Pain is the most common symptom of vascular disease. It has been estimated that 10 million Americans suffer from symptomatic vascular disease and will have pain at some time in the course of their illness. The mechanisms of ischemic pain are unclear, but several factors clearly are operative. The first is related to inadequate perfusion itself, with changes in pH and other metabolites that activate nociceptive nerves. The second is due to secondary changes of ischemia such as skin ulceration and gangrene that lead to tissue destruction. A third potential cause of pain is rapid change in the tone and diameter of blood vessels with activation of their intrinsic nerves. The most common types of vascular disease that lead to chronic pain are: arteriosclerosis obliterans (ASO), thromboangiitis obliterans (Buerger’s disease) (TAO), Raynaud’s disease, Raynaud’s phenomenon, and acrocyanosis. Other forms of vascular disease are not as likely to produce pain and will not be specifically discussed here.
KeywordsSpinal Cord Stimulation Intermittent Claudication Sympathetic Blockade Ischemic Pain Lumbar Sympathectomy
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