For several years it was a part of my job as Medical Examiner for the Oregon State Industrial Accident Commission to examine injured workmen whose cases presented specific problems relating to treatment or disability rating. Among these cases there were a considerable number of finger amputations. The symptoms elicited from the men who were most dissatisfied with the prescribed “permanent partial disability ratings” based on purely anatomic considerations, were almost always the same. Over and over I heard this combination of complaints: “The stump pains all the time; it is always cold; and I can hardly bear to let anything touch it.” The superficial hyperesthesia was readily demonstrable, and in many cases the impairment of circulation was equally obvious. The stump and often the whole hand might be colder and more cyanotic than the normal hand, and exposure to cold brought out the difference even more clearly. The pain was most commonly described as an ache, sometimes as a “burning” and it became worse when the hand was cold or when exposed to heat. In the worst of these cases the combination of burning pain, vasomotor and sudomotor disturbances and the dusky-red, shiny and smooth, thin skin of the stump and neighboring parts, was strongly suggestive of the principal features of causalgia.
KeywordsHerpes Zoster Trigeminal Neuralgia Pain Mechanism Burning Pain Morphine Sulphate
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