Causalgia

CAUSALGIA, causalgia (from the Greek cau-sis-burning and algos-pain), "burning pain", a special form of traumatic (usually gunshot) injury to peripheral nerves. The first published observations of this type of injury were made by Pirogov during the Crimean War of 1855-56, but in a more complete form, the description and name of this condition was given by the American Weir Mitchell based on material from the American War of Independence (1860s). Pirogov, in his reports on the Russo-Turkish War of 1877-78, again returned to his earlier and newly collected observations. It would be more correct to call C. a form of Pirogov-Weir Mitchell or Weir Mitchell-Pirogov. Interest in C. again increased during the recent imperialist and civil wars. C. appears in gunshot wounds to the extremities usually in cases where the peripheral nerve (especially often the median nerve and sciatic nerve) is not severed, but the vascular-nerve bundle is affected along the bullet's path. The disease develops several days after injury and lasts for many months. In cases where a blood vessel or nerve is severed, C. usually does not occur. Apparently, the necessary conditions for the development of C. are the presence of a traumatic irritating process or scar and at least relative preservation or integrity of the peripheral nerve fiber, both somatic and autonomic (vascular nerve plexus). The patient with a peripheral injury suffering from C. complains of constant, peculiar pain in the affected extremity. The pains are of a burning nature, extremely unpleasant, tormenting, and allowing no rest. Any kind of irritation and even simply more or less strong sensations aggravate this pain and make it unbearable. The patient "nurses" the affected extremity, cannot find a comfortable position for it, seeks various ways to relieve the pain, and usually finds relief by applying wet rags to the injured extremity; this indeed alleviates the sensation of constant burning. Particularly unpleasant is light contact with the affected extremity by a dry hand; conversely, a wet, water-moistened hand is tolerated much more easily or even painlessly upon contact; this is the basis for relieving C. by wearing a rubber glove on the affected hand (moistening of the hand due to preventing the skin from drying out). In addition to the phenomenon of burning pain in C., there are various symptoms of loss of function of the peripheral nerve due to its injury (traumatic neuritis): paralyses, pareses, contractures, anesthesias, hypesthesias, etc. Usually in C., sharply expressed angiotrophic disorders are observed: glossy atrophic skin, pathological growth of nails and hair, anomalies in perspiration and sebum secretion, muscle atrophy, bone atrophy (osteoporosis), etc. The pathogenesis of C. should be understood as phenomena of sensory irritation in the area of somatic and autonomic peripheral nerve fibers, arising due to the presence of traumatic damage in the form of neuritis or a scarring process around the vascular-nerve bundle. The phenomenon of sensory irritation is transmitted to the periphery to the terminal nerve sensory endings apparently through the autonomic nerve apparatus of Timofeyev contained in them. The pathogenesis of C. can be clarified by observing the results of systematically performed surgical intervention on both the somatic and autonomic peripheral nervous system (neurolysis, alcoholization of the nerve trunk, periarterial sympathectomy). C. should be classified as a group of sympathalgias. It is very likely that C. affects predisposed individuals of an asthenic constitution with increased nervous sensitivity and a certain instability of the autonomic nervous system. The degrees of C. vary in intensity of manifestation: from extremely unbearable to relatively mild. Gradually, with the resolution or end of the pathological process, the phenomena of C. subside or cease, transforming into paresthesias, dysesthesias, itching, etc. The treatment of C. on a conservative basis is reduced to the principles of treatment of traumatic neuritis.

V. Khorshko. Attempts were made to eliminate C. by surgical intervention on the nerve trunks by resection of the affected nerve segment (Weir Mitchell), then by alcoholization of the nerve trunk (Sicard). Leriche proposed for C. to interrupt the sympathetic innervation in the affected extremity according to the type of arterial desympathization (see Gangrene) and obtained success after such operations. Good results obtained by Pussepp, who thoroughly cleaned the affected nerve from scars and performed vigorous traction on it, should probably also be attributed to desympathization, since during vigorous traction of the nerve, thin sympathetic fibers running in the thickness of the nerve and emerging from it segmentally to blood vessels inevitably rupture. (See also Desympathization.)

p. of internal diseases, under the editorship of G. Lang and D. Pletnev, vol. IV, issue 3, M.-L., 1929); Turbin V., Peripheral Sympathectomy according to Leriche in Severe Cases of Causalgia, Klin. med., 1920, XI; Ustevskaya V., On the Clinic of Causalgia and the Results of Surgical Intervention for It, Collection of Articles on Neuropathology, edited by L. Minor, G. Roseolimo and V. Khorshko, No. 1, M.-P., 1923; Leriche R., De la causalgie, Presse med., 1916, No. 23.