RSD Puzzle #048

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 #48
MS Contin... Pain Reliever, But Not A Key To Recovery

Dear Margaret,

Many thanks for your comments regarding MS Contin. I agree that MS Contin, as you say, "doesn't aggravate inactivity". This is the key to the whole problem. MS Contin is nothing but a continuous anesthesia. You don't feel anything so you feel good. The problem is that recent research in the past two years has shown that there are a certain type of sensory nerves deep in the muscle and bone in the extremities that are called "sleeping nociceptors". God has gifted us with these sensory nerves that are usually totally silent and do not give any kind of pain signals unless the extremity become inactive for a long period of time. In RSD, the first response of the body to the pain is keeping the painful extremity still. Temporarily there is nothing wrong with it. However, if it is done on a long term basis such as with the application of cast or with the intake of a lot of narcotics that cause inactivity, then these "sleep nociceptors" wake up. As they become activated (because of prolonged lack of exercise of the extremity), the patient feels severe pain in the extremity. If the patient is given copious amounts of addicting narcotics causing drowsiness and inactivity, the pain will be gone but the damage to the extremity will continue under the protection of the pain medication. This is in the for of osteoporosis weakness and atrophy of the muscles. That's the reason God gave us these sleeping nociceptors (which I call the "Maytag repair men"). MS Contin, being one of the most potent pain medications, takes away the pain but doesn't stop the damage of osteoporosis, fracture of bone, atrophy of muscles, etc. Enjoy yourself while you are inactive and doing nothing about this disease in the extremities because sooner or later the price has to be paid in the form of sympathectomy, amputation, permanent confinement to wheelchair or bed, etc.

Dr. Basbaum, who is the number one researcher in RSD changes in animals, has shown that narcotics cause problems with spread of the RSD to other parts of the body in the animals. He has also shown in animals that the use of narcotics causes permanent changes in the genetic structure of the nerve cells making them lose their plasticity (power of recovery). This may be the reason for inactivity accelerating the course of the RSD from stage I through stage IV and causing serious complications that are part and parcel of the late stages of RSD.

As we always say, if you want to take your medicine and rest and watch O.J. on T.V. power be with you. My job is to warn you, but please, for God's sake don't kill the messenger. Incidentally, if you are interested, I can mail to you the reprints of some of the excellent work done in the past one year by Dr. Basbaum (which I have quoted here).

H.Hooshmand, M.D.

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