RSD Help

[polarisgold]

Is there any new or experimental cures for RSD?

[polarisgold]

Thanks so much for your time in writing your response to my question. I am in the process of getting a spinal cord stimulator. Unfortunately since I can not work and have no money I may not be able to obtain this surgery. The doctor is willing to wave his fees because his mother - in law is my friend. But the hospital will not wave their fees and their fees amount to 135,000 dollars.

I've tried the gov't for help and many other sources. Do you know of any other sources that may donate to my cause??

[Joyce K Lee, MD]

Thank you for submitting your question.
I will answer your concerns to the best of my abilities.

Please be reminded that this is solely for educational purposes and should in no way be a substitute for a formal evaluation by a certified physician.

To begin, Reflex Sympathetic Dystrophy (RSD) - also known as Complex Regional Pain Syndrome (CRPS) - is a chronic neurological syndrome characterized by:
severe burning pain
pathological changes in bone and skin
excessive sweating
tissue swelling
extreme sensitivity to touch

Some experts believe that RSD represents an exaggerated response of the sympathetic nervous system to some form of injury or insult (eg. surgery) to the area resulting in chronic, severe, sometimes debilitating pain.

There are Two Types of CRPS - Type I and Type II

*CRPS Type I (also referred to as RSD) - cases in which the nerve injury cannot be immediately identified  
*CRPS Type II (also referred to as Causalgia) - cases in which a distinct "major" nerve injury has occurred
CRPS is best described in terms of an injury to a nerve or soft tissue (e.g. broken bone) that does not follow the normal healing path

Since there is no single laboratory test to diagnose RSD/CRPS, the physician must assess and document both subjective complaints (medical history) and, if present, objective findings (physical examination).

In my clinical practice, RSD is often difficult to treat and alleviate.

At the most basic level, the goals of treatment are to control pain and to maintain as much mobilization of the affected limb as possible.
An individualized treatment plan is designed, which often combines physical therapy, medications, nerve blocks, and psychosocial support.

To elaborate a little further:
Medications often used include nonsteroidal anti-inflammatory drugs (e.g., aspirin, ibuprofen, naproxen, indomethacin) for pain associated with inflammation, central acting agents (e.g. tramadol) for pain not associated with inflammation, antidepressants (e.g. amytriptyline, doxepin, nortriptyline, and trazodone) and  anticonvulsants (e.g., carbamazapine, gabapentin).

Generalized, severe pain that does not respond to other medications may be treated with opioids (e.g., propoxyphine, codeine, morphine).
Muscle cramps (spasms and dystonia) can be treated with clonazepam and baclofen and other muscle relaxants.

We also use Capsaicin® cream for localized pain, but its effectiveness has not been proven and the results are variable.

Physical therapy should include daily range of motion exercises. Patients should be advised to avoid activities that could accelerate osteoporosis or joint injury.

If management with medications fail, we resort to Nerve Blocks.
Sympathetic nerve block interrupts the transmission of pain signals from a group of nerve cell bodies (called a ganglion).
The procedure, usually performed by an anesthesiologist familiar with the technique, involves the insertion of a needle into the appropriate location and the injection of anesthesia into the ganglion. The effect is monitored over time.

Patients who have a good but temporary response to nerve block may be candidates for sympathectomy. The goal of surgery is suppression of sympathetic nervous system activity in the affected area.
Another surgical option is the use of a TENS unit, or a transcutaneous electrical nerve stimulation (TENS) unit  to treat the affected area.
In some cases, spinal cord stimulators are implanted permanently to supply a low intensity impulse to a location in the spinal cord in an attempt to interrupt the pain signals that are being transmitted to the brain.

Again, surgical referrals are reserved to those patients who are extremely refractory to medical management.
I only seen a handful of patients who opted for sympathectomies or SC stimulators and fortunately saw good results in all 4 of the patients.
As with any surgery however, there are risks that need to be discussed by a certified neurosurgeon.

Either way, any one suffering from RSD should have a good relationship with a neurologist, psychologist for psychological support and a pain specialist.

I hope this helps,
Best of luck,
JKL, MD






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