[Peripheral vascular pain].

Abstract

Peripheral vascular pain consists of complex factors, and may be divided into three types, i.e., arterial pain, microvessel pain and venous pain. Among these, arterial pain requires intensive pain control because of severe ischemic pain due to arterial obstruction. Under ischemic condition, adenosine is generated, and activates unmyelinated afferents to produce pain. In addition to adenosine, acidic pH itself produces pain and sensitization to mechanical stimuli. Moreover bradykinin generated by kallikurein in acidic pH can produce pain. Nerve block is indicated to improve tissue circulation and to relieve pain. Endoscopic thoracic sympathectomy is indicated for upper extremities, and high frequency thermocoagulation is applied for lumbar sympathectomy. Spinal cord stimulation and the gene therapy with vascular endothelial growth factor have also been reported effective.