Pain: Reflex Sympathetic Dystrophy Prevention and Management
Boca Raton, Florida
H. Hooshmand, M.D.
Narcotics and Chronic Pain of RSD
The management of acute vs. chronic pain requires a
completely opposite approach. Whereas in severe acute pain the use of narcotics in vital
and essential, in chronic pain application of narcotics is contraindicated and dangerous.
Approaches such as the use of Dilaulid as a focal
perfusate in the RSD extremity make no sense. Although the narcotic results in immediate
relief of pain it is followed by an exaggerated painful withdrawal.
Oral or intramuscular (i.m.) application of
narcotics flood the CNS with resultant inhibition of endorphin formation followed by
severe pain of withdrawal.
For the purpose of lasting analgesia - in chronic
pain of RSD - the CNS should be stimulated to form more endorphins. The use of narcotics
results in a marked inhibition and reduction of endorphins. Exercise and proper nutrition
stimulate the formation of endorphins.
The chemical treatment of choice for chronic pain of
RSD is antidepressants or ACTH, both of which raise the concentration of endorphins in