Do nerve resection, amputation, and immunotherapy relieve causalgia in the long term?

Reported here is the unpublished long follow-up (22 years and 14 years) of 2 patients with longstanding causalgia initially successfully treated by nerve resection and reported in detail previously in this journal. There are very little such long-term data for causalgia of this nature available. This is a rare opportunity to reevaluate these 2 patients who began their stories not too differently but went on to follow very different paths. One of these patients (CH) had causalgia after a traumatic right infraorbital nerve injury. This pain was relieved by nerve resection with no recurrence of facial pain for over 22 years. The other patient (HG) had many years of intractable complex regional pain syndrome type 2 of the common peroneal and sural nerves after a left leg injury in childhood. HG had 4 years and 4 months of good relief by nerve resection. At this time, severe pain recurrence and incipient gangrene of the left leg required amputation, which saved the leg but did not affect the pain, a worsening severe skin rash, and frequent respiratory infections. The amputated limb pathology suggested an autoimmune response and further tests provided evidence of autoimmune antibodies and immunoglobulin deficiency. Only after immunotherapy did these problems resolve and this improvement has persisted for 4 years and 9 months. There are few long-term assessments of causalgia treated by nerve resection, amputation, and/or immunotherapy. Short-term failures of these treatments may be due to treatable conditions such as immunological abnormalities.