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a painful condition that develops after injury to the extremities, characterized by excruciating, unendurable, intermittently intensifying pains, mostly of a burning nature.
Causalgia results from injury to a nerve trunk (when it is not completely severed) that has an abundance of sympathetic nerve fibers such as the sciatic and tibial nerves in the leg and the median and (less commonly) ulnar nerves in the arm. Between five and ten days after injury, pain arises in the extremity along with marked autonomic disturbances—vascular, secretory and trophic. These changes, like the burning pains, sometimes involve the neck and upper part of the chest, when an arm is affected, and the lower part of the abdomen when a leg is affected. The pains intensify at the slightest movement or light contact with the skin (especially stroking) and are affected by emotional stress, noise, and light. Cooling and constantly wetting the skin usually diminishes the pains.
Causalgia occurs in two forms—ischemic (coldness and pallorof the extremity, trophic disorders) and hyperemic; the latter ismilder and its disorders are less pronounced, and it tends todisappear spontaneously after four or five months. Treatmentinvolves the injection of novocain or alcohol into the area of theaffected nerve trunk or of the ganglion-blocking substances intothe sympathetic ganglia. Physical therapy may be helpful (elec-trophoresis with novocain, X-ray therapy). Surgery is indicated(freeing the nerve from scars) if more conservative treatmentfails.[H-1604–4]