Rest Pain

Rest pain is persistent pain caused by nerve ischemia leading to ischaemic neuropathy, and usually indicates two hemodynamically significant arterial blocks in series (Bowker, 2001). Rest pain has peaks in intensity, is aggravated by heat, elevation and exercise and decreases with dependency. The pain associated with ischaemic neuropathy is generally described as sharp, shooting, but poorly localised. The pain radiates throughout the extremity but follows no distinct nerve root and commonly presents as a tearing, pulling, or agonizing discomfort often with burning, throbbing, and tingling similar to that of reflex sympathetic dystrophy (Nelson, 1992).

During sleep the circulation is essentially of the core variety, the blood being shunted away from the periphery resulting in decreased arterial perfusion. With severe atherosclerosis, resistance in the atherosclerotic vessels in the lower extremity is extremely high; sleeping in the supine position eliminates gravity’s contribution to peripheral perfusion. In combination these two factors cause a build up of noxious metabolites in the muscles of the extremity and reduced blood supply to the peripheral nerves. The ensuing ischaemic neuritis/myalgia becomes intense and disrupts sleep patterns. Relief is invariably obtained by dangling the feet over the side of the bed or taking a couple of short steps. The increased cardiac output combined with the renewed effects of gravity leads to improved perfusion of the lower extremity and relief of ischaemic pain (Bowker, 2001).

If the lesions that produce this pattern of pain are not corrected by vascular surgery, tissue necrosis and gangrene are likely to develop resulting in amputation (Bowker, 2001). Rest pain is therefore an indication to consider vascular surgery to relieve arterial occlusions.

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Last Updated: October 24th, 2001