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.
Risks
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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