RSD Puzzle #094

H. Hooshmand, M. D.

DIPLOMATE AMERICAN BOARD OF PSYCHIATRY AND NEUROLOGY

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EPILEPSY, PAIN, MS

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RSD Puzzle #94
Information On Catapres Or Clonidine Patches

Regarding the question about Catapres patch. The generic name for it is Clonidine. It is a very effective alpha II sympathetic blocker. The patch SHOULD NOT be applied over the area of nerve damage, e.g. , on the hand, foot or knee. It should be applied to the referred pain distribution in the lumbar or cervical spine region on the same side. The area of application of the patch is identified by pressure on the muscle immediately to the side of the midline on the side where the pain and nerve damage is present. This pressure is applied up and down the cervical or lumbar spine until the tender spot is identified. The patch is applied there and is changed once a week. Every time the patient takes a shower or a bath the patch is temporarily removed, laying face up on a napkin. After the skin is dried the patch is reapplied. This acts as a continuous nerve block and provides very good pain relief. It certainly is better than the standard sympathetic ganglion nerve block done with local anesthetic which lasts no more than a few hours to one to two days.

The reasons doctors are reluctant to apply this treatment, are because of the fact that when the patch is applied to the area of nerve damage it causes more damage to the sympathetic system, more pain, and reddish discoloration of the skin. The second reason is as, an alpha blocker, Clonidine drops the blood pressure and if the patient already has low blood pressure they cannot tolerate it.

The same principal applies to all other nerve blocks in RSD. The area of the nerve damage over hand, foot, arm, or leg, should not be stuck with a needle for nerve block injection or a Clonidine patch because both methods aggravate and expand the area of nerve damage where the nerve and the skin are already extremely tender and irritated.

Both methods should be applied on the path of sensory nerve fibers just before the nerves into the spinal cord- over the cervical spine region or lumbar spine region.

Applying nerve blocks and patch on the area of lesion to stop the pathologic irritation of the nerve is the same as bombing a hospital to kill the occupying enemy. The bomb will kill the enemy and the patients simultaneously.

H. Hooshmand, M.D.

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