Vascular Pain

The origins of vascular pain are a complex area. Pain can come from three different areas:

1. Arterial pain such as arterial occlusive disease.
2. Dysfunction of the micro circulation such as that is found in diabetes
3. Venous pain

Arterial insufficiency and pain can be due to a variety of different causes.

• Arteriosclerosis and/or thrombosis can lead to a variety of different symptoms including intermittent claudication, non-healing skin ulcers, and ischemic rest pain.
• Arteritis such as thromboangiitis obliterans (Burgers disease) is an obstructive arterial disease caused be segmental inflammatory and proliferative lesions of the medium and small arteries and veins of the limbs. The symptoms are essentially the same as arteriosclerosis except the course is much more rapid and occurs in younger individuals. Smoking is often associated with this disease.
• Some other syndromes that can effect the arterial circulation are Takayasu's syndrome, Systemic giant cell arteritis.

Dysfunction of arterioles can lead to pain and loss of function. Examples of these include:

• Raynaud's phenomenon or disease is characterized be a sudden spasmodic constriction of the arterioles. A variety of causes can be attributed to Raynaud's disease. Raynaud's phenomenon is considered to have an indopathic origin.
• Erthromelalgia is a syndrome characterized by an extremity with red discoloration, increased temperature of the skin, deep and superficial burning pain and often accompanied by tingling and pricking symptoms with edema.

Treatment

A variety of therapies exist to treat vascular pain. These can include medications, angioplasty, or bypass surgery. The pain management center has a number of therapies available that can provide relief for vascular pain as well as potentially saving the patient's extremity even when other treatments have failed.

1. Sympathetic blockade through percutaneous techniques or by continuous infusion can improve circulation as well relive pain. In certain syndromes such as Erthromelalgia sympathetic blockade can prove curative.
2. Sympathectomy can be done through percutaneous techniques in the upper or lower extremity. This procedure is effective in situations where temporary sympathetic blockade has proven useful.
3. Spinal cord stimulation (SCS). Through mechanisms not completely understood SCS is able to improve circulation in extremities, even in situations where medications, bypass or sympathectomies have not been helpful. SCS been shown in studies to be able to salvage limbs in addition to reliving pain. The SCS electrode is placed in the patient's epidural space at the dermatomal level of the patient's pain. A trial is performed prior to implantation to prove efficacy. The implantation of SCS can be easily done under local anesthesia. For more information, please see the section on interventional therapies.
4. Preemptive analgesia has been proposed recently to help reduce the incidence of phantom limb pain in patients who require amputation because of vascular insufficiency. In order for this to be effective, preemptive analgesia should be instituted as soon as the patient exhibits significant amounts of vascular pain. Pain relief can be obtain by a variety of techniques, depending on coexistent medical problems that the patient my have.