Rest Pain

Ischaemic neuropathy

Ominous sign  indicating severe arterial occlusion. Always have intermittent claudication and other signs of occlusive PVD.
ABI generally <0.3 Initially occurs at rest – appear as paraesthesia, burning, prickling, tingling, coldness, numbness – all associated with severe pain that travels down the limb. Can get relief by sitting up in bed with legs dangling over edge or walking around room  recur when lie down. Eventually only way to sleep may be sitting in chair with feet on ground  dependency oedema. Pain due to insufficient oxygen requirements to meet the tissue metabolic needs at rest.Pain occurs on lying down as the hydrostatic mechanism that exists on sitting and standing drives blood into diseased tissues  loose this when lying.Differential diagnosis: • Peripheral neuropathy • Restless legs syndrome • Musculoskeletal/biomechanical/rheumatological

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