Sympathetic nervous system and pain: A clinical reappraisal

Author(s): Hoffmann, U., Mohadjer, M., Scheremet, R.

Journal/Book: Behav Brain Sci. 1997; 20: 40 West 20TH Street, New York, NY 10011-4211. Cambridge Univ Press. 426.

Abstract: The target article discusses various aspects of the relationship between the sympathetic system and pain. To this end, the patients under study are divided into three groups. In the first group, called ''reflex sympathetic dystrophy'' (RSD), the syndrome can be characterized by a triad of autonomic, motor, and sensory symptoms, which occur 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 a second group, called ''sympathetically maintained pain'' (SMP) syndrome, the principal symptoms are spontaneous pain, which is felt superficially and has no orthostatic component, and allodynia. 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 between these cases. A very small third group of patients exhibits symptoms of both RSD and SMP. The dependence or independence of pain on sympathetic function reported in most published studies seems to be questionable because the degree of technical success of the block remains uncertain. Therefore, pain should not be reported as sympathetic function independent until the criteria for a complete sympathetic block have been established and satisfied.

Note: Article Blumberg H, Univ Freiburg, Dept Neurosurg, Hugstetter Str 55, D-79106 Freiburg, GERMANY

Keyword(s): causalgia; pain; quality control; reflex sympathetic dystrophy; skin temperature; sympathetic block; sympathetic nervous system; sympathetic reflexes; sympathetic-sensory coupling; sympathetically maintained pain; REGIONAL INTRAVENOUS GUANETHIDINE; NORADRENALINE-EVOKED PAIN; DYSTROPHY SYNDROME; BLOOD-FLOW; POSTTRAUMATIC PAIN; STELLATE GANGLION; NEUROPATHIC PAIN; MAINTAINED PAIN; BLOCKADE; TEMPERATURE

Zurück | Weiter