81. Jim Schmidt-Medical Department-August 2002 The story is a ‘classic,’ and of interest to medical historians, mainly becauseof the detailed clinical description of both ‘causalgia’ and ‘phantom http://civilwarmed.home.att.net/August2002.htm

"The Medical Department" August 2002 a monthly column in the Civil War News by Jim Schmidt "The Case of George Dedlow" In July 1866, readers of the popular magazine, The Atlantic Monthly Mitchell had written the story for his own amusement, and did not intend for it to appear in print. He lent the manuscript to a friend, who then sent it to the Rev. Edward Everett Hale. Hale offered it to The Atlantic "Civil War Medicine From the Perspective of S. Weir Mitchell’s ‘The Case of George Dedlow,’" recently published in the Journal of the History of the Neurosciences (March 2002, Vol. 11. No.1, pp. 11-18) . The original 1866 Atlantic Monthly story is available on the internet through Cornell University’s "Making of America" website at: http://moa.cit.cornell.edu/moa/browse.journals/atla.1866.html Over the years, the Dedlow story has become a classic of American literature and medicine. "The story is a ‘classic,’ and of interest to medical historians, mainly because of the detailed clinical description of both ‘causalgia’ and ‘phantom limb’ syndrome in a popular magazine before they were widely recognized in the medical literature of the day," Dr. Canale told me. In the story, George Dedlow is ambushed by Confederate guerillas and shot. The bullet passed through the left biceps into the right arm below the shoulder. The right arm became cold and was without sensation. Within a short time, Dedlow felt a terrible burning in his right hand:

82. RESEARCH INTEREST causalgia is a pain syndrome that occasionally develops after traumatic nerveinjury and is characterized by spontaneous burning pain accompanied by http://www2.utmb.edu/chunglab/kchung/rsrch_intrst.htm

RESEARCH INTEREST

83. Research Interest One of the most devastating consequences of peripheral nerve injury is the developmentof causalgia, which is a neuropathic pain that sometimes follows damage http://www2.utmb.edu/chunglab/jmchung/rsrch int.html

Research Interest the neurobiological mechanisms of chronic pain. Currently, two additional topics of research in Dr. Chung's lab focus on the mechanisms of acupuncture analgesia and lower back pain.

84. EMedicine - Reflex Sympathetic Dystrophy : Article Excerpt By: Eugenia-Daniela H medicine experts, suggested that the term complex regional pain syndrome (CRPS)should replace reflex sympathetic dystrophy (RSD) and causalgia—CRPS type 1 http://www.emedicine.com/neuro/byname/reflex-sympathetic-dystrophy.htm

(advertisement) Excerpt from Reflex Sympathetic Dystrophy Synonyms, Key Words, and Related Terms: acute peripheral trophoneurosis, algodystrophy, causalgia, chronic traumatic edema, mimocausalgia, neurovascular posttraumatic painful syndrome, neurovascular reflex dystrophy, neurovascular reflex sympathetic dystrophy, posttraumatic chronic edema, posttraumatic osteoporosis, posttraumatic pain syndrome, posttraumatic sympathetic dystrophy, RSD, shoulder-hand syndrome, spreading neuralgia, Sudeck atrophy, sympathalgia, thermalgia, traumatic angiospasm, traumatic vasospasm, complex regional pain syndrome type 1 Please click here to view the full topic text: Reflex Sympathetic Dystrophy Background: In 1994, the International Association for the Study of Pain (IASP), after development of consensus by a group of pain medicine experts, suggested that the term complex regional pain syndrome (CRPS) should replace reflex sympathetic dystrophy (RSD) and causalgia—CRPS type 1 for RSD, and CRPS type 2 for causalgia. However, the IASP diagnostic criteria were never fully validated, and several pain specialists raised concerns about their clinical and scientific value. The criteria have poor diagnostic specificity and may result in overdiagnosis of CRPS. RSD is a descriptive term meaning a complex disorder or a group of disorders that may develop as a consequence of trauma affecting the limbs, with or without an obvious nerve lesion. RSD also may develop after visceral diseases or CNS lesions or, rarely, without an obvious antecedent event. It consists of pain and related sensory abnormalities, abnormal blood flow and sweating, abnormalities in the motor system, and changes in structure of both superficial and deep tissues (“trophic” changes). Not all components need be present.

85. CRPS Also Reflex Sympathetic Dystrophy (RSD), Sudeck's Atrophy, causalgia. CRPS type II(causalgia) includes all foregoing features with a peripheral nerve lesion. http://www.orthoteers.co.uk/Nrujp~ij33lm/Orthcrps.htm

Go Back to SYLLABUS Find in this Page: enter a search term and hit 'enter' (may take a few seconds) Search the Orthoteer Site: Complex Regional Pain Syndrome Also: Reflex Sympathetic Dystrophy (RSD), Sudeck's Atrophy, Causalgia First clinical description was in 1864 when Doctor Mitchell published a classic description of causalgia in a paper entitled, "Gunshot Wounds a nd Other Injuries of Nerves" Definition An abnormal reaction to injury characterised by pain, swelling, stiffness, vasomotor changes and osteoporosis of the affected part New Classification: CRPS type I (RSD) the clinical findings include regional pain, sensory changes, allodynia, abnormalities of temperature, abnormal sudomotor activity, edema, and an abnormal skin color that occur after a noxious event. CRPS type II (Causalgia) includes all foregoing features with a peripheral nerve lesion. Old Classification of RSD (Langford): Minor causalgia Purely sensory nerve to distal portion of limb Minor Tramatic dystrophy Most common type Shoulder hand syndrome Proximal trauma or painful visceral lesion (shoulder or neck injury, cervical disc, PU, MI, pancost tumour etc)

86. Reflex Sympathetic Dystrophy Syndrome The syndrome, which is a variant of a condition known as causalgia, is a nerve disorderthat occurs at the site of an injury (most often to the arms or legs). http://healthlink.mcw.edu/article/922675234.html

Search Articles: search tips Please Take the HealthLink Survey Email this article Print this article Find related articles: By topic: Neurology By keywords: Receive Health Link via email! Subscribe now >> Reflex Sympathetic Dystrophy Syndrome Reflex sympathetic dystrophy syndrome (RSDS) is a chronic condition characterized by severe burning pain, pathological changes in bone and skin, excessive sweating, tissue swelling, and extreme sensitivity to touch. The syndrome, which is a variant of a condition known as causalgia, is a nerve disorder that occurs at the site of an injury (most often to the arms or legs). It occurs especially after injuries from high-velocity impacts such as those from bullets or shrapnel. However, it may occur without apparent injury. Causalgia was first documented in the 19th century by physicians concerned about pain Civil War veterans continued to experience after their wounds had healed. Doctors often called it "hot pain," after its primary symptom. Over the years, the syndrome was classified as one of the peripheral neuropathies, and later, as a chronic pain syndrome. RSDS is currently classified as a variant of causalgia, not necessarily caused by trauma. The symptoms of RSDS usually occur near the site of an injury, either major or minor, and include: burning pain, muscle spasms, swelling, increased sweating, softening of bones, joint tenderness or stiffness, movement problems, and changes in the nails and skin. One visible sign of RSDS near the site of injury is warm, shiny red skin that later becomes cool and bluish.

87. CRPS II Complex Regional Pain Syndrome Type II (CRPS II)/causalgia. Complex injury.CRPS II/causalgia is characterized by severe, burning pain. http://www.metropolitanpain.com/CRPS II.htm

Complex Regional Pain Syndrome Type II (CRPS II)/Causalgia Complex regional pain syndrome II (CRPS II), also called causalgia, is an extremely painful, progressive response to a peripheral nerve injury. CRPS II/causalgia is characterized by severe, burning pain. Causalgia differs from CRPS I/RSD in that it does not migrate from the site of the original insult. CRPS II/causalgia is triggered by trauma to a large nerve. The trauma can be as simple as a minor crushing injury or cut, or as destructive as a gunshot wound. As the disease progress, there is often a loss of function in the affected area, and the skin and nails undergo destructive changes. The pain, which in early stages may respond to analgesics, generally becomes resistant to pain medication. The treatment plan for CRPS II/causalgia depends upon many factors, such as the severity of the disease, dysfunction and pain, the type and location of the pain, as well as patient’s age, ongoing medical conditions, and ability to tolerate other medical therapies. The doctor will take all of these factors into consideration when prescribing a treatment plan. In general, the standard course of therapy for pain associated with CRPS II/causalgia will follow the chronic pain treatment continuum, and may include pain medications, exercise therapy, physical and occupational therapy, TENS, nerve blocks, surgery, neuromodulation, and neuroablation. Neurostimulation particularly spinal cord stimulation is an option for treating any unresolved neuropathic pain, which is common with CRPS II/causalgia.

88. Reflex Sympathetic Dystrophy And Complex Regional Pain Syndrome UK Home Pages, W This condition is sometimes called causalgia (literally hot pain ). Changes inskin texture. Recurrent infections. Depression. CRPS TYPE 2 (causalgia). http://www.rsd-crps.co.uk/types.htm

Please note these pages use Java menus which may not function in earlier version browsers. To update Internet Explorer please visit their download Browser section. Thank you. RSD UK - Helping those with Complex Regional Pain Syndrome Here are two explanations of the different types of CRPS, reproduced with permission of the authors. CRPS (full name Complex Regional Pain Syndrome) is the new World Health Organisation name for RSD, Reflex Sympathetic Dystrophy and its definition is subdivided into CRPS type I and CRPS type II. CRPS is pain that develops after a relatively minor injury to an arm or leg, but lasts much longer and is much more severe than would normally be expected. CRPS II is diagnosed when pain can be traced to an identifiable nerve injury. This condition is sometimes called Causalgia (literally "hot pain"). CRPS I is diagnosed when similar symptoms are manifested but there is no identifiable nerve injury. This is intended to cover the strict definition of Reflex Sympathetic Dystrophy (RSD). For patients the difference is academic because the symptoms are similar, especially the pain, and the same range of treatments are offered. Note also that a "Type I" diagnosis indicates that no nerve injury has been identified - which is not the same as saying that no nerve injury exists.

89. Details | Vascular Surgery | Fletcher Allen Health Care 5. Systemic Disease (see above). 6. causalgia. DIAGNOSTIC STUDIES 4. Sympatheticblock where causalgia is suspected. SWOLLEN LEG ALGORITHM. DIAGNOSIS http://www.fahc.org/Vascular_Surgery/education_7372_3_12.html

Details Surgery Vascular Surgery Eastern Vascular Society Educational Materials MANAGEMENT OF VENOUS AND LYMPHATIC DISEASE Eastern Vascular Society GOALS 1. To identify cause of leg swelling, differentiating, venous, lymphatic and cardiac sources. 2. Initiate appropriate therapy to eliminate long term sequelae. PERTINENT HISTORY/FINDINGS: 1. Unilateral or bilateral swelling. Bilaterally suggests a systemic disease (e.g. cardiac, hepatic, renal, thyroid, lipodystrophy). 2. History of DVT, recurrent leg infection. 3. Dilated veins, pigment changes. 4. Significant food edema. 5. Prior pelvic surgery, history of neoplasia or trauma. 6. Lymphadenopathy. 7. GYN, GU or GI history consistent with neoplasia. DIFFERENTIAL DIAGNOSIS: 1. DVT 2. Venous insufficiency 3. Lymphadema 4. Lymphatic obstruction 5. Systemic Disease (see above) 6. Causalgia DIAGNOSTIC STUDIES: 1. Venous duplex to include iliac veins. 2. CT scan of pelvis and abdomen if duplex is negative, especially in patients with suggestion of or history of malignancy. 3. Lymphoscintography - only in patients with atypical findings where diagnosis is in doubt.

90. ASA October 2002 Newsletter Phantom Limb and causalgia Pain in the Three Great Wars. 3. Phantom Limb and causalgiaThe Tragic Enigmas, Relief of Pain and Suffering Web site exhibit, . http://www.asahq.org/Newsletters/2002/10_02/feature3.htm

ASA NEWSLETTER October 2002 Volume 66 Number 10 Phantom Limb and Causalgia Pain in the Three Great Wars Doris K. Cope, M.D. Committee on Pain Medicine Silas Weir Mitchell, M.D. (1829-1914). Photo courtesy of Library of the College of Physicians of Philadelphia. Civil War (1861-1865) There have been few conflicts in history as bloody as the American Civil War, where technology in the form of rifled muskets able to fire up to eight aimed shots a minute at a killing range of 500 yards were employed by soldiers of both sides while still using outmoded "close-order drill military tactics more appropriate to Revolutionary War technology." But Dr. Mitchell was confronted with real patients in pain, and so he carefully documented their presenting symptoms and course of illness. He described the "hallucinations," which we now call phantom limb pain as "the sensorial delusions to which persons are subject in connection with their lost limbs."

91. Hyperhidrosis USA Get a onetime surgical treatment for this condition that is characterized by excessive sweating and blushing. Also treats Raynaud's syndrome. http://redirect-west.inktomi.com/click?u=http://www.looksmart.com/og/pr%3Dcdd%3B

92. Welcome To WebMD Health WebMD Today Home WebMD Newscenter Member Services Newsletters Alerts Boards Events WebMD University My WebMD Find a Doctor, Clinic Medical Info Diseases Conditions Check Symptoms Medical Library Drugs Herbs Quizzes, Calculators Clinical http://images.onhealth.com/content/asset/miller_keane_6225

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93. ±è¼®¹üÀÇ »ý¸®ÇÐ 3¹ø° ¼÷Á¦ The summary for this Korean page contains characters that cannot be correctly displayed in this language/character set. http://aids.hallym.ac.kr/d/kns/tutor/medical/9471143.html

Causalgia by ±è¼®¹ü median nerveÀÇ lesionÈÄ¿¡ ³ªÅ¸³ª´Â sensory loss´Â ´Ù¼Ò ´Ù¾çÇÑ ÇüÅ·Π³ªÅ¸³­´Ù. ´ë°³´Â ±× nerve°¡ supplyÇÏ´Â area º¸´Ù´Â ´ú ±¤¹üÀ§ÇÑ ºÎÀ§¿¡¼­ sensory loss°¡ ³ª Ÿ³­´Ù. index¿Í middle fingerÀÇ volar surfaceÀ§¿¡¼­ °¡Àå ÀϹÝÀûÀ¸·Î ³ªÅ¸³­´Ù. light touch¿¡ ´ëÇÑ ½Äº° ´É·ÂÀÇ »ó½ÇÀÌ pinprick¿¡ ´ëÇÑ ½Äº°´É·ÂÀÇ »ó½Çº¸´Ù ´õ¿í´õ ±¤¹üÀ§ÇÏ°Ô Áö¼ÓÀûÀ¸·Î ³ªÅ¸³­´Ù. nerve compressionÀº carpal£¦discarpal radial bonesÀÇ fractureÀÌÈÄ¿¡ ³ªÅ¸³ª°Å³ª external stress¾øÀÌ ³ªÅ¸³ª±âµµ ÇÑ´Ù. ¿©±â¼­ ¸»ÇÏ´Â injuries(Áï, nervesÀÇ lesionÀ» Æ÷ÇÔÇؼ­)°¡ ÀÖÀº ÈÄ¿¡´Â secondary autonomic system overactivity°¡ ¹ß»ýÇϱ⵵ ÇÑ´Ù. ÀÌ·¸°Ô ¼Õ»óµÇ¾ú´ø nerve°¡ ¼­¼­È÷ ȸº¹µÉ ¶§ incomplete regeneration of nerve½±â¿¡ inteniveÇÏ°í persistentÇÑ "burning pain"ÀÌ ¼Õ»ó¹ÞÀº nerveÀÇ distal cource ºÎ±Ù¿¡¼­ one point ¶Ç´Â ±× ÀÌ»óÀÇ ¿©·¯ºÎÀ§¿¡¼­ ´À²¸Áø´Ù. À̸¦ causalgia¶ó°í ÇÑ´Ù. median nerve¿¡¼­ ÀϹÝÀûÀ¸·Î causalgia°¡ ¹ß°ßµÈ´Ù. ¿ä¾àÇØ º¸¸é, nerve injury½ ƯÈ÷, gunshot wound½¿¡ ÀϾ ¼ö Àִ Ưº°ÇÑ ÇüÅÂÀÇ neuralgiaÀÌ´Ù. À̶§ ³ªÅ¸³ª´Â Áõ»óÀº Áö¼ÓÀûÀ̸ç, °íÅ뽺·± painÀÌ ¼Õ»ó¹ÞÀº nerve°¡ supplyÇÏ´Â ºÎÀ§¿¡¼­ ³ªÅ¸³ª¸ç vascular £¦ trophic disturbanceµµ ±× ºÎÀ§¿¡¼­ ³ªÅ¸³­´Ù. blood flow¿Í tissue nutrition ÀÇ impairment´Â sympathetic nervous systemÀÇ involvement¸¦ °¡¸®Å²´Ù. Àú¿¡°Ô MailÀ» º¸³»ÁÖ¼¼¿ä.

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