Make Pain a Thing of the Past – Causalgia – Physician Partners of America

Tag Archive for: Causalgia

Doctors have known for years that topical pain medications – those applied to the skin – are effective for some pain patients. Recently, however, they were surprised to learn that those creams, patches and ointments are more helpful than previously thought.

In fact, half of patients taking oral opioids stopped them after trying topicals, a recent study shows. Another 30 percent were able to quit using all types of pain medications and switch to topical analgesics.

The study, published in Clinical Focus: Pain Management Fast Track, surprised even its authors. “As a clinician active in the pain world, I have seen it [discontinuation of opioids] but certainly not at this magnitude,” study leader Jeffrey Grudin, M.D., told Practical Pain Management. Grudin is director of pain management and palliative care at Englewood Hospital and Medical Center in New Jersey.

About the Topical Pain Medications Used

The study followed 121 chronic pain patients. After treatment with topical analgesics, 49 percent of those followed after three months and 56 percent of those followed up at six months said they had stopped using opioids altogether.

Another 31 percent followed up at three months, and 30 percent reporting at six months, said they were not taking any more pain medications. This included nonsteroidal anti-inflammatory drugs (NSAIDS), which target the inflammation   that causes most neck and back pain.

The patients who took part in the study suffered moderate symptoms of neuropathy, arthritis, radiculopathy, myofascial musculoskeletal or tendonitis pain.

The Most Effective Topical Pain Medications

The topical analgesics used in the study included diclofenac, ketoprofen and flubiprofen. Other topical pain medications readily available through pharmacies are also shown to be effective. They include baclofen, ketamine (3-5%) and lidocaine (7-8%).

More Research Needed

It is clear that more research needs to be done. The study was small, and 67 of 121 study participants dropped out before the six month follow-up. Still, the study shows this is one opioid alternative that holds promise for people suffering from chronic pain.

“Topical analgesics are effective for a variety of types of pain,” Dr. Grudin, the study leader told Practical Pain Management. “Our study supports the fact that we can eliminate opioid use in a certain percentage of patients with chronic pain conditions.”


Host: Sometimes when your pain is caused by a rare syndrome, it can be hard to get a correct diagnosis. But when it’s connected to the central nervous system that is linked to your brain and spinal cord, it’s important to get that diagnosis as quickly as possible.

Dr. Rudy Gari from the Florida Pain Relief Group joins us now to talk about one of these rare syndromes. Dr Gari, good to have you back.

Dr. Gari: Thank you.

Host: There’s something called causalgia?

Dr. Gari: Yes.

Host: What in the world is that?

Dr. Gari: So causalgia is another name for the same syndrome. It’s also called reflex sympathetic dystrophy. It’s also called complex regional pain syndrome.



Host: All right.

Dr. Gari: And we’ve actually talked about complex regional complex pain syndrome before, and this is along the same lines. And it basically has to do with the fact that you have a short circuit of your nervous system where the pain doesn’t go away. So the way that I explain this to my patients is just imagine if you touch your finger on a stove, you get the little shock that goes from your finger to your brain, and then it stops. It just tells you, “It hurts, you’re about to burn your finger, you know, take it away.”

What happens with causalgia or complex regional pain syndrome, RSD, reflex sympathetic dystrophy, the same thing, is that it goes to your brain, but instead of stopping there, it actually turns into a loop. So it goes from your finger to your spinal cord, back to your finger, back to your spinal cord and it doesn’t end. So it’s like constant, constant…the pain doesn’t go away.

A lot of these patients, what happens is, even if you were to like breathe or just a slight touch to the skin, it’s extremely painful. It’s called hyperalgesia, which means just an extreme painful syndrome just by touching skin.

Host: Who is a typical patient that would suffer from causalgia?

Dr. Gari: Typical patient could be either a male or female. I’ve seen that also happen as young as 12 years old.

Host: Really?

Dr. Gari: And it’s just basically…the analogy is like a little bit like a seizure that goes from the spinal cord to your fingers or your feet or so forth and it doesn’t go away. The treatment for that is to stop that cycle.

Host: Well, yeah, obviously we wanna stop that cycle as quickly as possible, because what a horrible way to live. What kind of treatments are available for something like that?

Dr. Gari: Sure. So what happens with causalgia is that the pain travels via these nerves called sympathetic nerves. They’re tiny little nerves. And the pain just keeps going over and over again. So the way you stop it is to do something that’s called a sympathetic block.

Host: Okay.

Dr. Gari: So if it’s in your legs, we do what’s called a lumbar sympathetic block. If it’s in your arm we do something called a stellate ganglion block. And it blocks those fibers and it causes it to stop. So you kind of like stop the seizure.

Host: How do you do that? Do you go in and inject something into the nerve?

Dr. Gari: It’s an injection. Yes, it’s an injection. So these nerves travel down your spinal cord. So if it’s the arm, the bundle of nerves for that is right here in your neck. It’s a tiny, little needle that we go on and put an injection there, we put the local anesthetic to stop that. If it’s in your legs, it goes from your back on the side of the spinal cord, we put in a spinal [inaudible 00:03:12] local anesthetic that gets it to stop. A simple procedure to us because we’ve done so many of them. It’s done using fluoroscopy x-ray to make sure we have the needle in the right place. Patient goes in and goes out the same day.

Host: Oh my gosh, it must be so life-changing for people who are suffering.

Dr. Gari: It’s actually one of the syndromes that is curable.

Host: Oh, isn’t that great?

Dr. Gari: So our specialty is often called pain management because unfortunately, a lot of pain that we have is not curable. But causalgia, when it’s treated early, you can cure that.

Host: Good news for a lot of people. Dr. Gari, thank you very much. You can visit their website. It is, and schedule your same-day appointment. Or give them a call, 844-KICK-PAIN. You don’t have to live with pain. We’ll be right back so don’t go away.