Post Traumatic Reflex sympathetic dystrophy ?

[DiverDoc]

Besides basic physiology of whats going on, could someone please tell me some clinical presentations and treatment for this disorder as well as some treatment regimines and why this is often misdiagnosed?

Thanks

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[TerraMedicX]

I think they're calling this Complex Regional Pain Syndrome now...you may have better luck looking under that as well, BUT here's a link that has other links with LOTS of resources:

http://www.rsdhope.org

My little sister has this, and the biggest thing I can tell you is that treatment is VERY individual...some things work for some people and don't do anything for other people. To date she's had epidural blocks, electro-stims implanted in her spinal nerve junctions, varying drug regimes and intensive physical therapy...(she's had it for 5-6 years now)...none have offered anything except temporary relief and most have had pretty severe side effects. There is a pretty strong psychiatric component of the disease as well, and that is difficult to treat with some people.

I know I'm still pre-med and I generally try to stay out of posting in this forum, but since I've been helping my family and sister deal with this somewhat I thought I'd share what I've seen.

PM me if you'd like anything more.

Nate.

 

[DiverDoc]

Hey thanks so much. Your linked proved useful !

 

[exgatr]

What I've heard from a top pedi rhem prof:

RSD patients fall into two groups:

1. Fybromyalgia (without physical manifestations of RSD)

2. Raynaud's disease (with physical manifestations of RSD)

Delve into the patient's home life a little and you'll uncover a hot mess.

 

[minstral]

Treatment should be given asap preferably witin 8 weeks or you risk permenent problems.

A CT-guided sypathetc chain block is diagnostic. Patient will feel warmth and decrease or cessation in pain following the procedure.

If that works commence ablation of level that worked with dianostic.

bottom line--- SEE A SKILLED PAIN DOC

 

[neurodoc]

...or "CRAPS" as I like to pronounce it. This is a real, debilitating, and frustrating to treat syndrome, though it can be difficult to sort out from other chronic pain syndromes, including stuff with psychiatric overtones. I've seen a lot of it. Basically, you've got to look for a typical progression of stages (classically there are three), ranging from an "acute" form with rubor, calor, and dolor (think acute inflamation) on through a chronic stage of pallor along with skin appendage atrophy and coolness.

Various theories of the pathophysiology, but this is what I've learned clinically. Drugs and sympathetic blocks help, but the key to treating this syndrome is twofold: 1) Begin treatment as early as possible; and, 2) Physical manipulation and forced mobilization of the affected limb are needed to effect a cure. If the syndrome progresses to the chronic phase, it's very difficult to treat. Because of the pain, the patient naturally wants to guard the limb from painful movement. Guarding may be adaptive in other painful conditions, but not in this one. This is a neurological disorder where we really need to work with our colleagues in PT and OT.

Nick

 

[Spine Specialist]

Spinal Cord Stimulator (SCS) brings magical relief to some Chronic CRPS patient. The key is selection of appropriate patient. If all conservative treatment fails, SCS is the way to go. I think all neurologists must be educated about SCS and what it can do to help their suffering patients.

 

[dave2626]

What I've heard from a top pedi rhem prof:

RSD patients fall into two groups:

1. Fybromyalgia (without physical manifestations of RSD)

2. Raynaud's disease (with physical manifestations of RSD)

Delve into the patient's home life a little and you'll uncover a hot mess.

So... no disrespect to the top pedi rheum prof... but neither of these are subdivisions of RSD.

 

[futurebraindoc]

Dr. Schwartzman at Hahnemann published all of the details of the disease in an article titled reflex sympathetic dystrophy that can be found in Curr Rheumatol Rep. 2002 Apr;4(2):165-9. The only real cure is not done in the united states because of safety issues. However, inpatient ketamine treatments are very effective and reduce all of the symptoms.

 

[exgatr]

he argues that RSD is not its own disease; it's either one of those diseases I listed, but misdiagnosed

So... no disrespect to the top pedi rheum prof... but neither of these are subdivisions of RSD.