In nine cases of IS and MS (patients 3, 5, 8, 10, 17, 18, 21,
22 and 26) we noted a dissociation of spreading symptoms,
J. Maleki et al. / Pain 88 (2000) 259±266 263
where parts of the CRPS-I/RSD symptom complex other
than pain (abnormal vasomotor or sudomotor function,
and/or difficulty with movement) were the first to be noted
in the new area. This phenomenon has been described
previously (Schwartzman, 1995). The variable presentation
of CRPS-I symptoms is well known (Stanton-Hicks et al.,
1995; Baron et al., 1996; Schwartzman, 1996), and it has
been suggested that some patients may present with all of
the symptoms except pain (Blumberg, 1988; Baron et al.,
1996). The significance of DS is unclear. In particular, it is
difficult to say whether or not the appearance of the other
symptoms first implies that they cause the pain. It does, of
course, suggest the opposite ± that pain need not be the only
cause of the associated symptoms.