International disability studies
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The authors report on a series of patients with severely painful disorders of peripheral nerves--they review the modern theories on the nature of causalgia and reflex sympathetic dystrophy. Peripheral causes include spontaneous discharges from neuroma sprouts, their sensitivity to adrenergic compounds, ectopic generator activity in abnormally myelinated fires and increased firing in dorsal root ganglia. Central causes include spontaneous activity of deafferented nerves in the dorsal horn and development of response to new receptive fields. ⋯ Recurrences depend on the degree of initial response. Those who obtained virtually complete relief of pain had a lower recurrence rate but a high proportion needed repeated sessions of treatment at yearly intervals. Follow-ups must therefore be indefinite.