Questions posted in the Neurology and Neurosurgery Forum have been answered by doctors from The Cleveland Clinic Foundation.

Question Title: RSD and new problems arising

Forum: Neurology Forum
Topic: Pain

Re: RSD and new problems arising

Re: RSD and new problems arising

Posted by CCF Neuro MD on August 03, 1997 at 09:38:21:

In Reply to: RSD and new problems arising posted by Michelle Schlaefke on July 12, 1997 at 05:02:40:


I have been diagmosed with RSD which has at times been termed Sympathetic Mediated Pain. I have an implanted Morphie pump. Just recently I have developed this leg shaking. Actually it is keeping me up at night now too. My right leg just shakes and when it isn't shaking, I can see the muscles in my thigh twitching. It seems like a fairly constant contraction and release throughout the day. The at times my leg shakes like it is having a seizure all by itself. The pain clinic raised my pump level but the contracting of the muscles is causing more and more pain and discomfort. I finally got back in touch with the pain clinic and my neurosurgeon. My doctors have been on vacation. However, this is getting to be a bit much. I am only getting a few hours of sleep each day and often it is whenever I can finally fall asleep. We are starting to see signs when the leg is going to shake although it does not always happen this way- however, throughout the day, my right foot turns way to the inside. In fact it is hard to keep it straight. My knee rotates in as well and does not feel comfortable at all when I try to put it to the outside. Anything you could suggest would be of value. I am on Neurontin- any suggestions for dosages. I am also on Valium as a muscle relaxant and also Elavil to help up my pain tolerance. This new stuff has only been going on for about 3 weeks now but it is getting old real fast. I am very tired and just cannot sleep. Just as I nod off and relax the contractions in my leg get stronger. There are points in the day that things let up and I try to catch a bit of sleep whenever I can. Otherwise I try to occupy my mind as well as I can to keep from thinking about this at all. I llok forward to hearing from someone who may be able to offer a suggestion. Thank you!


Hello, Michelle,
As you well realized, RSD (reflex sympathetic dystrophy) is a rather complicated condition, and not only difficult to diagnose but very difficult to treat as well. It can easily be confused with many chronic pain syndromes. The leg muscle twitching and shaking that you recently have been experiencing is a rather common complication with this condition, although pain is always the main symptom. In general, RSD is managed in several ways, some of which you have tried. These include oral medications, pump medications, nerve blocks, and nerve stimulators. The basic idea behind them is the same: to block the pain conduction or raise the pain tolarence. As a rather late problem, shaking legs may be from the readjusted sensory levels that result in unusual sensory perception to the leg position, or from the sudden change of morphine dosages as experinced by Sandra. If the pump works fine, there are several meds that may help, including levodopa, and bromocriptine.
Neurontin is a new medication for pain control. The tolerated dosage differs from patient to patient. In general, it can go up to 500mg three times a day.
As far as getting a better sleep, you may want to try benzodiazepine drugs. They have been proven to be helpful to reduce the fragmentation of sleep.
This condition requires a team of doctors that specializing in pain and neurology work together. It sounds like you have been under such care. Alternatively, the doctors at cleveland clinic foundation can offer you a reevaluation, and explore the newer treatment modelities. Feel free to call (800) 223-2273 ask for neurology appointment desk if you decide to come.
This information is provided for general medical education purposes only. Please consult your physician for the diagnostic and treatment options of your specific medical condition.
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