RSD Puzzle #144

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

This type of pain is not at all uncommon in relatively advanced CRPS patients. Two different factors contribute to this pain:

1. Allodynia, which refers to the fact that the more the area is painful, the less tendency by the patient to touch that area. Lack of touch and massage to the affected area causes more sensitization of the spinal cord and aggravates the pain.

2. Neuro-inflammation, which usually develops after the patient has had this problem for several months or even years. This is due to the fact that sensitization of the spinal cord allows more and more pain input to the central nervous system, resulting in stimulation of the sympathetic system mobilizing the immune system to counteract the itching and neurodermatitis secondary to CRPS/RSD.

c. Modulation of immune system. The immune system problem causes neuro-inflammation, which is by far the most disabling manifestation of CRPS/RSD.

1. The treatment of choice for this condition is soaking in the bathtub with Epsom salt added to the water, which acts as a calcium channel blocker and calms down the neuro-inflammation.

2. The use of surface analgesic creams, especially Zonalon, or Emla Cream to the involved areas.

3. Avoidance of any kind of inactivity, any braces, any wheelchair, or cane, etc., if at possible, because inactivity causes more and more inflammatory reaction. The inactivity causes cold surface of the extremity, but the same blood circulation to the extremity is directed to the deep structures causing osteopenia even fracture of the bone, aggravating the pain tremendously.

4. It is too late for stellate ganglion or lumbar sympathetic ganglion block to do anything for this advanced condition. The patient would benefit from treatments with cervical or lumbar epidural nerve blocks, depending on which part of the body is involved. These blocks should contain not only local anesthetic Marcaine 0.25%, but also Depo- Medrol® in small amounts (no more than 15-20mg at a time). The epidural block provides marked improvement lasting for at least 2-4 months. This is in contrast to sympathetic ganglion blocks that don’t last any more than a few hours or days.

5. Other helpful treatments are hydrotherapy, swimming and exercising in a warm heated pool, and most importantly, treatment with analgesic antidepressants such as Trazodone, which prevents the pain to begin with.

Sincerely,
H. Hooshmand, M.D.

Copyright © 1997-2006 H. Hooshmand, M.D. No part of this publication may be reproduced, transmitted, stored in a retrieval system other than this specific media, transcribed, or translated into any language without the expressed written permission from the author; H. Hooshmand, M.D. and Eric Phillips and CMNE. This material 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.
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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 © 1999-2006 H. Hooshmand, M.D.