RSD Puzzle #104

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

Alcohol blocks which are chemical blocks in the form of phenol, alcohol, etc., are the most dangerous and destructive forms of nerve blocks. They are also called "lytic" blocks which better describe them. The term "lytic" refers to "lysis" which refers to a meltdown of every soft tissue in the target area of the block including nerves, connective tissue, etc. This destruction is not limited to the area of injection-because nothing keeps the alcohol to destroy only "bad nerves", but it also destroys the adjacent perfectly normal nerves. Incidentally, intervention or destructive lytic nerve blocks or sympathectomy are done on no "bad nerve". There is no such thing as "bad nerve". The nerve is nothing but the conveyer of the impulse. In RSD (CRPS), the disease originates from microscopic sensory nerves in the wall of the small blood vessels. The large trunk of the nerve fibers that are the target of nerve blocks or sympathectomy, are just the messengers. Destroying the messenger is not going to solve the problem, but it is going to add a new source of pain. Alcohol causes extensive scar formation of the soft tissues including the nerves and such scar formation becomes a new source of severe pain far worse than the original pathology. Alcohol blocks, sympathectomy, or neurectomy (cutting nerve fibers) only adds assault to the injury. Such destructive procedures relieve the pain for a few weeks to a maximum two months, only for the pain to return with more intensity and in a larger area of the body.

Any destruction of nerve fibers should be definitely avoided. These procedures are all doomed to fail and are dangerous.

On the other hand, performing epidural nerve blocks or paravertebral nerve blocks which flood the nerves in the muscle or in epidural space with a combination of local anesthetic and a small amount of anti-inflammatory medication (such as Depo- Medrol Ž, Kenalog, or Celestone) do not destroy the nerves. They simply block the input of painful chemical such as substance P from the extremity into the spinal cord. They don’t anatomically destroy any of the nerve fibers and they provide excellent relief lasting anywhere from 2-3 months. In the meantime, during that 2-3 months proper physical therapy and massage and other measures should preclude the necessity of repeating such nerve blocks in at least 80% of the patients.

Not only the surgical procedures, chemical sympathectomy and neurectomy should be avoided, but also application of ice on the extremity by the virtue of destroying the myelin covering of the nerve (the protective sheaths of the nerve) should be definitely avoided.

All the above statements refer to benign, complex, chronic pain. Obviously, if the patient suffers from cancer and has a few months to live, any of these blocks will give the patient a few months of relief and are palliative. In cancer patients any surgical procedure that gives a temporary relief to the patient is justifiable, humane, and should be done. CRPS (RSD) patients do not suffer from cancer. They are quite young. They have 4-5 decades of live ahead of them, and should not be exposed to such destructive procedures which cause more pain than the original disease.

The material on the Neurological Associates Pain Management Center Homepage and all it's associated, linked or reference pages is for informational and education purposes. It is not meant to take the place of your physician. Before starting, changing, or stopping any treatments or medicines consult your physician. H. Hooshmand, M.D., Neurological Associates Pain Management Center and Associates will not be held liable for any damage or loss as a result of information provided on this page or associated documentation. Again, this WEB SITE is simply published as an information source and should not be used to treat or make judgments on RSD/CRPS. All associated material on this web site may not be copied, reproduced or quoted without expressed written permission from the owner; Copyright Š 1999-2006 H. Hooshmand, M.D.