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Subject: Re: RSD
Forum: The Neurology and Neurosurgery Forum
Topic Area:
Posted by CCF Neuro MD on April 25, 1997 at 12:45:46:
In Reply to: RSD posted by Carol Abern on April 15, 1997 at 22:01:00:
: My sister has been diagnosed with Reflex Sympathetic Dystrophy, following
an operation on a malignant brain tumor. After the operation, she lost
complete use of her right arm and hand. After three weeks of physical therapy,
she began to regain some use of this hand and arm....and then, she fell on
the very same arm. She is seeing a physical therapist, and has taken a dose
pack of prednisone. She also has sought out alternative treatments for both
the cancer and RSD. Much of the time, she is in great pain.
Can you please send me information re RSD, the chances of recovery, and
all known treatments.
Thank you very much.
Hello Carol, Refelex sympathetic dystrophy is a poorly understood disorder. It is very likely that what has been referred to as RSD in the past actually represents a variety of different disorders brought on by different mechanisms. This probably explains, to some extent, the difficulty in treating this group of patients. Recently, there has been an attempt to change the classification of this group of disorders so that they can be seperated into various distinct entities. This will be the first step taken in order to study these disorders scientifically. The term RSD has been used to characterize a process of pain in an extremity out of porportion of any injury that may have occured, loss of function, and signs of dysfunction of the autonomic nervous system (the part of the nervous system that innervate blood vessels, skin, sweat gland etc) in that limb. There is usually an association with a psychiatric disorder brought on by the illbness. The diagnosis is made by clinical examination, x-ray, bone scan, and other
nuclear medicine related tests. The mechanism of how these disorders are produced is not known. In some instances there is an associated injury to a nerve innervating the affected limb, in which case the disorder is termed causalgia. A small percentage of these disorders are thought occur as a result of sensitization of sympathetic neurons in the spinal cord (a part of the autonomic nervous system.) This has been refered to as sympathetic mediated pain. The main stay of therapy is physical therapy to the affected limb with the hopes of improving function. Various other medication including nonsteriodal drugs, antidepressants, and narcotics have been used. Other more invasive procedures such as injection to block the sympathetic pathway as well surgical section of sympathetic nerves have been performed with varing degrees of sucess. If you are interested in seeking a second opinion here at the Cleveland Clinic for your sister, I would suggest you contact Dr Staton-Hicks who is the head of our
Pain clinic. You can arrange for an appointment by calling 216-444-5559. Good luck!
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