Name: Causalgia Syndrome
Causalgia syndrome
Causalgia syndrome is a pain syndrome caused by damage to the peripheral nerve and irritation of its sympathetic fibers, manifested by intense pains of a burning nature, vasomotor and trophic disorders of the zone of its innervation.
Etiology
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- The occurrence of an incomplete break in the nerve fibers, which develops, for example, with a gunshot wound
- Conduction of efferent sympathetic impulses (after stimulation of sympathetic endings) to the sensory fibers of the area of damage to the mixed nerve
- Reflex sympathetic dystrophy
- Pathological circulation of impulses along the conductors of the spinal
brain and involvement of the thalamus and cerebral cortex
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- Most often occurs with damage to the median, sciatic, tibial nerves
- Psychogenic factors play an important role. Pathomorphology
- Partial or complete destruction of the afferent nerve pathways of the affected nerve
- Atrophy of innervated muscles.
Clinical picture
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- Sharp, burning, difficult to localize, widely radiating pain with attacks of its intensification (shooting pain)
- Severe hyperesthesia and hyperpathia of the skin in the zone of innervation of the affected nerve
- Most often, pain appears in the palms and feet, aggravated by the most insignificant physical stimuli, external stimuli (rubbing, heat, noise, touching the bed of the sick person)
- The intensity of pain is reduced when wetting the skin with cold water or wrapping it in a wet cloth (wet rag symptom)
- Trophic disorders develop rapidly
- Skin – edematous, cold, with increased susceptibility, smooth, shiny
- Stiffness in the joints
- Hyperhidrosis.
Special research methods
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- X-ray of bones
- Intravenous regional sympathetic blockade with guanethidine (octadine) or reserpine (a special anesthesia technique that also has a therapeutic effect).
Differential Diagnosis
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- infections
- Hypertrophic scars
- Neurinoma
- Tumors of the central nervous system or a pathological increase in its cavities.
Treatment:
Tactics of conducting
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- Pain blockades (medical or surgical) of sympathetic nerves
- Intravenous regional sympathetic blockade with guanethidine (octa-din) or reserpine administered by an anesthesiologist
- transcutaneous electrical nerve stimulation
- Pain relief for trigger points
- Gently rubbing the affected area several times a day
- Acupuncture
- Hypnosis
- Relaxation exercises (alternating muscle contraction and relaxation)
- Autotraining
- In severe cases, the patient is referred to a specialized clinic. Drug therapy
- The effectiveness of products is individual
- Prazosin -1-8 mg / day orally in several doses
- Phenoxybenzamine -40-120 mg / day orally in several doses, initial dose
– no more than 10 mg
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- Nifedipine 10-30 mg 3 times a day
- Prednisolone 60–80 mg/day orally, tapered over 2–4 weeks
- Anticonvulsant Products
- Carbamazepine 200-1000 mg/day
- Phenytoin (difenin) 100–300 mg/day orally
- Clonazepam 1-10 mg/day orally
- Valproic acid – 750-2,250 mg / day orally (no more than 60 mg / kg)
- Baclofen – 10-40 mg / day orally.
- Alternative Products
- Narcotic analgesics (with the ineffectiveness of other means)
- Other a-blockers or calcium channel blockers are derivatives of dihydropyridine.
Surgery. Sometimes sympathectomy is used.
Course and forecast
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- The course is variable – can be chronic, non-recurrent
- If the patient for some reason (social benefits, desire for increased attention from
relatives and friends) is not ready to assist the doctor in the treatment, therapy in the majority of cases is ineffective. Complications
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- Articular contracture
- Spread of symptoms to the opposite side.
Prevention
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- Immobilization after injury
- Avoid nerve damage during surgery
- Splinting of the injured limb for the required period
- Adequate pain relief for the entire period of recovery after injury.
Synonyms
- causalgic syndrome
- Pirogov-Mitnam disease ICD G56.4 Causalgia