Causal Gia

CAUSALGIA
DEFINITION :
• Causalgia is a typical pain syndrome
affecting mostly upper and lower limbs.
• The condition is preceded mostly after
injury which mainly affects peripheral
nerves and leads to histological changes
on the particular part of the body.
DEFINITION :
• The intensity of the pain is varied and
depending upon this, Causalgia may be
mild or severe.
• A severe burning sensation sometimes
accompanied by redness and
inflammation of the skin.
• Also called COMPLEX REGIONAL PAIN
SYNDROME and REFLEX
SYMPHATHETIC DYSTROPHIES
PATHOGENESIS
• The Causalgia development has two
mechanisms :
1) The early pain syndrome is associated with
peripheral nerve injury. This leads to
stimulation of the postganglionic
effectors and peripheral nerve endings.
Often this causes vascular, especially
arteriolar contraction. This contraction is
continued due to release of
neurotransmitter, epinephrine.
PATHOGENESIS
2) The tissues do not obtain sufficient amount
of oxygen supply which leads to anoxia.
This effect mainly occurs in the cutaneous
tissue of the affected area, which leads to
different skin texture changes like shiny,
scaly, dry skin or excessive moist skin with
patchy brown discoloration due to
neurological injury.
SYMPTOMS
• The most common symptoms are pain
sensations, including burning, stabbing,
grinding, and throbbing. Moving or
touching the limb is often intolerable.
SYMPTOMS
• The patient may also experience muscle
spasms; local swelling; extreme sensitivity
to things such as wind and water, touch and
vibrations; abnormally increased sweating;
changes in skin temperature (usually hot
but sometimes cold) and colour (bright red
or a reddish violet); softening and thinning
of bones; joint tenderness or stiffness;
changes in nail and hair growth and/or
restricted or painful movement.
CAUSES
• The exact cause of development of
Causalgia is not known. More than one
factor which mainly involve to stimulation
of the sympathetic nervous system and
leads to over activity of the peripheral
neurological effects are causes Causalgia.
Inflammatory mediators release may also
have role to promoting the condition.
CAUSES
• The scientific evidence predicted that
peripheral nerve injury leads to impair the
vasomotor control at the affected part of the
limbs and produce severe pain at the
site. Intense pain prolongs the neurological
sensitization of the arteriolar smooth
muscle. This leads to increase the plasma of
epinephrine amount than the normally.
Untreated condition causes tissue anoxia
which produce irreversible histological
changes in the affected part.
TRIGGERING FACTORS
• Accidental Trauma
• Bone fracture
• Immobilization of the limb
• Delayed healing process than the usual
time
• Drug induced condition which includes
Angiotensin Converting Enzymes Inhibitors
(ACEI).
DIAGNOSIS
• Spontaneous pain or allodynia (pain
resulting from a stimulus which would not
normally provoke pain, such as a light
touch of the skin) is not limited to the
territory of a single peripheral nerve and is
disproportionate to the inciting event.
DIAGNOSIS
• There is a history of oedema, skin blood
flow abnormality, or abnormal sweating in
the region of the pain since the inciting
event.
• No other conditions can account for the
degree of pain and dysfunction.
• The two types differ only in the nature
of the inciting event. Type I develops
following an initiating noxious event
that may or may not have been
traumatic, while Type II develops after
a nerve injury.
• No specific test is available for
CAUSALGIA, which is diagnosed
primarily through observation of the
symptoms. However, thermography,
sweat testing, x-rays, electro
diagnostics, and sympathetic blocks
can be used to build up a picture of the
disorder.
• Diagnosis is complicated by the fact
that some patients improve without
treatment. A delay in diagnosis and/or
treatment for this syndrome can result
in severe physical and psychological
problems. Early recognition and
prompt treatment provide the greatest
opportunity for recovery.
• Thermotherapy
• Radiography
• Electrodiagnostic testing
MEDICAL MANAGEMENT
• Early diagnosis and initiation of treatment can
restrict the continuous degenerative condition of
the affected tissues.
• Sympathetic block: 18-25% of patients have
satisfactory long-lasting relief after a series of
nerve blocks using a local aesthetic injection..
• Anti inflammatory drugs
• Antidepressant (amitriptyline)
• Anti convulsant (phenytoin)
• Calcium channel blocker
PHYSIOTHERAPY MANAGMENT
• Physical therapy interventions may
include transcutaneous electrical nerve
stimulation, progressive weight bearing,
desensitization technique, massage, whirlpool
bath and contrast bath therapy
• Sensory re-education
• Aquatic therapy
• Mirror therapy
• Gradual weight bearing
• Stretching
• Fine motor control
• ACUTE PHASE : immobilization and
contrast therapy.
• CHRONIC PHASE :
- Passive physical therapy including
mobilization, manual therapy.
- Lymphatic drainage can be used to
facilitate regression of oedema.
- Various isometric exercise.
- Strengthening exercise.
- Gait training.

Causal Gia

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CAUSALGIA

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