Original communication Society for Vascular Surgery| Volume 24, ISSUE 3, P485-504, September 1948


III. A general discussion
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      I have reviewed the early and recent contributions to the problem of causalgia and have attempted to discuss the signs and symptoms, the vasomotor status, the treatment, and the mechanism of pain. Much of the broad experience with this disorder was obtained only recently as a consequence of World War II. Though every effort was made to segregate such cases in special centers where the best opportunity existed for their careful evaluation and treatment, it is nevertheless true that the enormous volume of work, the limited personnel, and the lack of availability of certain apparatus precluded particular studies which in retrospect would have been informative. It is unlikely that an opportunity will again present itself for study of such large groups of cases. It is entirely possible, however, that intensive study of fewer cases may settle some of the remaining problems.
      It would seem important to study the vasomotor responses in each patient by every available method, including digital plethysmography and venous occlusion plethysmographic blood flow methods whenever possible. It will be profitable to pursue further the reaction of patients to alterations in the state of vascular tonus induced by various methods, and to study the effect of a variety of drugs affecting autonomic function, including such agents as tetraethylammonium chloride. It will be important to correlate better the time of onset of vasodilatation and of pain relief following sympathetic block, and to evaluate carefully any persistence of pain during spinal anesthesia. Particular study must be made of cases of incomplete relief of pain after sympathectomy. The so-called atypical causalgias require further clarification. Finally, it is hoped that more animal experimentation may throw new light upon the problem of the nerve pathways and the mechanism of pain. Better understanding of the fudamental problems connected with major causalgia may be of aid in understanding more clearly the other allied painful states.
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