Tuesday, May 16, 2006

Trauma to hands or feet leads to lasting pain

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Trauma to hands or feet leads to lasting pain

Tuesday, May 16, 2006

I was diagnosed with RSD after an injury to my arm. The pain is very severe. My fingers are stiff and painful, and there is pain in my wrist, arm and elbow. Can you give me more information about this problem, which I had never heard of before now?

Reflex sympathetic dystrophy is part of a disorder called "complex regional pain syndrome." The cause of this poorly understood condition is not known. It is a malfunction of a part of the nervous system that usually starts after a traumatic event to the hands or feet. This event can be a sprain, dislocation, fracture, crush injury, laceration or surgical procedure. The syndrome also has been associated with medical conditions such as diabetes, multiple sclerosis, stroke, and heart attack.

Complex regional pain syndrome is uncommon. Many cases are misdiagnosed for extended periods of time. The symptoms typically begin a few days or weeks after an injury, and include severe throbbing or burning pain, swelling and changes in skin color, temperature and moistness. The skin over the affected area becomes very sensitive to even light touch. In many cases, the muscles and bones are eventually affected.

Psychological symptoms, including depression and anxiety, are common. The symptoms of complex regional pain syndrome persist long after the initial injury should have healed.

Making the diagnosis of complex regional pain syndrome can be a challenge. A detailed history and physical examination are often the best tools. X-rays, bone scan, nerve blocks, MRI, and certain other tests can sometimes help.

The treatment of this condition is complex. Each case is treated according to the special needs of the patient. Usually, treatment includes a team approach involving a physical therapist, pain specialist or anesthesiologist, orthopedist, psychiatrist, occupational therapist, physiatrist and the patient's family physician. No one treatment has been shown to be more effective than others.

Some of the medications used are painkillers, including nonsteroidal anti-inflammatory agents, topical anesthetic creams, narcotics, antidepressants, certain anticonvulsants and clonidine. Other treatments include transcutaneous electrical nerve stimulation, invasive spine stimulation techniques and nerve blocks.

The long-term outlook for people with complex regional pain syndrome is mixed. Milder cases may resolve over time, while more severe cases can progress to produce crippling changes. Hopefully, future research will lead to the development of more effective therapies.

For more information, contact the Reflex Sympathetic Dystrophy Syndrome Association of America at (203) 877-3790 or go online to www.rsds.org).

Write to Dr. Dennis Cardone, at UMDNJ-Robert Wood Johnson Medical School, Department of Family Medicine, 1 Robert Wood Johnson Place, New Brunswick, N.J. 08903. Or e-mail him at askthedoc@umdnj.edu.

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