Phức tạp hội chứng đau khu vực, trước đây gọi là loạn dưỡng giao cảm phản xạ hoặc causalgia, là một vấn đề điều trị khó khăn cho bác sĩ phẫu thuật chỉnh hình điều trị một cực thấp bị ảnh hưởng. Mặc dù có nhiều giả thuyết khác nhau và thường xuyên mâu thuẫn, nguyên nhân của sự đau đớn nghiêm trọng, thay đổi lưu lượng máu khu vực, và phù là không rõ. | Treatment of Complex Regional Pain Syndrome of the Lower Extremity Christopher J. Hogan MD and Shepard R. Hurwitz MD Abstract Complex regional pain syndrome formerly known as reflex sympathetic dystrophy or causalgia is a difficult therapeutic problem for the orthopaedic surgeon treating an affected lower extremity. Despite many divergent and often conflicting theories the cause of the severe pain alterations in regional blood flow and edema is unknown. Interventions that have proved successful for treating similar conditions in the arm and hand frequently do not relieve pain similarly in the lower extremity. Common treatment regimens target individual components of this symptom complex namely sympathetic or afferent nerve hyperactivity vasomotor instability or regional osteoporosis. Despite widespread use of some of these treatments few controlled clinical trials quantify their effectiveness. This challenging syndrome is best managed by a multidisciplinary team including chronic pain management specialists physical therapists and orthopaedic surgeons. J Am Acad Orthop Surg 2002 10 281-289 The normal physiologic response of an extremity to a painful injury involves humoral and neural signals that give rise to increased blood flow edema limited joint excursion and hypersensitivity to pain. These signs and symptoms are usually proportional to the severity of the injury and resolve with healing of the damaged tissues. When this injury response is prolonged a chronic pain syndrome results. With time painful symptoms may expand from the site of injury to involve the entire extremity leading to a persistently swollen painful and ultimately functionless limb. This progressive pain pattern has been recognized for over 100 years and has been described variously as causalgia minor causalgia major causalgia mimocausalgia pseudocausalgia reflex sympathetic dystrophy algodystrophy algo- neurodystrophy posttraumatic dystrophy Sudeck s atrophy and sympathetically maintained pain
