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What I would do if I was diagnosed with
Reflex Sympathetic Dystrophy?
Come to Caring Medical for
Prolotherapy!
Ross
Hauser, M.D.
The first pain syndrome I encountered that really got me interested in a
career in pain medicine was
reflex
sympathetic dystrophy, also known as RSD. I don’t want to sound
disrespectful for folks who suffer with this condition, I am just saying
that one reason I went into the
chronic pain field was that I loved
studying about RSD. I amassed quite a bit of medical literature on the
topic of RSD when I was first studying pain. What I felt from the getgo
was that modern medicine was not getting at the root as to what was
perpetuating the disease.
It was clear to me even as a Physical Medicine and Rehabilitation
resident that immobility was one of the reasons RSD occurred. Almost
every case I saw in residency presented with the patient experiencing
quite a bit of time after the initial injury with the limb, foot, or
elbow immobilized. In my opinion, it is a bad idea to immobilize part
of the body, except after a
fracture.
Immobilization is about the worst thing an injured person can do.
Providing movement and circulation to the extremity is the only chance
to heal the area. Even when a joint is swollen, we recommend moving it.
Heat is also recommended instead of ice, as heat increases circulation
to the area, which will mean that healing substances are then sent to
the injured area. Immobility and ice, and for that matter elevation,
decrease healing substances to the area. This means a greater chance of
non-healing and a greater chance for RSD to develop.
RSD is a condition where the patient experiences continuous pain in an
extremity with sympathetic hyperactivity. RSD is typically progressive.
The pain is typically described as burning or aching which is
exacerbated by touch, emotional upset, or active/passive movement. The
pain is tremendous. Yes, even the feel of the bed sheet on a foot with
RSD can be excruciating. Because the person doesn’t move the limb much,
the sympathetic hyperactivity can even cause abnormal blood flow to the
skin,
soft tissues, and bones of the joint. Eventually this may result
in
osteoarthritis of the limb and the person can develops a permanently frozen or
contracted limb.
Recently I had a severely
pinched
nerve in my neck. If I wasn’t a pain doctor and knew what to do, I
definitely would have not moved my involved arm because moving the right
arm caused sharp pains to go down my arm. I suspect I would have
developed RSD with that injury. So what would I do now if I had that
diagnosis?
Number one, I would get as quickly to Caring Medical in Oak Park, IL as
I could. An RSD client needs a doctor passionate about the condition and
one who has had success in treating it and getting people back to normal
living. This involves not only Prolotherapy, but a comprehensive natural
medicine approach. Plus, being a Physiastrist or Physical Medicine and
Rehabilitation Specialist, I can recommend exercises for the patient to
do that will help in treating this disorder.
Why is RSD perpetuated?
Many times RSD occurs after a trauma or fracture of a bone. Typical
starting areas involve the hand or foot. I surmised once I learned the
technique of
Prolotherapy that it was an unhealed
ligament injury that was perpetuating
the RSD. People with RSD who have had trauma to the foot or hand, often
had a fracture. The fracture is treated with immobility. This is good
for the fracture, but bad for the ligaments that were injured during the
trauma. Once the fracture is healed, the orthopedist tells you that you
are fine now and sends the person to
physical therapy.
When the pain increases, the physical therapist and the orthopedist
believe that this is normal after a fracture because of the stiffness of
being in a cast. What they don’t realize is that the person has a
ligament injury and what they need is Prolotherapy. You can guess the
rest of the scenario. The person is put through a host of treatments
that are bad for ligament healing. This includes more immobility,
elevation, ice, and
anti-inflammatory
medications. They really should
be called anti-healing medications. Yes, this includes
Motrin,
ibuprofen, Aleve, Naproxen, and the rest. They have their place, but not
in ligament injuries. Eventually the person sees a chronic pain
specialist that diagnoses the RSD. That is the good news. The bad news
is that they don’t have great treatments for it. The treatments are more
anti-healing therapies like morphine, codeine, vicodin, or other strong
pain relievers. There has to be a better way. The good news is - there
is!
What we do at Caring Medical is to
do a comprehensive natural evaluation.
The person with RSD can do a lot to get themselves healthy. The mainstay
treatment involves natural
hormone replacement. The
hormone tests typically
show that the person with chronic pain has poor healing ability because
of low anabolic hormone levels. Treatments may include
DHEA,
human growth
hormone (HGH), and possibly
Testosterone.
Hauser Diet Typing is done which will show problems with carbohydrate
metabolism and/or
blood pH. These are balanced with changes in the
patient’s diet.
Food allergy testing is also done and allergenic foods
are eliminated from the diet which decreases
systemic inflammation,
which decreases pain to some degree. A
sleep program and
Xyrem for sleep
(if needed) is typically prescribed. Getting a good night’s sleep helps
tremendously. What next?
Exercises are done to tolerance. Putting pressure on the area is
typically ok to do once the extremity has healed some from the
Prolotherapy. Prolotherapy is given to all the painful areas in the
extremity. Typically conscious sedation is given including
Demerol
and/or versed. This makes the
Prolotherapy injections,
(Watch where do
Prolotherapy injections go and do they hurt?)
much more
tolerable for the person with RSD. If they don’t want to get conscious
sedation then pain medications can be taken about 30 minutes before the
visit. Pain control after Prolotherapy is with Ultram, muscle relaxers
(yes valium and its cousins are ok) and Tylenol. Generally one year’s
worth of care is necessary to get the person back to normal function.
Back they come. Back to smiling. Back to laughter. Back to being the son
or daughter they want to be. Back to being the spouse they used to be.
Most of us could be better at that one. Yes, even yours truly! Most
importantly, back to having hope. Hope that the world is a great place
to live and that we all can make a difference in making it better. Hope
that there is a cure out there for RSD and one of the pieces of the
puzzle is Prolotherapy.
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