Causalgia is a pain syndrome that can be minor or severe with symptoms usually appearing within 24 hours of an injury to the peripheral nerves. The peripheral nerves extend from the spine and brain to the arms, legs, as well as the internal organs.
There is a bundle of nerves that run from the neck to the arm, and in the majority of cases of causalgia, this is where injury occurs. People who suffer from causalgia syndrome are hypersensitive in the area of the affected nerve. Causalgia is often referred to in the medical profession as complex regional pain syndrome type 2.
Causes of causalgia
It is important to point out the different types of complex regional pain syndrome. Type 1 is called reflex sympathetic dystrophy syndrome and tends to happen after an illness or injury that has nothing to do with direct damage to the nerves. Type 2 or CRPS II does follow a nerve injury.
A trauma to a leg or arm, including a crush, fracture, or amputation can lead to causalgia. There are also cases where surgery, infections, heart attacks, and simply a sprained ankle can lead to complex regional pain syndrome type 2. While we don’t know exactly why these traumas lead to CRPS II, some medical researchers suggest that it may be from a dysfunctional interaction between the central nervous system and the peripheral nervous system that triggers “inappropriate inflammatory responses.”
Nerve injury can lead to loss of motor control as well as severe pain. While minor causalgia describes less severe cases, some sufferers in this category have been known to experience bone density changes along with the typical causalgia pain.
Those who experience an accidental trauma, a bone fracture, immobilization of a limb, or a delay in the healing process following a trauma are more likely to get causalgia.
Symptoms of causalgia
Causalgia symptoms vary from person to person. They can also change over time, but here’s a look at some of the typical signs and symptoms.
- Constant burning in the arm, leg, hand, or foot
- Continuous throbbing in the arm, leg, hand, or foot
- Sensitivity to touch or cold
- Skin changes—sometimes sweaty, other times cold
- Swelling in the painful area
- Skin color may be red or blue
- Skin becomes tender, thin, or shiny in affected area
- Joint stiffness
- Muscle spasms and weakness
- Changes in hair and nail growth
- Decreased mobility
- Decreased blood circulation
- Dry scalp and dry skin
There are situations where causalgia pain spreads from its source to somewhere else in the body. For example, some people who experience causalgia of the lower limb find that the pain moves to the opposite limb. Some research suggests that emotional stress may make the symptoms worse.
Sometimes the signs and symptoms of complex regional pain syndrome type 2 go away on their own, while others experience the symptoms for months or even years.
Causalgia tends to impact people between the ages of 40 and 60; however, younger people have also been known to experience the syndrome.
Diagnosis of causalgia
Unfortunately, there is no single test to diagnose causalgia. Normally, a doctor will perform a physical exam and look at your medical history. A number of different tests can help provide more information that could lead to a definitive diagnosis of CRPS II.
The following tests are considered common when causalgia is suspected:
- Bone scan – This can detect bone changes.
- Sympathetic nervous system test – Disturbances in the sympathetic nervous system can be seen through sympathetic nerve testing. Thermography is one test that measures skin temperature and blood flow to the affected limbs.
- X-rays – In the later stages of the disease, an x-ray may be able to show loss of minerals from the bones.
- Magnetic resonance imaging (MRI) – The MRI is capable of showing tissue changes.
- Sweat tests – These tests can compare the amounts of salt chemicals in the affected limbs versus the non-affected limbs.
Treatment for causalgia
Early diagnosis of causalgia can be important. This is because getting causalgia treatment right away can lower a person’s chances of sustaining degenerative muscles and tissue damage. While each case of causalgia is different, there are specific treatments recommended for the syndrome. The list below outlines the most prescribed treatments for causalgia.
- Pain medications
- Nerve blocks
- Physical therapy
- Spinal cord stimulation
- Surgical interventions
In cases that are severe and may not respond to drugs that act on nerve pain, surgical interventions for blocking the affected nerve signal can be an option. There is a procedure where the complete removal of the affected sympathetic nerve takes place. This is known as a sympathectomy. There are other techniques that can be used, but it is important to understand that there are some risks, such as spinal cord injury. Thankfully, studies show the risk is not more than five percent.
When it comes to lower limbs, blocking the sympathetic nerve chain by using medications, such as Intracain and Procaine have been effective. Anti-inflammatories have also been widely used to help those with causalgia manage inflammation.
Notice that psychotherapy is on the list above. This is due to the fact that causalgia has been linked to an increased risk of suicide. As many studies have pointed out, there is a link between emotional perceptions and pain, and psychological stress and physical pain. While it can’t cure the causalgia, psychotherapy has proved to be effective in helping many people reduce their physical discomfort level.
Causalgia or CPRS is rare, but for those who do suffer from the syndrome, it can be life-altering. In addition to the constant pain, many people who suffer from causalgia feel isolated, as if they are alone and no one understands what they are going through. Stories from others who are suffering from CPRS II and are coping can be inspiring to people who are struggling with the syndrome.
If you have causalgia and are doing relatively well, share your story so that others might benefit. For those who are having a hard time, there are supports, including the RSDS, which supports the CPRS community by providing all kinds of information and resources on this ailment. You will find a link to the organization below.