KUENKEL V H
Calif Med. 1952 Dec;77(6):374-6.
Gross and microscopic anatomical evidence indicates that pain fibers involved in causalgia are those distributed to blood vessels-possibly to the arterioles-and that, for the greater part, these fibers constitute part of the general visceral afferent system. Several investigators have reported evidence that injury to a peripheral nerve of such a type as to cause damage to the vasomotor control of any area produces the initial pain in an extremity, and it is predicated that the arteriolar constriction causing the pain is then prolonged by the sensitization of arteriolar smooth muscle to the amount of epinephrine normally in the blood. If the condition is not treated, tissue anoxia occurs to such an extent that irreversible changes take place in the affected area.Treatment of causalgia in the lower extremities is directed toward interruption of either the vasomotor or afferent supply of blood vessels by blocking or excision of the second to fourth lumbar ganglia inclusive with the intervening chains. For the upper extremities, the blocking or disconnection of the second and third thoracic ganglia with interruption of the sympathetic chain between the third and fourth ganglia is considered a feasible method of treatment which does not produce the concomitant disability of Horner's syndrome.
大体和微观解剖学证据表明，与灼性神经痛相关的痛觉纤维是那些分布至血管（可能是小动脉）的纤维，并且在很大程度上，这些纤维构成了一般内脏传入系统的一部分。几位研究者报告了这样的证据：对某一类型的外周神经造成损伤，从而导致对任何区域的血管运动控制受损，会在肢体产生初始疼痛，并且据推测，导致疼痛的小动脉收缩随后会因小动脉平滑肌对血液中正常量肾上腺素的敏感化而延长。如果这种情况得不到治疗，组织缺氧会发展到如此程度，以至于在受影响区域发生不可逆的变化。下肢灼性神经痛的治疗旨在通过阻断或切除第二至第四腰神经节（包括其间的神经链）来中断血管运动或血管的传入供应。对于上肢，阻断第二和第三胸神经节并中断第三和第四神经节之间的交感神经链被认为是一种可行的治疗方法，该方法不会产生伴随的霍纳综合征残疾。
