Pain: Reflex Sympathetic Dystrophy Prevention and Management
Boca Raton, Florida
H. Hooshmand, M.D.
The following principles play a major role in the
prevention of RSD and its further deterioration:
1. Early diagnosis,
especially with the help of thermography.
2. Early aggressive
3. Avoidance of the
unnecessary use of braces, crutches, casts, and immobilization when the
patient has a soft tissue injury rather than a fracture or major ligament
4. Avoidance of the
use of ice on the involved area. Ice is the treatment of choice for acute
somatic pain. It is also instigator, aggravator, and perpetuator of RSD
because of its vasoconstrictive effect.
5. Avoidance of
alcohol in any amount.
6. Avoidance of
narcotics and benzodiazepines in any amount and at any stage, except for
clonopin used for seizure disorder.
7. Avoidance of
unnecessary surgery such as cutting and suturing in the area of scars,
unnecessary surgery such as done for back or cervicolumbar spinal pain when
the patient's problem is only nerve root contusion or chronic pain, or when
the MRI or myelography do not corroborate the exact abnormality or the EMG,
somatosensory evoked response, or thermography. The same is true with
unnecessary operations such as amputation and sympathectomy and injection
with steroids to the area of ephaptic scar.
Arthroscopy should be avoided until
absolutely necessary because the trauma of arthroscopy can cause injury to the
sensory nerves around the knee and start ephaptic RSD.
Finally, unnecessary surgery for
improperly diagnosed carpal tunnel syndrome, tardy ulnar palsy, or rotator cuff
tear should be avoided.