Disturbances of the surrounding vascular system and the severe cicatrical entrapment of the injured plexus should be considered, with its neural damage, in brachial plexus injury by Gun-Shot. Therefore, Subclavian arteriography and Subclavian venography before operation should be essential and the correction of the deficit of the vascular system may be a factor in the determination of prognosis in relation to pain control. We have reported 2 cases of the brachial plexus injury by Gun-shot and discussed the importance of Subcalvian arteriography and Subclavian venography. External neurolysis seems to be beneficial in Causalgia caused by brachial plexus injury.
Angiography ; Brachial Plexus* ; Causalgia ; Phlebography ; Prognosis

Complex regional pain syndrome (CRPS) type II is a syndrome that develops after nerve injury. Symptoms may be severe, and vary depending on the degree of sympathetic nerve involvement. As yet, there is no satisfactory treatment. We report the case of a female patient who had an L5 left transverse process fracture and an S2 body fracture, who developed symptoms of CRPS type II in her left lower leg that were aggravated during ambulation in spite of absolute bed rest for one month after the trauma. Several treatments, including bed rest, medication, and numerous nerve blocks were attempted, but the pain persisted. We finally tried injection of polydeoxyribonucleotide (PDRN) solution at the left L5 transverse process fracture site because we knew of the anti-inflammatory effect of PDRN. One day after this treatment, her symptoms had almost disappeared and three days later, she was discharged. We will also further discuss the possibility of using PDRN solution for the treatment of CRPS.
Bed Rest ; Causalgia* ; Female ; Humans ; Leg ; Nerve Block ; Polydeoxyribonucleotides ; Walking

Owing to the advancement of imaging techniques which include the CT scan, it became easier to evaluate fracture patterns of calcaneal fractures accurately. Moreover, it is possible to obtain good results with operative treatment as a consequence of the development of good operative equipment and new operative technique. In 1988, Regazzoni and Benirschke in 1990, recommended L-shaped extensive lateral approach for calcaneus which provide extensive exposure of calcaneus and so allow easier reduction and fixation. We carried out L-shaped extensive lateral approach in 11 cases from June, 1993 to April, 1994. This approach did not produce any skin problems and allowed excellent anatomical reduction and fixation. But we experienced some severe causalgia on the heel region in several cases. We tried to analyse the cause of pain and concluded that it was the damage to the lateral calcaneal branch of the sural nerve. We are reporting the problems of tbis approach.
Calcaneus ; Causalgia ; Heel ; Skin ; Sural Nerve ; Tomography, X-Ray Computed

The long-term prognosis of complex regional pain syndrome is difficult to predict because of its unclear pathophysiology. The syndrome can spontaneously spread to other regions in the body. We report a case in which a complex regional pain syndrome that occurred in a 75-year-old male patient after a stroke spread to the opposite side.
Aged ; Causalgia ; Humans ; Male ; Prognosis ; Reflex Sympathetic Dystrophy ; Stroke

It is well documented that dorsal root entry zone(DREZ) lesions were good method to control intractable chronic deafferentation pain of spinal origin which was not controlled with various medical and surgical treatment. Experience with radiofrequency lesions of dorsal root entry zone in 3 of patients with post herpetic pain and 1 of patient with post amputation pain are reported. The follow-up period ranging from 3-20 months and all patients obtained satisfactory pain relief.
Amputation ; Causalgia ; Follow-Up Studies ; Humans ; Pain, Intractable* ; Phantom Limb ; Spinal Nerve Roots*

Pain is a sensory experience that is subjective and individual. It frequently exceeds its protective function and becomes destructive. We have met one case of causalgia, three cases of Buergers disease, and one case of arteriosclerosis obliterance. They sufferred from persistent pain and exkausted with the marked distrophy of affected limbs. Management of these patient involving lower limbs is a continuing challenge. Many other therapheutic procedures could be tried for these patients, but we tried chemical lumbar sympathectomy for these cases. With respect to the lower extremity, four patients had neurolysis of the 1st, 2nd and 3rd ipsilateral or 2nd and 3rd bilateral lumbar ganglia using 3 to 5 ml pure alcohol for each space under the image intensifier. Immediately after these procedure, rest pain has relieved dramatically in most cases and marked skin temperature rising. This implied increased peripheral blood flow of sympathectomised portion and the relief of rest pain is probably explained by destrcution of the afferent pain fibres running with the sympathetic trunk.
Arteriosclerosis ; Causalgia ; Extremities ; Ganglia ; Humans ; Lower Extremity ; Running ; Skin Temperature ; Sympathectomy* ; Thromboangiitis Obliterans

OBJECTIVE: The authors present dorsal root entry zone(DREZ) operations on deafferentation pain patients suffered from brachial plexus avulsion(BPA), phantom pain(PP) and postherpetic pain(PHP). METHODS: Eight patients(Six BPA, one PP and one PHP) underwent DREZ operations on the cervical, thoracic and thoracolumbar spinal cords. The patients were 7 men and 1 woman who were in between thirties and sixties. The lesions were made by inserting 2mm bare tip of standard type DREZ electrode connected to Radionics radiofrequency generator into the DREZ 45 degree off the sagittal plane. The tissue was heated to 75degrees C for 15 seconds. RESULTS: All BPA patients had immediate and long-lasting pain relief regardless of the duration and character of the pain but patients with PP and PHP complained rather aggravation of pain after the operation. CONCLUSION: DREZ operation is effective for BPA pain, however, it needs to have attention in performing this surgery for PP or PHP.
Brachial Plexus ; Causalgia* ; Electrodes ; Female ; Hot Temperature ; Humans ; Male ; Phantom Limb ; Spinal Cord ; Spinal Nerve Roots

We produced the cauaalgiform pain by unilateral 1/3-1/2 ligation of sciatic nerve in rats.. Withdrawal thresholds to non-noxious stimulation were reduced(mechanical allodynia), and withdrawal thresholds to heat stimulation were reduced(heat hyperalgesia) too. After that, we injected 50 mg/kg guanethidine intraperitoneally for the study of the effects of chemical sympathectomy in postopertive 7th day, 37th day respectively. The results were as follows 1) Mechanical allodynia was alleviated partially in 12 hours, first day after sympathectomy. 2) Heat hypera1gesia was alleviated completely in first day to 4th day after sympathectomy, and reappeared after 5th day.
Animals ; Causalgia ; Guanethidine ; Hot Temperature ; Hyperalgesia ; Ligation* ; Rats* ; Sciatic Nerve* ; Sympathectomy ; Sympathectomy, Chemical*

The superficial peroneal nerve is vulnerable to damage from ankle sprain injuries and fractures as well as surgery to this region. And it is also one of the most commonly involved nerves in complex regional pain syndrome type II in the foot and ankle region. We report two cases of ultrasound-guided pulsed radiofrequency treatment of superficial peroneal nerve for reduction of allodynia in CRPS patients.
Ankle ; Ankle Injuries ; Causalgia ; Foot ; Humans ; Hyperalgesia* ; Neuralgia ; Peripheral Nerves ; Peroneal Nerve* ; Pulsed Radiofrequency Treatment* ; Ultrasonography

Treatment of pain related to various types of deafferentation remains a neurosurgical challenge. Medical therapy and conventional surgical techniques for pain relief have not been effective due to this problem. Six patients with intractable pain following a brachial plexus injury were treated with dorsal root entry zone(DREZ) lesions. These lesions were made with CO2 laser. All patients were followed from 5 months to 5 years after surgery. Two-third of the patients were relieved of more than 50% of their preoperative pain. Post-operative neurosurgical complications were ipsilateral leg weakness and loss of proprioception in 2 cases. The laser technique is exact, makes uniform lesion, shortens the duration of the procedure, lessens cord manipulation and makes shalow penetration into the surrounding spinal cord. Dorsal root entry zone(DREZ) lesions made with CO2 laser appeared to be a satisfactory treatment for brachial plexus injury patients who have failed to respond to more conservative modes of therapy.
Brachial Plexus* ; Causalgia ; Humans ; Lasers, Gas* ; Leg ; Pain, Intractable ; Proprioception ; Spinal Cord ; Spinal Nerve Roots*