Funct Neurol
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Painful neurogenic syndromes commonly diagnosed as reflex sympathetic dystrophy (RSD) may not be the consequence of sympathetic dysfunction. Recent experimental data on the mechanism of hyperalgesia indicate that the primary pathophysiological mechanism of RSD may be sensitization of either peripheral nociceptors, or central neurons, or both. The sympathetic system might be involved in maintaining this condition, but this is not always the case. This presentation is an attempt to interpret clinical neuropathic syndromes on the basis of new scientific knowledge.
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There is a spectrum of conditions which have in common burning pain, often with hyperpathia, hyperalgesia, vasomotor and sudomotor changes. When due to major nerve damage, the condition is known as causalgia; when due to minor nerve damage or other factors, various terms such as algodystrophy or reflex sympathetic dystrophy are employed. ⋯ The classical view that the peripheral sympathetic nervous system is involved in generation of pain is questioned, and the possible roles of the central nervous system and of non-adrenergic mechanisms are summarised. That pain could be due to dysfunction of the polymodal nociceptor neurone is considered.