REFLEX SYMPATHETIC DYSTROPHY AND CAUSALGIA

Abstract

Mitchell 58 was the first to use the term causalgia in his classic description of the chronic pain syndrome observed in Union soldiers after injuries in the American Civil War. In 1916, the French surgeon Leriche 45 linked the sympathetic nervous system to causalgia, postulating that the pain was related to une nervite du sympathique. The term reflex sympathetic dystrophy (RSD) was first introduced by Evans. 26 The principal function of the sympathetic nervous system is to prepare the individual to face life-threatening or challenging stimuli from the environment. Clinical experience, however, has shown that the sympathetic nervous system can be linked to the maintenance of certain chronic pain syndromes. During the last 15 years, there has been a resurgence of interest among clinicians and basic scientists in the role of the sympathetic nervous system in pain (see the article by Yaksh and Chaplan). 38 This article reviews in brief current knowledge of the pathophysiologic mechanisms of causalgia and RSD and the association of the sympathetic nervous system with these chronic pain syndromes. The clinical implications of current understanding of these chronic pain syndromes for the diagnosis and treatment of patients with RSD and causalgia are discussed.