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June 13, 1980

Pain Following Laceration

Author Affiliations

University of Washington School of Medicine Seattle

JAMA. 1980;243(22):2286. doi:10.1001/jama.1980.03300480012007

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To the Editor.—  We would like further clarification of the discussion of "Reflex Sympathetic Dystrophy and Causalgia" (242:1790, 1979). There are problems in satisfactorily interpreting the data in this interesting case presentation as well as in understanding the labeling of the question and answer discussion.The patient described apparently had a laceration and later had persistent burning, pain, and discomfort in a median nerve distribution. One wonders why this case is being labeled reflex sympathetic dystrophy at all rather than being called just causalgia. There is no evidence in the presentation that the patient had reflex sympathetic dystrophy.There are difficulties accepting the electrodiagnosis data presented. It is stated that in June 1979, "the amplitude of the evoked potential was 2 μV," and the implication is that this figure refers to the compound muscle action potential. Such a small response, if obtained using surface electrodes, may well be indicative of