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 #54
How To Detoxify

1. Dr. Basbaum did not concoct the "sleeping nociceptors". It was a researcher from Germany by the name of Dr. Koltzenburg. It was the most significant research reported in RSD in 1995. Those nerves are there and they become active causing severe pain when the limb is inactive (wheelchair) so the patient needs more and more pain medicine.

2. Dr. Basbaum used the standard equivalent dose of pain medicine in the animals.

3. I hate the term addiction. It is a political terminology. The proper word is drug dependence. If I need food to live then I am dependent on it. If a person needs alcohol to calm himself on an as needed basis then he is dependent on it, etc... Unfortunately, I receive many late stage RSD patients who are dependent on narcotics that cause withdrawal pain, tolerance, and inactivity. Once the doctors given them such drugs on a long term basis, they then advise the patient "You do not have RSD, You are an addict". There are better narcotics which are stronger than MS Contin and do not cause dependence.

4. In late stages of RSD or failed back syndrome there is the alternative of the morphine pump which provides excellent pain relief without dependence; however, because of the universal misunderstanding regarding pain medicines, the patient is provided with both the pump and other drug dependent narcotics. The end result is disastrous to the patient.

5. Taking Methadone and Percocet is a sign of tolerance, (increasing dependence).

6. The previous study regarding dependence in chronic pain was flawed by the fact that a lot of the patients died from the disease and a lot of other patients were kept on drug dependent medications with the excuse that they were prescribed by a doctor.

7. The alternative is, first of all, cold turkey, switch to drugs such as Stadol and Ultram, but do not overlap old and new drugs. This should be followed by the patient to "Say No" to spinal stimulators, sympathectomy, and other unnecessary operations. Get up and walk to calm down the sleeping nociceptors.

8. Finally, I may not feel the pain but I spend my life helping the unfortunate victims. You are frustrated with the pain. I am frustrated with the latest most destructive trend in the management of RSD consisting of spinal cord stimulators that only stimulate the sympathetic system and make the RSD worse, multiple unnecessary surgeries for fictitious, imaginary conditions secondary to inflammation of RSD. I do not need to name them because practically everyone of you have had these operations. The end result is Stage IV with horrible consequences. All of this is done while you are going through the "Rip Van Winkle" phenomenon, slowing watching yourself deteriorate.

H. Hooshmand, M.D.