RT Book, Section
A1 Stanton-Hicks, Michael
A2 Warfield, Carol A.
A2 Bajwa, Zahid H.
SR Print(0)
ID 3416112
T1 Chapter 39. Complex Regional Pain Syndrome
T2 Principles & Practice of Pain Medicine, 2e
YR 2004
FD 2004
PB The McGraw-Hill Companies
PP New York, NY
SN 9780071443494
LK accessanesthesiology.mhmedical.com/content.aspx?aid=3416112
RD 2024/04/24
AB Ever  since  Claude  Bernard  implicated  the  sympathetic  nervous  system  in  sensation,  its  role  in  nociception  has  been  the  subject  of  debate.1  No  one  would  argue  with  the  fact  that  the  sympathetic  nervous  system  is  intimately  involved  with  the  preservation  of  homeostasis  and  noxious  challenges  in  humans,  although  the  manner  in  which  it  influences  the  sensation  of  pain  has,  until  recently,  escaped  explanation.2  Anatomically,  the  sympathetic  nervous  system  constitutes  a  highly  complex  arrangement  of  preganglionic  and  postganglionic  neurons  that  subserve  specific  and  diverse  functions  of  target  organs,  including  enteric  neurons,  smooth  muscle,  syncytial  muscle,  and  striated  muscle.3  Physiologically,  the  sympathetic  nervous  system  is  associated  in  some  way  with  both  systemic  and  specific  local  reactions,  which  are  expressed  by  supratentorial  and  confrontational  aspects  that  are  represented  in  the  periaquaductal  gray  matter  of  the  midbrain  (e.g.,  non-opioid  analgesia).4,5  In  contrast,  rest  and  quiescence  are  represented  in  the  ventrolateral  periaquaductal  gray  matter,  being  associated  with  endogenous  opioid  analgesia.