Emergency War Surgery NATO Handbook: Part III: General Considerations of Wound Management: Chapter XX: Wounds and Injuries of Peripheral Nerves

True Causalgia

United States Department of Defense

Causalgia is a severe burning pain, often associated with autonomic changes and typically relieved by sympathetic block. Aggressive management is usually required. While vasoconstriction and dryness with trophic changes of skin and nails are more common later on, vasodilation of skin vessels and hyperhydrosis predominate initially. The pain is all consuming and the patient does not tolerate the least bit of manipulation of the affected extremity. In the combat situation, close to 50% of true causalgia presents within hours to several days after wounding. This pain pattern is invariably associated with incomplete injury to a nerve, typically the median or posterior tibial. Analgesics and even narcotics provide only minimal relief. Early sympathetic blocks with a local anesthetic are preferred. If the pain pattern is relieved but then recurs despite repetitive blocks, surgical sympathectomy is indicated. Other lesser pain patterns can be treated fairly successfully with pharmacological agents, at least in the early stages.

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Operational Medicine 2001

Health Care in Military Settings

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