Sympathetic Pain

THE CLINICAL SYNDROME

You have been referred to the Interventional Pain Medical Group because pain should no longer be an option. Your physician has suspected an abnormal function of your sympathetic (autonomic) nervous system, which may be causing pain out of proportion to the original injury.

Sympathetic pain is a very complicated syndrome. The correct terminology for sympathetic pain is Complex Regional Pain Syndrome (CRPS), which includes Reflex Sympathetic Dystrophy (RSD), Causalgia, Sympathalgia, Sympathetically Medicated Pain and Sympathetically Independent Pain.

Your pain physician will perform a comprehensive evaluation and make a diagnosis to differentiate these conditions. The pain you experience may be increasingly severe. It affects people of all ages and has physical, emotional and psychological ramifications.

Making the Diagnosis of RSD/CRPS

The diagnosis of RSD/CRPS can be made in the following context. A history of trauma to the affected area associated with pain that is disproportionate to the inciting event plus one or more of the following:

Thus patients do not have to meet all of the clinical manifestations listed above to make the diagnosis of RSD/CRPS. The new CRPS classification system acknowledges this fact by stating that some patients with RSD/CRPS may have a third type of CRPS by categorizing it as "otherwise not specified". There seems to be a small group of patients whose pain following trauma resolves over time, leaving the patient with a movement disorder. The pain and symptoms of RSD/CRPS may exceed both the magnitude and duration of symptoms expected from the normal healing process expected from the inciting event. Similarly, the RSD/CRPS diagnosis is precluded by the existence of known pathology that can be explained by the observed symptoms and degree of pain. There are "grades" of this syndrome described in the literature with symptoms ranging from minor to severe.

Your pain may have been caused by mild to moderate trauma such as a contusion, bump on the shin, minor surgery or fracture. Occasionally, direct trauma to a major nerve such as a laceration may initiate the condition. The initial injury heals but your condition may progress causing increasingly severe disability secondary to pain. Symptoms include intolerance to any touch or pressure, swelling, redness, sweating, hair, skin and color changes, ulceration, coldness, and osteoporosis. In advanced stages, the limb can be rendered useless. Depression may overwhelm the patient’s life due to increasing pain and dysfunction.

Treatment needs to be early, aggressive and multi-disciplinary to avoid lifelong complications!

The Interventional Pain Medical Group can treat your sympathetic by coordinating medical treatments, providing psychological counseling and diagnostic and therapeutic injections specific to diagnose and treat your pain. These may include sympathetic blocks , epidural injections, regional blocks, intravenous sympathetic blocks and implantable pump and stimulator techniques. Specifics of risk vs. benefit will be discussed between you and your doctor.

Injection therapy works to interrupt and reset the abnormally functioning sympathetic nervous system. Nutritional supplementation coupled with a wellness product alternative may be helpful in treating this condition. Ask your doctor for a program. Early aggressive treatment leads to the greatest success and prevents progression of the disease. In some cases, pain is completely relieved after the first injection. Success varies with the duration and stage of complex regional pain.