The precise causes of algodystrophy remain a question mark. According to some doctors, the origin of the condition in question would be a simultaneous malfunction of several systems of the human body, including the nervous system, the immune system and the circulatory system.
Generally, events such as a bone fracture, cut, burn, or severe joint sprain / distraction precede the onset of algodystrophy.
In addition to pain, algodystrophy can also cause changes in the appearance of the skin, hair and / or nails, strange sensations in the affected limb, tremors, joint stiffness, joint swelling, etc.
In severe cases, algodystrophy can seriously compromise the patient's quality of life.
Currently, there is no specific cure for algodystrophy, only a series of symptomatic treatments.
complex regional pain, is a chronic condition characterized by the presence of extreme pain in a limb or parts of an upper or lower limb.
Arms, legs, hands and feet are by far the anatomical regions of the human body most affected by "algodystrophy.
The idea for which these systems would be involved arises from the observation that, in subjects with algodystrophy, the functions controlled by the aforementioned systems are altered; for example, among the impaired functions c "is the transmission and perception of painful sensation, which is under the careful control of the central and peripheral nervous systems.
Causes of Algodystrophy: What Are They?
Researching the causes of algodystrophy, doctors and experts have found that, very often (more than 90% of cases), the condition appears after traumatic events or injuries such as:
- Bone fractures, especially those involving the wrist;
- Cuts;
- Joint sprains or distractions;
- Surgery (triggers could be surgical incisions, sutures or even scars following a "surgery);
- Prolonged immobilization of a limb (eg due to a "cast).
In less than 10% of cases, it is not possible to identify an "association" between algodystrophy and one of the aforementioned conditions of a traumatic nature; in such circumstances, there is a suspicion that the algodystrophy depends on the irritation of some nerve, thrombotic phenomena or even, in some cases, neoplasms or infections.
Types of Algodystrophy
Experts recognize two forms of algodystrophy: type 1 algodystrophy (also called reflex sympathetic dystrophy or Sudeck's atrophy) and type 2 algodystrophy (also known as causalgia).
Type 1 are all forms of algodystrophy for which there is no evidence of direct damage to the nervous structures; on the other hand, all forms of algodystrophy are type 2 for which the presence of direct damage to the nervous structures is evident.
Algodystrophy and Genetics
In the past, some doctors had advanced the hypothesis that genetic factors also affected the onset of algodystrophy.
However, the researchers who went to great lengths to prove the aforementioned hypothesis in the following years failed, finding no connection between algodystrophy and genetics.
Algodystrophy and Psychology: is there a connection?
Also in the past, some pathologists considered algodystrophy and the pain it caused a psychological disorder.
Today, the aforementioned theory is no longer taken into consideration.
In medicine, these two terms indicate exaggerated responses to pain-causing stimuli.
Specifically, we talk about allodynia when an individual feels pain even after mild stimuli and which, in conditions of normalcy and good health, would be completely harmless.
Instead, the word "hyperalgesia" is used to indicate all those situations, in which there is "a" hypersensitivity to painful stimuli.
Other Symptoms of Algodystrophy
In addition to chronic pain, algodystrophy can cause:
- The strange sensation that the painful limb or part of the limb does not belong to the rest of the body;
- The strange sensation that the painful limb (or part of it) seems larger or smaller than the non-painful contralateral limb;
- Changes in the appearance of the skin, where the patient complains of pain. The painful region may become red, hot and dry or cold, blue and sweat;
- Changes in the hair and nails (nails on the affected limb) Hair and nails may grow slower or faster than normal;
- Joint stiffness and swelling. The affected joints are those belonging to the painful limb;
- Tremors and muscle spasms (dystonia);
- Difficulty moving the painful limb;
- Insomnia;
- Bone fragility (osteoporosis) in the painful limb.
Algodystrophy: Complications
Physical Complications
In rare circumstances, algodystrophy can lead to complications of a physical nature, such as muscle wasting, skin infections, skin ulcers and muscle contractures.
Those who suffer from these complications have considerable difficulty moving around and leading a normal life.
Psychological Complications
In people with algodystrophy, the presence of chronic, continuous and severe pain is often responsible for psychological problems, including depression and anxiety.
When to contact the doctor?
A valid cause for concern and for which it is advisable to consult your doctor is the presence of persistent pain, which prevents the carrying out of the simplest daily activities.
, in order to thoroughly evaluate the symptomatological picture.Continuous and persistent pain is a symptom whose presence is fundamental, but it is not the only important clinical manifestation of algodystrophy.
The use of diagnostic tests to rule out possible underlying conditions (eg blood tests to rule out the presence of infections) is a particular approach, which takes the specific name of differential diagnosis.
To diagnose a condition such as algodystrophy, proceeding by exclusion is probably the most adopted and most effective strategy.
The purpose of physical therapy is to allow the patient to carry out normal daily activities without experiencing pain.
For physical therapy to be truly effective, doctors recommend that you go to a physiotherapy expert in the field of algodystrophy.
Algodystrophy and Drugs
Medicines that doctors may prescribe for algodystrophy include:
- Non-steroidal anti-inflammatory drugs, also called NSAIDs. They are medicines which, by acting against inflammation, reduce pain.
Examples of NSAIDs are aspirin, ibuprofen and naproxen. - Corticosteroids. They are powerful anti-inflammatories, whose prolonged use can have serious side effects (eg: osteoporosis, diabetes, cataractod obesity).
Common corticosteroids prescribed for algodystrophy are prednisolone and methylprednisolone. - Anticonvulsants. These drugs are specifically indicated for the treatment of epilepsy.
The most commonly given anticonvulsants for algodystrophy are gabapentin and pregabalin. - Tricyclic antidepressants. They are medicines specifically indicated for the treatment of depression.
In the case of algodystrophy, amitriptyline and nortriptyline appear to have an effect. - Bisphosphonates. They are drugs used classically in the management of the most severe forms of osteoporosis.
In the presence of algodystrophy, one of the most used bisphosphonates is alendronate.
It should be noted that some studies suggest that ketamine (a powerful anesthetic) and opioids (morphine, oxycontin, hydrocodone, fentanyl) may have positive effects on the symptoms of algodystrophy. However, since these are medicines with important side effects, the medical community it is somewhat reluctant to use.
Algodystrophy and Psychotherapy
Doctors recommend psychological therapy (or psychotherapy) to all those subjects who, as a result of algodystrophy, have developed psychological problems, including depression, anxiety, post-traumatic stress disorder, etc.
One type of psychotherapy that is found to be of benefit among patients with algodystrophy and psychological problems is the so-called cognitive-behavioral therapy.
Other Treatments for Algodystrophy
Less common forms of symptomatic treatment of algodystrophy are:
Sympathetic nerve block (or sympathetic nervous system block)
It involves the injection, near the spinal cord, of an anesthetic capable of blocking the activity of one or more nerves of the sympathetic nervous system.
With the aim of reducing the intensity of painful sensation, sympathetic nerve block produces temporary analgesic effects, in fact it is not effective in the long term.
Sympathectomy
It is the surgical removal of one or more structures making up the sympathetic nervous system. In theory, its execution should lead to a reduction in pain intensity; in reality, it is useful to some patients, while for others it is counterproductive.
Spinal cord stimulation
It involves the installation of some stimulating electrodes on the spinal column, in the extreme vicinity of the spinal cord, and the use of a device capable of activating the aforesaid electrodes.
Thanks to the activation of the electrodes present on the spine, the stimulation of the spinal cord should modify the painful sensation, making it less intense.
Intrathecal pumps
They are medical devices used to administer small amounts of analgesic or anesthetic drugs into the cerebrospinal fluid.
The purpose of intrathecal pumps is to reduce the intensity of the painful sensation.
Expert Advice on How to Check Algodystrophy
According to doctors, to better control algodystrophy it would be advisable to:
- Find out about the characteristics of the condition, in order to understand it better;
- Keep active with the painful limb, then avoid immobility;
- Learn some pain control techniques
- Learn some relaxation techniques, to improve the quality of life;
- Try your hand at physiotherapy treatments even at home. Performing them only in specialized centers has limited benefits;
- Attend support groups for people with algodystrophy or similar disorders.
