Wednesday, February 01, 2006

PAIN THAT LINGERS LONG AFTER AN INJURY IS A TREATMENT CHALLENGE


Sun-Herald, originally uploaded by rsdscrpsnews.

12/29/05

PAIN THAT LINGERS LONG AFTER AN INJURY IS A TREATMENT CHALLENGE

DEAR DR. DONOHUE: My niece was rear-ended in a car accident more than a year ago. There was extensive damage to her right shoulder, arm and hand. She was still in pain long after the accident, without anyone being able to tell her why. Finally, a doctor diagnosed sympathetic reflex dystrophy. Even now, she is in constant pain, with no mobility of her right hand. The hand has changed color. Please address this condition in your column. -- C.S.

ANSWER: Reflex sympathetic dystrophy's name has been changed to complex regional pain syndrome. It involves pain, nerve impairment and blood vessel changes that occur at the site of an injury and persist well after the usual expected recovery time. The injury does not have to be as severe as your niece's. A simple sprain can bring it on.

A series of changes occurs. Somehow, nerve disturbance produces lingering pain and great sensitivity to weather changes -- especially to cold. Early on, the skin is red and warm. Three to six months after symptoms appear, the skin becomes blue and cold. Joints in the affected area can stiffen, and muscles shrivel and weaken. In time, the skin thins and takes on a glossy appearance. It's speculated that the sympathetic nervous system -- the part of the nervous system not under voluntary control and the part involved with such things as blood flow -- is misfiring. That's why the syndrome used to be called sympathetic reflex dystrophy.

Physical therapy is a must for anyone with this problem. Occupational therapists can teach patients how to overcome their disability by demonstrating how to use special devices that permit them to cope with their disability. Pain-relieving drugs like ibuprofen often help. If they don't, stronger analgesics are prescribed. The seizure medicine Neurontin and the antidepressant medicine amitriptyline are given, not to prevent seizures or to treat depression but to provide pain relief. Both can be used for that purpose. Nerve blocks help some people.

If you niece is not making progress, she should investigate rehabilitation centers or pain clinics. Both can be found in all metropolitan areas.



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