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SYMPATHETIC NERVOUS SYSTEM AND PAIN: A CLINICAL REAPPRAISAL

Blumberg, Helmut , Hoffmann, Ulrike , Mohadjer , Mohsen and Scheremet, Rudolf (1997) SYMPATHETIC NERVOUS SYSTEM AND PAIN: A CLINICAL REAPPRAISAL.

Short Abstract:

The target article discusses various aspects of the relations between the sympathetic nervous system and pain. The patients under study are divided into three groups: in "reflex sympathetic dystrophy" (RSD), a triad of autonomic, motor and sensory symptoms occurs in a distally generalized distribution. The pain is typically felt deeply and diffusely, has an orthostatic component and is suppressed by the ischemia test. Under those circumstances, the pain is likely to respond to sympatholytic interventions. In "sympathetically maintained pain" (SMP) syndrome, the principal symptoms are spontaneous pain felt superficially with allodynia and no orthostatic component. These symptoms, typically confined to the zone of a lesioned nerve, may also be relieved by sympathetic blocks. Since the characteristics of the pain differ between RSD and SMP, the underlying kind of sympathetic-sensory coupling may also vary. A very small third group of patients exhibit both RSD and SMP. Pain should not be reported as independent of sympathetic function until the criteria for a complete sympathetic block have been established and satisfied.

Long Abstract:

The target article discusses various aspects of the relations between the sympathetic nervous system and pain. The patients under study are divided into three groups: in "reflex sympathetic dystrophy" (RSD), a triad of autonomic, motor and sensory symptoms occurs in a distally generalized distribution. The pain is typically felt deeply and diffusely, has an orthostatic component and is suppressed by the ischemia test. Under those circumstances, the pain is likely to respond to sympatholytic interventions. In "sympathetically maintained pain" (SMP) syndrome, the principal symptoms are spontaneous pain felt superficially with allodynia and no orthostatic component. These symptoms, typically confined to the zone of a lesioned nerve, may also be relieved by sympathetic blocks. Since the characteristics of the pain differ between RSD and SMP, the underlying kind of sympathetic-sensory coupling may also vary. A very small third group of patients exhibit both RSD and SMP. Pain should not be reported as independent of sympathetic function until the criteria for a complete sympathetic block have been established and satisfied.

Keywords:	sympathetic nervous system - pain - sympathetic-sensory coupling - reflex sympathetic dystrophy - sympathetically maintained pain - sympathetic block - quality control - skin temperature - sympathetic reflexes - causalgia
Subjects:	BBS Special Issues: Controversies in Neuroscience: V - Persistent Pain Neuroscience: Behavioral Neuroscience Psychology: Clinical Psychology Neuroscience: Neuroanatomy Neuroscience: Neuroendocrinology Neuroscience: Neuropharmacology
ID code:	bbs00000433
Deposited by:	Helmut Blumberg on 01 May 2001