Post-sympathectomy neuralgia:

Copyright © 1996 Published by Elsevier Science B.V.

Clinical review

Post-sympathectomy neuralgia: hypotheses on peripheral and central neuronal mechanisms

Ronald C. Kramis^a, , William J. Roberts^{b, a} and Richard G. Gillette^c

^a Legacy / Good Samaritan Hospital, Portland, OR 97209, USA

^b R. S. Dow Neurological Sciences Institute, Portland, OR 97209, USA

^c Western States Chiropractic College, Portland, OR 97209, USA

Received 2 February 1995.

Available online 2 March 1999.

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Post-sympathectomy neuralgia is proposed here to be a complex neuropathic and central deafferentation/reafferentation syndrome dependent on: (a) the transection, during sympathectomy, of paraspinal somatic and visceral afferent axons within the sympathetic trunk; (b) the subsequent cell death of many of the axotomized afferent neurons, resulting in central deafferentation; and (c) the persistent sensitization of spinal nociceptive neurons by painful conditions present prior to sympathectomy. Viscerosomatic convergence, collateral sprouting of afferents, and mechanisms associated with sympathetically maintained pain are all proposed to be important to the development of the syndrome.