Wednesday, January 11, 2006

Pain as constant companion

Jill Korzon, originally uploaded by rsdscrpsnews.

Pain as constant companion

A simple fall or broken bone can sometimes lead to reflex sympathetic dystrophy — a chronic pain syndrome.
Posted by the Asbury Park Press on 01/10/06

Jill Korzon of Brick ran track in high school. When she was 15, she hurt her knee in the weight room, had arthroscopic surgery, and, in a very real sense, the pain has rarely left her.

That was nearly a decade ago.

"On a bad day, I couldn't get out of bed," she says. "The pain would spread all the way down my leg to my foot."

Korzon has something called Reflex Sympathetic Dystrophy Syndrome also known as Complex Regional Pain Syndrome, a chronic neurological syndrome. According to the RSD Association, the condition is a malfunction of part of the nervous system after an injury. Nerves misfire, sending constant pain signals to the affected area.

The syndrome involves the sympathetic nervous system, says Dr. Richard Fernicola, a pain management specialist affiliated with Shore Rehabilitation Institute of the Ocean Medical Center in Brick.

The sympathetic nervous system, Fernicola explains, is a part of the nervous system that operates involuntary responses such as the "fight or flight" response.

There are four basic factors that can bring about the condition, he says: infection, trauma, surgery or some vascular abnormality.

"The trauma can be anywhere from minimal to severe," Fernicola says.

RSD is felt in the two or three weeks after the initial assault on the system, but sometimes is triggered by a trauma or infection so ostensibly minor that it goes unnoticed in the patient.

"What happens is that things don't go in the right direction," says Fernicola. "There is a change or worsening in the area characterized by redness, burning sensation and swelling. And pain. The trauma can be anywhere from minimal to severe," Fernicola says. "In fact, it seems that a fracture of the long bones in the arm or the leg is less likely to bring on the condition than, say, a fracture of a bone in the hands or the feet."

The fact that the malady goes by a number of different names may make a diagnosis of RSD difficult, says Fernicola.

And that's not good.

"Early intervention is key to treatment of RSD," Fernicola says. "Even with early diagnosis, it can take a full year and a half to regain a productive life. As the condition goes through three stages, the chances for a cure decline, leaving only palliative care."

Andrew Aylett agrees that early therapy can be very effective in treating RSD. Aylett, an occupational therapist and certified hand therapist whose practice, Advanced Hand Therapy in Wall, knows that RSD is not a common diagnosis but one that needs to be treated quickly when detected.

There is a limited window of opportunity to make an improvement, Aylett says.

Fernicola says that in the latter stages of the syndrome, doctors may be reduced to giving palliative care.

"What you have with RSD are nerve endings firing incorrectly, causing disproportionate pain. I've seen patients who could be brought to tears by blowing on their arm," Aylett says.

Aylett says that in the presence of RSD, therapy has to include gentle desensitization techniques.

"Aggressive therapy may well reinforce the incorrect firing of nerve cells and make the condition worse.

Korzon was diagnosed with RSD within three months of her injury.

"Some people go years without being diagnosed," Korzon says.

Indeed, after physical therapy and treatment, Korzon's RSD went into remission for a number of years.

"Then, during my first week in college, I slipped and fell on a wet floor," she says.

And from that day to the present, Korzon has battled the pain.

Treatments can include physical therapy to increase the range of motion. For more severe cases anti-depressant or anti-seizure medicines are prescribed.

Then there are the needles.

"Blockers," Korzon calls them, and over the years, she has had plenty of them.

They are injections of numbing agents and a steroid that can provide relief for weeks at a time. But they are not without their own kind of pain.

"When the needle touches the nerve, it can feel like something touching the exposed nerve of a tooth," she says.

Their value, says Fernicola, comes in their ability to "break the cycle" that causes the excruciating pain.

Korzon also has used devices that provide electrical stimulation to surface nerves, which helps block the transmission of pain.

In some cases, Fernicola says, surgery is indicated. "Cutting away part of the "ganglia" — the bundle of nerves that sends the messages of pain.

Korzon has not had that kind of surgery.

For now, Korzon says, she lives with an implanted device to block pain, takes daily medicines and is researching experimental treatments.

Over the years she has undergone a wide variety of treatments.

"Everything helps, but nothing helps permanently," Korzon says.

Yet there is hope.

"My daughter, Raina, is 1 year old," she says. "I look at her, and know I have to push through the pain."


Reflex Sympathetic Dystrophy Syndrome, also known as Complex Regional Pain Syndrome, is a chronic pain syndrome characterized by severe and relentless pain. It affects between 200,000 and 1.2 million Americans.

CRPS/RSD is a malfunction of part of the nervous system. Nerves misfire, sending constant pain signals to the brain. The syndrome develops in response to an event the body regards as traumatic, such as an accident or a medical procedure. This syndrome may follow 5 percent of all injuries.

CRPS/RSD is two to three times more frequent in women than men.

The mean age at diagnosis is 42 years. More injuries are being seen among young girls, and children as young as 3 years old can get CRPS/RSD.

Source: Reflex Sympathetic Dystrophy Syndrome Association
Related Links
RSD Association
Agency for Healthcare Research and Quality

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