SYMPATHETICALLY MEDIATED PAIN
Sympathetically Mediated Pain doesn’t have anything to do with feeling sympathy for anyone, it simply refers to the sympathetic nervous system, part of the nervous system controlling ‘involuntary’ or ‘unconscious’ functions of the body. The involuntary system controls numerous body functions such as sweating, the functions of the intestines and internal organs, dilation and contracting of the pupils in the eye, and blood flow through various tissues. The involuntary nervous system is further divided into two subclasses, the sympathetic and parasympathetic systems. These systems act in opposition to each other to maintain a balance between the various functions.
The sympathetic portion of the involuntary nervous system is capable of transmitting pain signals to the brain. In certain abnormal situations the pain signals from the sympathetic nervous system become constant and severe, even though there is no obvious cause of pain. The mechanism by which this happens is complex and not fully understood.
CRPS has a number of causes. Perhaps the most common situation is for CRPS to start a few weeks after a fracture or even a sprain of an ankle or wrist. It also has been reported after nerve injury, surgery, crushing injuries and a few rare cases start spontaneously.
Sympathetic pain usually has a severe, burning characteristic and often begins in the hand or foot. The affected area is very hypersensitive to even the lightest touch. Pink or bluish discoloration of the involved area may occur because of abnormal circulation, and abnormal sweating may also be noticed.
There are a number of diagnostic phrases used by physicians when discussing sympathetic pain syndromes. In the past the most commonly used phrase was Reflex Sympathetic Dystrophy, or RSD. Other terms used to describe the condition include causalgia (pronounced ‘caw-sall-gee-ah’) and sympathetically mediated pain. During the last decade the several medical groups have decided the term “Chronic Regional Pain Syndrome” or CRPS (pronounced “crips”) should be used in place of the older terms.
Sympathetic pain responds to pain medications to some degree, but is usually treated more effectively with nerve blocks or even nerve destruction of the sympathetic nerves going to the affected area. Since these nerves do not carry ‘normal’ sensations, there is usually no long term effect from destroying them. Aggressive physical therapy to restore normal movement and function is a key part of initial therapy.
Unfortunately, the procedures are not always successful in relieving the pain. When CRPS fails to respond to the usual treatments listed above surgically implanting a spinal cord or peripheral nerve stimulator may be required. Some cases do become permanent.
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