Bilateral burning foot pain: Monitoring of pain, sensation, and autonomic function during successful treatment with sympathetic blockade

Bradley S. Galer, Richard B. Lipton, Ronald Kaplan, Jerry G. Kaplan, Joseph Arezzo, Russell K. Portenoy

Research output: Contribution to journalArticle

9 Scopus citations

Abstract

We describe a patient with burning pain in both feet associated with local autonomic disturbances following bilateral traumatic sciatic mononeuropathies. The diagnosis of a sympathetically maintained pain was confirmed through a prompt response to sympathetic blockade. Although a mild alcohol-nutritional neuropathy was found, the clinical findings strongly suggested a diagnosis of bilateral causalgia. Clinical evaluation and quantitative sensory testing were performed prior to and after successive unilateral lumbar sympathetic nerve blocks. After unilateral blockade, bilateral improvement was recorded in measures of pain, sudomotor function, and foot temperature. Other measures of autonomic function showed variable responses to sympathetic blockade. Quantitative sensory testing revealed a dramatic alteration in the contralateral limb's thermal sense following unilateral block. This case underscores the potential for bilateral causalgia and provides additional evidence for a central mechanism operating in this disorder. The relationship between bilateral causalgia and the "burning feet syndrome" in alcoholic neuropathy is discussed.

Original languageEnglish (US)
Pages (from-to)92-97
Number of pages6
JournalJournal of Pain and Symptom Management
Volume6
Issue number2
DOIs
StatePublished - Feb 1991

Keywords

  • Causalgia
  • burning feet syndrome
  • quantitative sensory testing
  • reflex sympathetic dystrophy
  • sympathetically maintained pain

ASJC Scopus subject areas

  • Nursing(all)
  • Clinical Neurology
  • Anesthesiology and Pain Medicine

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