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 #14
Necessity Of Early Diagnosis And Treatment                                                                                                                        

(Revised on 2/14/2002)

"You have no dystrophic changes and no atrophy in the extremity. You are in stage-I of RSD. Your condition is mild, and you have had the RSD for five years. There is nothing that can be done for you and being in stage-I  RSD you should be able to go back to normal life."

The chronicity of RSD is far more important than the stage the patient is in.

The accurate predictor in regards to the patient's treatment is not presence or lack of atrophy in the muscles of the extremity.

What is more important is the length of time the patient has suffered from the illness. In the first six months, the disease is far more amenable to successful treatment. The success rate in the first six months, if the RSD is treated properly, is over 80-90%. Between six months to a year, it drops to 60-80% and after two years, there is a risk of over 40% failure and with the passage of each year, the disease becomes more established and more difficult to treat. The other accurate indicator is the patient's age. Up to 22 years of age, the patient has excellent recovery power ( please see RSD Puzzle #11 regarding Children).

All of these indicators mean nothing if the patient undergoes treatment with ice, addicting narcotics, unnecessary operations such as sympathectomy, spinal stimulator, amputation, or surgery in the form of exploration in the area of inflammation of the RSD. Such dangerous treatments render a far lower rate of success in the long run independent of the stage of RSD. The above mentioned risky and dangerous treatments would be replaced with treatment with non-addicting narcotic pain medications (e.g., Ultram or Stadol). Some examples are antidepressants that are treatment of choice for chronic pain, such as SSRI antidepressants that are analgesic pain medication of choice for chronic pain; Ultram, and other non-addicting pain medications. The patient also needs non-addicting muscle relaxants. Soma is extremely addictive because it changes to Meprobamate in the body which is an addicting tranquilizer. Robaxin is too weak to do anything for RSD. The ideal muscle relaxant is Baclofen which has direct effect on the anterior lateral horn cells of the spinal cord and relaxes the muscles as well as taking away the flexion spasms and enables the patient to get around. If the patient needs to have an anticonvulsant for the sharp, stabbing, electric short type of pain (such as causalgia), addicting anticonvulsants such as barbiturates should be avoided. The treatment of choice in these cases would be Tegretol (non-generic) and/or Neurontin. The patient with RSD should not suffer from pain. Eventually, in late stages when everything has failed, then the patient should be treated with an infusion pump (Please see RSD Puzzle #17 regarding infusion pump).



H. Hooshmand, M.D.