RSD Puzzle #040

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 #40
"YOUR SWELLING OF THE JOINTS IS NOTHING BUT ARTHRITIS,
YOUR SKIN SWELLING IS NOTHING BUT FIBROMYALGIA,
AND YOUR SKIN RASH IS FROM SKIN DISEASE AND HAS
NOTHING TO DO WITH RSD."

Of these four principle manifestations of RSD (pain, movement disorder, inflammation, and insomnia) the inflammation manifests itself in several different forms. This may be in the form of simple swelling of the extremities, joint pain, skin rash, blotching or cyanosis, trophic changes such as hair loss or fingernails degeneration, black and blue spots without any trauma to the skin, bleeding under the skin, and persistent itching.

The inflammatory aspect of the RSD is just as disabling as the pain or movement disorder. It requires the same assertive aggressive treatment as well. The treatment can be achieved by the following measures:

1. Anti-inflammatory medications. It is best to use anti-inflammatory medications that are less likely to enhance bleeding. Medications such as Oruvail, Lodine, and similar other newer forms of anti-inflammatory medications are quite helpful.

2. Physical therapy in the form of a combination of moist heat and epsom salt, the use of gloves and stockings to counteract progressive accumulation of edema or even elephantiasis, as well as massage and exercise are quite effective.

3. Brief and temporary use of corticosteroids both in the form of proximal somatic nerve blocks and by mouth may be effective. In this regard, Prednisone has a tendency to increase water retention. On the other hand, on the maximal 2-3 weeks duration, treatment with Dextromethasone (Decadron) can be helpful.

4. Treatment with ACTH which is not a corticosteroid but a polypeptide hormone extracted
from the hypothalamic region of the brain is quite effective and has far less side effects than corticosteroids. This should be given in a small dose of 40 units ACTH IM 3 times a week accompanied by the intake of antacid medications such as Zantac or Axid. It is an effective form of treatment for inflammatory manifestations of RSD.

5. Topical cream and medications can be quite affective.

One form of the topical cream that has been recently available and very effective is called Zonalon Cream which is a cream containing the antidepressant Sinequan. This is a very effective treatment in both reducing the inflammation and controlling the pain. Other topical corticosteroid creams can also be helpful.

6. For other more disabling manifestations of inflammation such as vascular headaches, persistent diarrhea, nausea and vomiting, and abdominal pain, other forms of treatment may be affective such as treatment with alpha blockers, elixir of paregoric, tincture of belladonna, and potable aloe liquid.

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.