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Painful disorders following injury ofperipheral nerves; bones and
othersoft tissueshaveoccurredfrom theearliesttimesofhuman
existence. Ambroise
ParewascalledupontotreatthepersistentpainexperiencedbyKing Charles
IXwhich wascausedbyalancetwound. Thepainwaspersistent,diffuseand
associatedwithcontractureofmuscles.
Thekingcouldneitherflexnorextend hisarmforamonth untilthepainfmally
disappeared WeirMitchell,
G.R.Moorehouse,andW.W.Keeneproducedamonumental treatisein
1864titled"GunshotWoundsandOtherInjuriesofNerves,"which containedan
account ofsymptoms and signs ofperipheral nerve injuries as
observed in Unionist Soldiers. After 1864, however, little mention
ofthis condition wasmade during peacetimeuntil a
spateofarticlesappearedagain afterWorldWarOneandTwo. With the
formation ofsocieties such as International Association for the
Study of Pain, renewed interest has been shown in understanding the
mechanismsandmanagementofpainsyndromes. Paincausedbysympathetic
disordershasalwayscaughtthefancyofclinicians,
andyetconfusionexistsas tothe
etiologyandpropertreatmentofreflexsympathetic dystrophy. Many new
names have been proposed for these syndromes; recent ones include
sympatheticallyornonsympatheticallymaintained pain. Taxonomy ofThe
International Association for the Study ofPain lists causalgia and
reflex sympathetic syndromes as two distinct entities. All
clinicians seem to feel that pain relieved by a diagnostic
sympathetic block should be labeled as causalgia or reflex
sympathetic dystrophy. Similarly, numerous
therapeuticmodalitieshavebeenproposed. Theyallcenteraround
sympathetic denervation of some sort, pharmacologically,
chemically, or surgically.
Inspiteofagreatadvanceinourunderstandingofpainmechanism in the last
quarter century, we are no closer to improving the outcome of
patientswithsevere reflexsympatheticdystrophy. Etiologyand
incidenceis xvi Serieseditorforeword still unclear. Diagnosis is
made late and treatment is not standardized Clinicians
whotreatcausalgiaandreflexsympatheticdystrophyhavedifferent
treatmentsbasedupon their background and experience,ratherthan on
the mechanism ofthesyndrome itself.
ThetimeisopportunenowtogathersomeunbiasedthoughtsonRSDand clem- the
air. Our editors, in particular Michael Stanton-Hicks, needto be
congratulatedfor organizing a timely symposium onthesubject and
inviting international expertsto discuss the pathophysiology and
treatmentofRSD. Whatfollowsinthismonograph
isaclear,concisepresentationanddiscussion ofnomenclature, etiology,
incidence, mechanism, treatment, and outcome of RSD.
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