Causalgia and Reflex Sympathetic Dystrophy
Complex Regional Pain Syndrome
What is it?
Causalgia and Reflex Sympathetic Dystrophy are sub-sets of Complex Regional Pain Syndorme (CRPS.) The etiology and very nature of CRPS are not well understood. However, the condition is characterized by severe, even disabling, pain in an extremity, persisting after what may be an otherwise innocuous injury. Furthermore, the degree of pain is out of proportion in both duration and severity to the original injury.
Pain is a complex phenomenon. The sensation of pain is noted in the brain, but involves a number of chemical reactions and pathways along nerves, as well as inside the brain itself. Some of these pathways use nerves of the sympathetic nervous system. A part of the sympathetic nervous system for the arms travels along the inside of the chest. It is this sympathetic chain that is one target of therapy for CRPS of the upper extremities.
How is it treated?
One of the ways to treat CRPS is by Endoscopic Thoracic Sympathectomy. In this procedure, the sympathetic nerves to the upper extremity are divided under endoscopic guidance. Please see the related article on this site: Thoracic Sympathectomy.
Stellate ganglion block is used as a predictor for thoracic sympathectomy. Endoscopic Thoracic Sympathectomy is reserved for patients who have had good success from prior stellate ganglion blocks. The best results are seen in patients who received several days of pain relief from each of at least three separate stellate ganglion blocks. Patients who have equivocal pain relief, or only very brief pain relief, from the blocks do not typically receive good relief from sympathectomy.
The risks of Endoscopic Thoracic Sympathectomy are outlined in the related article: Thoracic Sympathectomy. The specific risk of ETS for CRPS is the failure to relieve pain. Because pain is a complex and multifactorial process, relief of only one component, the sympathetic nerves, may be inadequate to solve an otherwise enigmatic problem.
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