Sympathetic maintained pain (causalgia) associated with a demonstrable peripheral-nerve lesion. Operative treatment

Nine patients who had sympathetic maintained pain (causalgia) and a total of ten identifiable lesions involving peripheral nerves were managed with a continuous sympathetic block; repair, reconstruction, or lysis of the involved nerve, or a combination of these procedures; and rotation of a muscle flap over the nerve in an attempt to enhance the blood supply in the area and to reduce scarring in the region surrounding the nerve. The lesions were located in the median nerve at the wrist in five of the patients; in both the ulnar nerve at the elbow and the median nerve at the wrist in one; and in the ulnar nerve at the elbow, the radial digital nerve of the index finger, and the posterior tibial nerve near the ankle in one patient each. The average duration of symptoms before treatment was seventeen weeks. All nine patients had clinical findings that were considered diagnostic of sympathetic maintained pain or causalgia. Electrophysiological evidence of dysfunction of one peripheral nerve or more was found in the eight patients who had an electromyogram and a nerve-conduction study. In all nine patients, the causalgic pain diminished within the first seventy-two hours after the operation, and none of the patients had had any recurrence of symptoms at an average of forty-eight months. Although all of the patients had some residual limitation of function, all had improvement after this treatment, and the improvement was maintained.