An article in this issue1 describes several patients in whom causalgia developed following surgery, intramuscular injections, or venipuncture. Horowitz has emphasized the legal implications of these neural injuries, and it requires no great leap of imagination to envision the outcome of a lawsuit asserting iatrogenic causalgia. It may be easy to show that the injury should not have occurred, and the potential is great for a large monetary recovery. Causalgia is a source of profound suffering and, as Horowitz has shown, may be incapacitating or may even evoke suicidal behavior. Fortunately for patients and physicians, iatrogenic neuropathies infrequently have such devastating effects. But the article is a cautionary tale.
In a lawsuit alleging iatrogenic causalgia, a claimant must prove by medical testimony that the nerve injury was caused by negligent conduct. This means that a knowledgeable physician must express an opinion that the defendant failed to observe reasonable
Beresford HR. Iatrogenic CausalgiaLegal Implications. Arch Neurol. 1984;41(8):819–820. doi:10.1001/archneur.1984.04050190025007