RSD Puzzle #030

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 #30
"YOU DID HAVE RSD BEFORE, YOU DON'T HAVE IT NOW.
THE SYMPATHETIC NERVE BLOCKS HELPED, NOW YOU DON'T HAVE IT"

The early stages of RSD sympathetic nerve blocks can be both diagnostic and therapeutic. The temporary elimination of pain following the sympathetic ganglion or regional block is the best diagnostic proof that the patient suffers from sympathetically maintained pain (SMP). However, as the disease becomes chronic and complicated with improper treatment, such as application of ice, the long term immobilization with braces and wheelchair, and unnecessary surgery such as exploration for carpal tunnel syndrome, then the pain is not a simple SMP. Instead, damage to somatic nerves secondary to the vasoconstriction and additional surgical trauma changes to sympathetically independent pain (SIP) which does not respond 100% to sympathetic nerve blocks.

The end result is that in the chronic stage of this disease the patient develops both sympathetic and somatic pain. By then, because the sympathetic block does not control the pain, the patient is told that she does not have RSD any more. Abruptly the treatments are discontinued and the patient is abandoned. This has become a serious problem.

By the time the above phenomenon develops, the patient has suffered from RSD for any where from a year and a half to four to five years. The treatments have complicated the disease, yet the patient is being punished for not responding to sympathetic nerve block.

Another problem is that in the best of hands the sympathetic nerve blocks are successful in only about 75-80% of the patients. This is because of the phenomenon mentioned above as well as the sympathetic anatomical structure being so variable from person to person that there is no guarantee that the nerve block can be done. The guaranteed forms of nerve block are Bier block and IV drip nerve block.

Finally, as the disease becomes chronic if the patient has been left totally untreated then one sees the classical four stages of RSD. On the other hand, any treatment for RSD changes the clinical picture of RSD and as the condition becomes atypical making the diagnosis that more difficult. There is a definite need in orienting and educating the care giver regarding the fact that treatment may change the clinical picture of RSD.

By the time the patient has suffered from RSD for quite a few years, the infusion pump may be the only form of treatment to control the patient's pain.

H. Hooshmand, M.D.

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.