Pain in Orthopedics

The pain in most post-traumatic injuries is nociceptive, but it must be remembered that after trauma (wounds, contusions, sprains, fractures or dislocations) there may also be neurological involvement and neuropathic pain.

That is why it is important that in the case of a post-traumatic injury, the physician must clearly distinguish whether the painful picture corresponds to a neuropathic pain or an inflammatory or nonceptive pain, due to the fact that both clinical pictures have a different therapeutic management.

According to Kehlet, the criteria for the definitive diagnosis of post-traumatic neuropathic injury are:

• Neuro-anatomically distributed pain.
• History of nervous system injury temporarily related to the development of pain.
• Complete or partial loss of sensation in the area of the lesion.
• Confirmation of injury by specific test.

The treatment of post-traumatic neuropathic pain of nociceptive and neuropathic type follows the guidelines described above and is fundamentally pharmacological, but there are some other options such as nerve blocks, invasive procedures, neurosurgical techniques, non-invasive physical therapy and psychological support.

One of the clinical pictures of difficult treatment after a traumatic injury in the locomotor system is the so-called "Complex regional pain syndrome". This clinical picture has been divided into two types: Type I or also called Reflex Sympathetic Dystrophy and Type II or called Causalgia which is caused by a demonstrable injury to a peripheral nerve.

Type I or Sympathetic Dystrophy Reflex, is a pathology whose causes are not yet fully understood and that can have serious consequences for people who suffer them, its diagnosis is usually late and there is a history of traumatic injury that may be in some cases a major injury such as a fracture or a minor injury such as a sprain, but as a common denominator, is a sensation of "burning or burning type of pain" followed by trophic disorders in the skin and intense sensitivity and pain to the minimum friction known as "allodynia".

It has been postulated that there is an abnormal activation of the sympathetic system, where substances are produced that activate the nociceptors and perpetuate pain while producing permanent vasomotor disorders.

In 1994, the International Association for the Study of Pain brought together several definitions and called it the "Complex Regional Pain Syndrome".

In the locomotor system, the Complex Regional Syndrome type I or "Reflex Sympathetic Dystrophy" is seen more frequently in young people, one of the main characteristics is that the symptoms are disproportionate to the intensity of the trauma and that the pain radiates to distal areas, not always contiguous, without a pattern or an area of innervation of a dermatoma, being many times a dissemination in "mirror" in the healthy contralateral extremity and even pictures have been documented in which they appear without a clear antecedent of precipitating traumatism.

If you need recommendations or help in orthopedic surgery and traumatology do not hesitate to contact me.