RSD Puzzle #025

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 #25
Failure Of Repetitive Sympathetic Nerve Blocks
In Chronic Stages Of RSD

A patient came to see me today because of persistence of pain in all four extremities. She is very upset because she has been told that she needs to have the following course of treatment:

1. Sympathetic nerve blocks. She had no objections to it and I welcome it.

2. Surgery for carpal tunnel syndrome.

3. Post operatively she is to be scheduled to see a psychologist to follow her course.

This is a preordained algorithm which already predicts failure of response to sympathetic nerve blocks necessitating surgery. It predicts failure to surgical treatment necessitating psychotherapy. What is most confusing is if the blocks and surgery are failure, why try them? If the blocks and surgery are failures, why expose the patients to psychotherapy as if to begin with there was nothing wrong with the patient an it was "all in her head"?

Being at the long term receiving end of the type of treatment that has been prescribed for the patient, the stereotyped pattern has convinced me that year-in year -out repetitive sympathetic nerve blocks in chronic RSD are a failure. Surgery is not just a failure, but a disaster in chronic stages of RSD.

The architectural design of the nerve block-surgery-psychotherapy is very similar to the work of an architect in a small town in Florida who designed a dead-end street to start with the police department, followed by the fire department, followed by hospital, followed by nursing home, followed by mortuary, followed by grave yard. The grave yard was quite large so it blocked the road and the sign declared "dead-end".

An old wise farmer once said "there is no lesson to be learned from the second kick of a mule".

The occurrence of carpal tunnel syndrome is late stage of RSD is common place. The occurrence of tarsal tunnel syndrome in late stages of RSD in the lower extremities is common place. In either case, it is the inflammatory nature of RSD which causes inflammation, swelling, and entrapment neuropathy. In either case surgery for the secondary carpal tunnel or tarsal tunnel syndrome results in disastrous acceleration and deterioration of RSD.

H. Hooshmand, M.D.

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