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orders such as polycythemia vera and with collagen vascular diseases, including thrombotic thrombocytopenic purpura (TTP), during the use of calcium channel blockers and certain dopaminergic agonists such as pergolide and bromocriptine, and with occlusive vascular diseases Some instances arise as a result of a painful polyneuropathy (more often in these latter conditions, the redness and warmth are constant and the result of damage to sympathetic nerve bers; see Chap 46) Treatment According to Abbott and Mitts and others, aspirin is useful in the treatment of paroxysms of secondary erythromelalgia and of some primary cases as well; others recommend methysergide maleate (Pepper) Even small doses of aspirin provide relief within an hour, lasting for several days, a feature that is diagnostic Reynolds and colleagues report that cyclosporine was of great bene t in a case of familial erythromelalgia that had not responded to other medications A similar condition, restricted in topography to the region of an acquired nerve or skin injury, has been described by Ochoa under the term ABC syndrome (angry, back ring C-nociceptors) Episodes of pain and cutaneous vasodilation were induced by mechanical or thermal stimulation and relieved by cooling There may be persistent hyperalgesia over the affected area Lance has suggested that a similar mechanism is operative in the red ear syndrome as a result of irritation of the third cervical root
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We have seen several patients with a similar bilateral hand pain but with only minor changes in color and temperature; cooling eliminated the symptoms temporarily but no cause could be assigned
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Myofascial Pain Syndrome (Fibromyalgia) A confusing problem in the differential diagnosis of neck and limb pain is posed by the patient with pains that are clearly musculoskeletal in origin but are not attributable to any of the aforementioned diseases of the spine, articular structures, or nerves The pain is localized to certain points in skeletal muscles, particularly the large muscles of the neck and shoulder girdle, arms, and thighs Ill-de ned, tender nodules or cords can be felt in the muscle tissue (page 1281) Excision of such nodules reveals no sign of in ammation or other disease process The currently fashionable terms myofascial pain syndrome, bromyalgia, and brositis have been attached to the syndrome, depending on the particular interest or personal bias of the physician Many of the patients are tense, sedentary women, and there is a strong association with the equally vague chronic fatigue syndrome (page 435) Some relief is afforded by procaine injections, administration of local vapocoolants, stretching of underlying muscles ( spray and stretch ), massage, etc, but the results in any given individual are unpredictable
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ABBOT KH, MITTS MG: Re ex neurovascular syndromes, in Vinken PJ, Bruyn GW (eds) Handbook of Clinical Neurology, vol 8 Amsterdam, North-Holland, 1970, chap 20, pp 321 356 ALEXANDER E JR, KELLY DL, DAVIS CH JR, et al: Intact arch spondylolisthesis: A review of 50 cases and description of surgical treatment J Neurosurg 63:840, 1985 CARETTE S, LECLAIRE R, MARCOUX S, et al: Epidural corticosteroid injections for sciatica due to herniated nucleus pulposus N Engl J Med 336:1634, 1997 CARETTE S, MARCOUX S, TRUCHON R, et al: A controlled trial of corticosteroid injections into facet joints for chronic low back pain N Engl J Med 325:1002, 1991 CHERKIN DC, DEVO RA, BATTIE M: A comparison of physical therapy, chiropractic manipulation, and provision of an educational booklet for the treatment of patients with low back pain N Engl J Med 339:1021, 1998 COLLIER B: Treatment for lumbar sciatic pain in posterior articular lumbar joint syndrome Anesthesia 34:202, 1979 COPPES MH, MARANI E, THOMEER RTWM: Innervation of annulus brosus in low back pain Lancet 1:189, 1990 CUCKLER JM, BERNINI PA, WIESEL SW, et al: The use of epidural steroids in the treatment of lumbar radicular pain J Bone Joint Surg 67:63, 1985 EPSTEIN NE, EPSTEIN JA, CARRAS R, HYMAN RA: Far lateral lumbar disc herniations and associated structural abnormalities: An evaluation in 60 patients of the comparative value of CT, MRI and myelo-CT in diagnosis and management Spine 15:534, 1990 EVANS BA, STEVENS JC, DYCK PJ: Lumbosacral plexus neuropathy Neurology 31:1327, 1981 FINNESON BE: Low Back Pain, 2nd ed Philadelphia, Lippincott, 1981 FRIIS ML, BULLIKSEN GC, RASMUSSEN P: Distribution of pain with nerve root compression Acta Neurosurg 39:241, 1977 HADLER NM, CURTIS P, GILLINGS DB: A bene t of spinal manipulation as adjunctive therapy for acute low-back pain: A strati ed controlled trial Spine 12:703, 1987 HAGEN KD, HILDE G, JAMTVELDT G, WINNEM MF: The Cochrane review of bed rest for acute low back pain Spine 25:2932, 2000 HASSLER O: The human intervertebral disc: A micro-angiographical study on its vascular supply at various ages Acta Orthop Scand 40:765, 1970 HUDGKINS WR: The crossed straight leg raising sign (of Fajerstagn) N Engl J Med 297:1127, 1977 JENSEN MC, BRANT-ZAWADZKI MN, OBUCHOWSKI N, et al: Magnetic resonance imaging of the lumbar spine in people without back pain N Engl J Med 331:69, 1994 KELLGREN JH: On the distribution of pain arising from deep somatic structures with charts of segmental pain areas Clin Sci 4:35, 1939 KELSEY JL, WHITE AA: Epidemiology and impact of low back pain Spine 5:133, 1980 KRISTOFF FV, ODOM GL: Ruptured intervertebral disc in the cervical region Arch Surg 54:287, 1947 LANCE JW: The red ear syndrome Neurology 47:617,1996 LAROCCA H: Acceleration injuries of the neck Clin Neurosurg 25:209, 1978 LAYZER RB: Hot feet: Erythromelalgia and related disorders J Child Neurol 16:199, 2001 LEFFERT RD: Thoracic outlet syndrome, in Omer G, Springer M (eds): Management of Peripheral Nerve Injuries Philadelphia, Saunders, 1980 LEYSHON A, KIRWAN E O G, PARRY CB: Electrical studies in the diagnosis of compression of the lumbar root J Bone Joint Surg 63B:71, 1981 LILIUS G, LAASONEN EM, MYLLYNEN P, et al: Lumbar facet joint syndrome: A randomized clinical trial J Bone Joint Surg (Br) 71:681, 1989 LONG DM: Low-back pain, in Johnson RT, Grif n JW (eds): Current Therapy in Neurologic Disease, 5th ed St Louis, Mosby, 1997, pp 71 76 LORD SM, BARNSLEY L, WALLIS BJ, et al: Percutaneous radio-frequency neurotomy for chronic cervical zygoapophyseal joint pain N Engl J Med 335:1721, 1996
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