Ischemic pain

Abstract

Ischemic pain is caused by tissue hypoxia and acidosis. Many conditions are implicated in the development of severe chronic ischemic pain. Among the most common ischemic pain conditions are peripheral arterial insufficiency and chronic bowel ischemia from vascular insufficiency, which result in mesenteric ischemia or celiac artery compression. Opioids have limited efficacy for the pain of critical limb ischemia because of their side effects. Besides vascularization, lumbar sympathetic blocks and neurolysis, regional anesthesia, and spinal cord stimulation can offer pain relief to patients with advanced peripheral arterial disease and chronic pain. Postprandial pain associated with mesenteric ischemia or decreased flow from fibrous bands compressing the celiac artery may respond to celiac ganglionectomy with local anesthetic or surgical manipulation; spinal cord stimulation may lessen pain in patients with ischemia in the mesenteric arterial bed.