RSD Puzzle #072

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 #72
LUPUS AND RSD

You have brought up a few interesting questions regarding the relationship of RSD and Lupus.

Lupus and RSD have one common feature. Both of them are diseases of the immune system. Lupus is due to the pathological response of the immune system toward skin and blood vessels and the nerves in these areas. RSD is a disease of the sympathetic system. This is not the hyperactive or hypo-active sympathetic disease, but a dysfunctional sympathetic disease. In the early stages there is a tendency for hyperactivity of the sympathetic system and in later stages, especially after a few years and several treatments, the sympathetic system becomes dysfunctional.

There are some features that are common between the two diseases:

1. Pain. Both diseases result in neuropathic pain, which refers to the fact that there is some involvement of the sympathetic system in early stages of these two diseases. This is usually in the form of burning and or stabbing regional pain.

2. Muscle spasm, muscle weakness and poor circulation to the skin and muscles.

3. The disturbance of the immune system is invariably present in both diseases. In the early stages of RSD, there is an up regulation of the immune system, and in later stages, there is a down regulation of the immune system. Lupus also goes through different stages of pathological regulation of the immune system.

The next question you had was in regard to the position of RSD in existing Lupus. RSD can happen as a complication of many different immune system diseases, such as Multiple Sclerosis, Lupus, Rheumatoid Arthritis and Polymyositis. It is definitely logical to conclude that the RSD in you case has been a complication of Lupus.

You have asked "How can one tell if the RSD is progressing throughout the body?" In RSD Puzzle #18 I describes how RSD spreads to other parts of the body.

You have asked two questions regarding the use of Stadol and Zoloft. Zoloft is an excellent antidepressant, but has very little analgesic value. It is very well tolerated and the usual dose is anywhere between 50 to 150 mg. Sometimes it is most effective when it is increased up to 200mg.

In regards to Stadol, Stadol is an effective analgesic. It is quite potent, without evidence of physical addition. Like any other drugs which are a strong analgesic, there is a tendency in a small number of patients for abuse, misuse and over use. However, physical withdrawal is not a complication of Stadol. It is an opiate antagonist, meaning that it does not suppress the formation of endorphins in the brain. The main drawback of Stadol is its cost. Buprenex which is superior to Stadol is less likely to be abused by the patient, and its annual cost is one half the annual cost of Stadol. It is mainly used to detoxify patients from dangerous drugs such as Methadone, Morphine, Heroin and Cocaine.

The last question you brought up was in regards to physical therapy and to testing and treatment for an orthopedic problem. Physical therapy is beneficial for an orthopedic problem. Physical therapy is beneficial at any stage of RSD. In regard to undergoing any kind of invasive test for an orthopedic problem, not only should the patient have physical therapy for several days before the test, but also it is a good idea to protect the patient with sympathetic nerve block before, during and after the test.

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.