RSD Puzzle #103

H. Hooshmand, M. D.

DIPLOMATE AMERICAN BOARD OF PSYCHIATRY AND NEUROLOGY

BOARD CERTIFIED IN ELECTROENCEPHOLOGRAPHY

BOARD CERTIFIED IN ELECTROMYOGRAPHY

BOARD CERTIFIED IN AMERICAN BOARD OF ELECTODIAGNOSTIC MEDICINE

INTRACTABLE NEUROLOGY

EPILEPSY, PAIN, MS

An International Referral Center dedicated to Treatment, Education and Research

RSD PUZZLE #103
"Good Days and Bad Days"
Neurovascular Instability of RSD

1. Reflex Sympathetic Dystrophy (CRPS) is due to dysfunction of sympathetic nervous system. The sympathetic nerves function in a dynamic fashion- at times being hyperactive and at other times being hypoactive. This is in regard to control of circulation and control of the immune system. From day to day the sympathetic control of circulation may fluctuate. This is usually in the form of neurovascular instability, meaning one day the hand or foot is bluish red, and the next day it is so white it looks like it is dead. The immune system control may undergo up-regulation or down regulation: one day the patient is feverish, and the next day the patient is "ice cold".

2. Another factor causing "good and bad days" is the fact that stress of RSD causes demand for the protective benefit of estrogens. Stress of RSD, as well as periodic fluctuations of opioids, cause hot flashes and severe fatigue in women of 20-80 years of age. This demand for estrogen to improve the function of immune system is easily corrected by estrogen therapy.

3. The third factor, partial arrest of sex and growth hormones formation due to large doses of narcotics, also cause fluctuation in daily course of RSD. Switching from opioids agonists (e.g. duragesic) to antagonists (e.g. buprenex) corrects this condition.

H.Hooshmand, M.D.

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