anesthetic sympathetic blocks that relieved their pain. The perceived intensity of the pain evoked by these stimuli was measured by the patients' responses on a visual analog scale and compared to the responses obtained when the same stimuli were applied to contralateral normal skin. In 5 of 7 patients tested, graded noxious heat stimuli (43-51 degrees C) applied to painful skin resulted in heat-pain intensity ratings that were essentially identical to the responses obtained when the same stimuli were applied to the normal side. Of the remaining two patients, one was clearly hypoalgesic for heat-pain and the other was probably hyperalgesic. The normal and subnormal heat-evoked responses obtained from abnormal skin were unchanged during completely successful sympathetic blocks. Trains of noxious heat pulses (52 degrees C) evoked summation of the second pain sensation in each of the 4 patients tested. This summation effect was normal and unaffected by a sympathetic block. Four of the patients had allodynia evoked by mechanical stimulation. In each of the 3 allodynia cases tested, transcutaneous nerve stimulation at an intensity that was at threshold for detection evoked burning pain and a coexistent sensation of tingle, indicating that both sensations were due to the activation of A beta axons. patients without touch-evoked pain reported that electrical stimuli at threshold for detection produced only the sensation of tingle. The pains evoked by touch and by threshold-strength nerve stimulation were eliminated during sympathetic block. In patients with allodynia, trains of gentle mechanical stimuli and trains of threshold-strength electrical nerve stimuli produced summation of the intensity of the burning pain sensation when the stimuli were presented at 0.3 Hz. These results add to a growing body of evidence indicating that the touch-evoked pain of some patients is due to abnormal central activity evoked by input from A beta low-threshold mechanoreceptors. The coexistence of A beta-evoked pain with normal heat-evoked pain and normal heat-pain summation suggests that the central abnormality cannot be a simple hypersensitivity of wide-dynamic-range neurons. The effect of sympathetic blockade on A beta-evoked pain and its summation suggests that the crucial sympathetic interaction may take place centrally. The results show that there is considerable heterogeneity of sensory abnormalities among patients with SMP.(ABSTRACT TRUNCATED AT 400 WORDS)- - - - - - - - - - ranking = 4keywords = physical (Clic here for more details about this article) |
4/6. The diagnosis and management of post-traumatic pain syndromes (causalgia).There are two major categories of post-traumatic pain syndroms: (1) causalgia; and (2) mimocausalgia states or reflex sympathetic dystrophy. vasoconstriction is usually present. Because of the pain, limitation of motion of the extremity occurs, and may result in permanent disability. There is often a great disparity between the apparent trauma and the severity of the pain. Sympathetic blocks and sympathectomy are definitive modes of therapy. In a series of 147 patients, 56% required surgical sympathectomy. The rest were treated by sympathetic blocks, physical therapy, and other medical measures. Eighty-two percent had excellent relief of pain, 11% had good relief, while 7% had no relief. Thirty-one percent of patients had residual symptoms resulting from the original injury, or from irreversible occurrences on the basis of pain and trophic changes. Emphasis is placed on early recognition and proper treatment.- - - - - - - - - - ranking = 1keywords = physical (Clic here for more details about this article) |
5/6. Post-traumatic pain syndromes.A number of post-traumatic pain syndromes may be grouped as causalgia or mimocausalgia. These are important entities and should be well known to most disciples of medicine. Our concern is the early recognition of patients whose complaints have an organic basis but whose physical signs are not of sufficient degree to make this fact readily apparent. These patients are often misunderstood and discredited. They are all too often mismanaged or neglected for so long that the underlying pathologic physiology secures supremacy over normal function. Recognized and treated properly by means of sympathetic ablation, either medical or surgical, the vast majority of symptoms can be relieved. The extremities then can be rehabilitated by appropriate measures.- - - - - - - - - - ranking = 1keywords = physical (Clic here for more details about this article) |
6/6. Complex regional pain syndrome.The term "complex regional pain syndrome" encompasses causalgia and reflex sympathetic dystrophy. Symptoms of burning pain with autonomic and tissue changes begin shortly after an injury, usually to a distal extremity. The diagnosis is based on the history and the clinical findings. No confirmatory tests are available, although plain radiographs or a three-phase bone scan may be helpful in diagnosing some cases. Aggressive treatment, which may include sympathetic blockade, medications, physical therapy and psychotherapy, is essential for a favorable outcome. Despite treatment, many patients are left with varying degrees of chronic pain and disability.- - - - - - - - - - ranking = 1keywords = physical (Clic here for more details about this article) |