causalgia
Introduction
Introduction to burning neuralgia Causalgia refers to the main symptoms of severe burning pain in the area consistent with the extent of the innervation of the nerve after a clear nerve injury, manifested as pain allody (allodynia), hyperalgesia Sympathetic dysfunction, blood flow disorder, abnormal sweating, bone and muscle atrophy, and sometimes chronic refractory pain syndrome with edematous changes. Statistics from different countries show that the incidence varies from 1 to 38%. . basic knowledge The proportion of sickness: 0.0026% Susceptible people: no specific population Mode of infection: non-infectious Complications: peripheral nerve injury
Cause
Cause of burning neuralgia
There are many factors contributing to this disease, which are mainly divided into the following categories:
Ischemia factor (20%):
1 The nerve is in a scar bed. 2 nerve associated with large blood vessel damage. 3 nerves in their own microcirculation damage, severe crush injuries such as drug-induced nerve damage. Experiments have shown that ischemia can cause demyelination of myelinated fibers, exposed nerve fibers lose their insulating components, tissue metabolism chemicals such as acidic ions, catecholamines, etc., local scarring of the scars directly on the axons , causing burning neuralgia. The transport of axoplasmic pulp requires the supply of adenosine triphosphate. The mitochondria in the axon are the source of energy supply. It must be based on oxygen metabolism. Experiments have shown that if sodium or sodium cyanide is used for hypoxia, rapid transport of axoplasm will stop rapidly within 15 minutes. If the oxygen supply is insufficient, the conduction abnormality occurs. When aerobic, the normal sensory fiber conducts, the conduction time is fast, the positioning is accurate, the range is moderate, and when the oxygen is deficient, the normal sensory fiber is blocked and the oxygen demand is slow. Fiber conduction, the pain transmitted by slow fibers, long conduction time, blurred positioning, large range, nature such as burning pain.
Sympathetic factors (18%):
(1) Sympathetic nerve: Small fiber, unmyelinated fiber is more resistant to ischemia. (2) The sympathetic nerve endings release a large amount of serotonin. (3) The reticular nerve fibers eventually enter the central reticular structure (anti-pain structure) to inhibit the reticular structure. The clinical data support the theory of sympathetic factors: 1 (median, ruler, sciatic nerve) is the sympathetic nerve rich, 2 remove the sympathetic ganglia, can relieve symptoms, 3 distribution of burning neuroma and distribution of sympathetic nerve with blood vessels Consistent.
Cerebral cortex factors (10%):
(1) The incidence of war time is significantly higher than that of peacetime.
(2) The cerebral cortex produces excitatory foci for burning neuroma and is consistent with the neurological "re-education theory" in recent years.
Prevention
Burning neuralgia prevention
Burning neuralgia is a complication of peripheral nerve injury. Although it is not common in clinical practice, it still occurs from time to time and is quite difficult to handle. Therefore, it should be taken care of to prevent nerve damage. Patients with nerve damage should be treated actively. Another study found that treatment with psychotherapy can help improve the treatment of this disease, so actively comforting patients will also benefit the patient's recovery.
Complication
Combustible neuralgia complications Complications peripheral nerve injury
Burning neuralgia is a complication of peripheral nerve injury. The complications caused by this disease are rare. For some serious cases, it mainly causes patients to suffer from restlessness and mood fluctuations, resulting in pathological personality and special behavior. Attention has been paid to the research, and studies have shown that treatment with psychotherapy will be beneficial to the recovery of patients, and it is also beneficial to prevent these complications.
Symptom
Symptoms of burning neuralgia Common symptoms The pain in the lower part of the face begins with the eye, dilatation... Burning pain, forehead acupuncture pain or burning sensation
Pain starts at 2 weeks of nerve injury, and has a wide burning area and a long duration. In severe cases, it suffers from restlessness and mood, and mood swings, resulting in pathological personality and special behavior. The incidence: male to female ratio is 5:1, 20 to 40. More common in age (very few children), the most common sites are brachial plexus, sciatic nerve, median nerve, phrenic nerve, and finger nerve.
Examine
Examination of burning neuralgia
The examination of this disease is mainly for neurological examination. Some methods of auxiliary examination are introduced as follows:
1, EMG: can show the performance of peripheral nerve injury.
2, thermal imager: can detect skin changes.
3, bone X-ray photography: bone atrophy can be found.
Diagnosis
Diagnosis and diagnosis of burning neuralgia
diagnosis
The diagnosis of this disease needs to be considered from the following points:
1, the time after the injury lasts for several months, several years or more, daily for several hours or even no intermittent time.
2, the nature of the burning pain.
3. The range exceeds the dominating area of the injured nerve.
4, the degree of light affects the mood, the heavy ones are suffering, do not think about food and accommodation, can not stand.
5, the incidence of men and women is 5:1, more common in 20 to 40 years old (rare children), the most common sites are brachial plexus, sciatic nerve, median nerve, phrenic nerve, finger nerve.
Differential diagnosis
1. fistula syndrome: only the burning of the soles of the feet, the degree is light, does not spread to the proximal end of the limbs, the calf pain is only occasionally seen.
2. erythema extremity pain: both feet at the same time, mainly for severe burning pain in the extremities, with paroxysmal vasodilatation, redness, increased skin temperature, and no spread to the proximal end of the limb.
