antiquity
01-28-2003, 11:22 AM
RSD: Abbreviation For Chronic Pain
By Debbe Geiger
Debbe Geiger is a freelance writer.
January 28, 2003
Five years ago, Dawn Ranieri of East Northport underwent surgery for carpal tunnel syndrome. Instead of getting better, her right arm swelled, and she experienced intense pain that was worse than before.
It was five months before doctors could pinpoint the cause - reflex sympathetic dystrophy (RSD) - but by then it was too late. The RSD had already progressed to its third and most debilitating stage, and the pain has been unbearable ever since.
"I'm at the point where there is nothing any doctor can do," says Ranieri, 29, who spends most days in bed under her mother's care. "I can't use my whole right arm. I'm at the point where I can't let water touch my arm. I can't go in a car without a pillow because of the vibrations of the car. I can't take the torture of cutting my nails.
"It's attacked my life," she says of the dystrophy. "And it hurts nonstop. I have pain medicine, but it doesn't take away all the pain."
RSD or complex regional pain syndrome is a chronic pain disorder that is often associated with nerve injury.
In Ranieri's case, severe carpal tunnel syndrome caused the RSD. But many times doctors don't know what triggers the nerve injury. According to Dr. Charles Argoff, a neurologist and director of the Cohn Pain Management Center at the North Shore-Long Island Jewish Health System, RSD can result from something as traumatic as a gunshot wound or as trivial as a sprained ankle. Surgery has also been known to cause the syndrome.
Whatever the trigger, the injury seems to rewire the sympathetic nervous system, which regulates skin temperature and blood flow to the limbs. As a result, the affected limb feels burning hot and can turn shiny red or become cool and bluish. Sweating, swelling, increased sweating, joint stiffness and changes in the nails and skin are also common.
RSD dates to the 19th century when it was called "causalgia," and physicians treating Civil War veterans were concerned about pain that lasted beyond the healing of their wounds. More recently it has been known as complex regional pain syndrome or CPRS.
According to the National Institutes of Health, RSD affects up to 5 percent of people who suffer from a nerve injury, but doctors believe this might be a low estimate. While it can strike at any age, it is most common in women between the ages of 40 and 60. Recent reports indicate that the number of cases is rising among adolescents and young adults.
Diagnosing RSD is difficult, partly because it means different things to different people. According to Dr. Srinivasa Raja, professor of anesthesiology in the division of pain medicine at Johns Hopkins University in Baltimore, "If you take five patients with RSD, they don't all look alike."
Patients are often mislabeled because the symptoms appear to be unrelated. "They have a sprained ankle and end up with a swollen limb," says Raja. The disorder often leads to depression, which further complicates diagnosis. "As a result, some physicians who are not familiar with the condition can label them as psychologically disturbed rather than patients in a disease state."
Just as there is no gold standard for diagnosis, there also is no standard for treatment. According to Dr. Steven Pinsky, an anesthesiologist and director of pain management at Mercy Medical Center in Rockville Centre, "Evidence-based medicine has not yielded any proven treatment. Everything is anecdotal."
Still, several options are available, and research is being done to find more effective treatments. Some doctors have success with nerve blocks, spinal cord stimulators and pain medicines, including morphine. Argoff is conducting research using Botox to temporarily halt the painful muscle spasms that appear to be associated with the nerve injury. Dr. Paul J. Sorrel, a physiatrist with North Shore Pain Specialists in Jericho, is using subcutaneous infusions of lidocaine to provide pain relief with promising results.
The goal to dull the pain enough so patients can restore function and mobility to the limb. That's why aggressive physical therapy is a must. "A lot of the nerve blocks are used in part to reduce the pain and facilitate the physical therapy of the patients," says Raja. "We can order physical therapy, but if the pain is severe, they will never go."
Without movement, the extremity can become useless. Ranieri has gotten to the point where she can't move her entire arm. And she fears that the pain is spreading to her legs.
Doctors are unsure whether the pain is actually spreading or if the nervous system has become so sensitized that it becomes almost reprogrammed to transmit pain. But they do know that the pain can go away if the condition is treated early and aggressively.
Ellie Byrnes of South Hempstead was diagnosed with RSD in her right arm after she underwent extensive thoracic surgery at age 15. "I went for nerve blocks three times a week for 12 weeks. I did some physical therapy. Once I started with the treatments, I didn't complain of pain."
The bottom line, says Argoff, is, "you don't want to wait for the problem to be well established. Ignore the people who say you can wait. You're missing the best opportunity to get it treated." Copyright © 2003, Newsday, Inc.
By Debbe Geiger
Debbe Geiger is a freelance writer.
January 28, 2003
Five years ago, Dawn Ranieri of East Northport underwent surgery for carpal tunnel syndrome. Instead of getting better, her right arm swelled, and she experienced intense pain that was worse than before.
It was five months before doctors could pinpoint the cause - reflex sympathetic dystrophy (RSD) - but by then it was too late. The RSD had already progressed to its third and most debilitating stage, and the pain has been unbearable ever since.
"I'm at the point where there is nothing any doctor can do," says Ranieri, 29, who spends most days in bed under her mother's care. "I can't use my whole right arm. I'm at the point where I can't let water touch my arm. I can't go in a car without a pillow because of the vibrations of the car. I can't take the torture of cutting my nails.
"It's attacked my life," she says of the dystrophy. "And it hurts nonstop. I have pain medicine, but it doesn't take away all the pain."
RSD or complex regional pain syndrome is a chronic pain disorder that is often associated with nerve injury.
In Ranieri's case, severe carpal tunnel syndrome caused the RSD. But many times doctors don't know what triggers the nerve injury. According to Dr. Charles Argoff, a neurologist and director of the Cohn Pain Management Center at the North Shore-Long Island Jewish Health System, RSD can result from something as traumatic as a gunshot wound or as trivial as a sprained ankle. Surgery has also been known to cause the syndrome.
Whatever the trigger, the injury seems to rewire the sympathetic nervous system, which regulates skin temperature and blood flow to the limbs. As a result, the affected limb feels burning hot and can turn shiny red or become cool and bluish. Sweating, swelling, increased sweating, joint stiffness and changes in the nails and skin are also common.
RSD dates to the 19th century when it was called "causalgia," and physicians treating Civil War veterans were concerned about pain that lasted beyond the healing of their wounds. More recently it has been known as complex regional pain syndrome or CPRS.
According to the National Institutes of Health, RSD affects up to 5 percent of people who suffer from a nerve injury, but doctors believe this might be a low estimate. While it can strike at any age, it is most common in women between the ages of 40 and 60. Recent reports indicate that the number of cases is rising among adolescents and young adults.
Diagnosing RSD is difficult, partly because it means different things to different people. According to Dr. Srinivasa Raja, professor of anesthesiology in the division of pain medicine at Johns Hopkins University in Baltimore, "If you take five patients with RSD, they don't all look alike."
Patients are often mislabeled because the symptoms appear to be unrelated. "They have a sprained ankle and end up with a swollen limb," says Raja. The disorder often leads to depression, which further complicates diagnosis. "As a result, some physicians who are not familiar with the condition can label them as psychologically disturbed rather than patients in a disease state."
Just as there is no gold standard for diagnosis, there also is no standard for treatment. According to Dr. Steven Pinsky, an anesthesiologist and director of pain management at Mercy Medical Center in Rockville Centre, "Evidence-based medicine has not yielded any proven treatment. Everything is anecdotal."
Still, several options are available, and research is being done to find more effective treatments. Some doctors have success with nerve blocks, spinal cord stimulators and pain medicines, including morphine. Argoff is conducting research using Botox to temporarily halt the painful muscle spasms that appear to be associated with the nerve injury. Dr. Paul J. Sorrel, a physiatrist with North Shore Pain Specialists in Jericho, is using subcutaneous infusions of lidocaine to provide pain relief with promising results.
The goal to dull the pain enough so patients can restore function and mobility to the limb. That's why aggressive physical therapy is a must. "A lot of the nerve blocks are used in part to reduce the pain and facilitate the physical therapy of the patients," says Raja. "We can order physical therapy, but if the pain is severe, they will never go."
Without movement, the extremity can become useless. Ranieri has gotten to the point where she can't move her entire arm. And she fears that the pain is spreading to her legs.
Doctors are unsure whether the pain is actually spreading or if the nervous system has become so sensitized that it becomes almost reprogrammed to transmit pain. But they do know that the pain can go away if the condition is treated early and aggressively.
Ellie Byrnes of South Hempstead was diagnosed with RSD in her right arm after she underwent extensive thoracic surgery at age 15. "I went for nerve blocks three times a week for 12 weeks. I did some physical therapy. Once I started with the treatments, I didn't complain of pain."
The bottom line, says Argoff, is, "you don't want to wait for the problem to be well established. Ignore the people who say you can wait. You're missing the best opportunity to get it treated." Copyright © 2003, Newsday, Inc.