RSD Puzzle #032

H. Hooshmand, M. D.

DIPLOMATE AMERICAN BOARD OF PSYCHIATRY AND NEUROLOGY

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EPILEPSY, PAIN, MS

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RSD PUZZLE #32
"My RSD Started From An Injury To The Hand And After Carpal Tunnel Surgery. Why Is It I Can't Remember Anything?"

RSD is not just the disease of peripheral nerves. The condition is not a simple burning or stabbing pain. Besides the pain the patient also has other manifestations such as movement disorder, constriction of blood vessels in the extremity, swelling of the soft tissues ( mistaken for "fibromyalgia"), and disturbance of the limbic system (the temporo-frontal lobe regions). The limbic system is the primitive cortical system in the cerebral hemispheres. Disturbance of the this system results in depression, poor judgement, poor memory, fatigue, irritability and agitation. It also results in insomnia.

The memory loss is not simply because of depression. As a matter of fact, not all the RSD patients are depressed. Somewhere around one-forth of the RSD patients have a normal depression test on psychological examination.

The number one factor in memory loss among RSD patients is the pain causing disruption of normal natural REM sleep. This results in the patient being fatigued, irritable, edgy and having poor memory the next day. Sleep is probably the most important recuperative state of our life. We need to sleep to give the brain a chance to put its house in order after a stressful day. Especially during REM sleep the brain stem and the limbic system undergo recovery and recuperation.

The same patients who suffer from memory loss also have a tendency to suffer from chronic fatigue as well.

The effective and successful treatment for memory loss in RSD are as follows:

1. Antidepressants that provide natural REM sleep. At the top the list is Trazodone.

2. Pain relief. Like any other RSD complication, the patient is not going to get better unless proper relief is provided.

3. Nerve blocks. The anesthesiologists who have extensive experience with nerve blocks, and the patients who have undergone the blocks, describe the phenomenon that the first successful nerve block that the patient receives is immediately followed by a deep sleep which helps the patient feel much improved.

4. It is imperative to discontinue existing BZ'S (especially Ativan, Xanax and Ambien) to give the patient a chance to have natural, normal REM sleep. Realizing that Ambien does not cause significant rebound (withdrawal), still it reduces the REM sleep.

Another medication that seriously disturbs the memory function and the general state of RSD patients is barbiturates in the pain medications such as Fiorinal, etc. The barbiturates which for decades have been used as a sleeping pill, are more anesthetic than sleeping pill. They provide an unnatural sleep and deprive the patient of REM sleep.

Alcohol is another drug that cannot be used in any amount in any RSD patient because of not only the caustic (damaging) effect of alcohol on the nerves but also because of depriving the patient of REM sleep.

In more severe cases, to counteract fatigue and memory disturbance, the patient may require Paxil, Zoloft, or Prozac in the morning and Trazodone and night. The same outline antidepressants are also effective in control of the chronic 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.