Friday, September 01, 2006

Treatment for RSD

Times Tribune, originally uploaded by rsdscrpsnews.

Treatment for RSD

The focus of last week’s column on reflex sympathetic dystrophy was cause and diagnosis. This week, we’ll discuss treatment and prognosis.

RSD is an overreaction of the body’s neuromuscular and immune system to trauma — sometimes relatively minor trauma.

The cornerstone of RSD treatment is normal use of the affected body part. All of these therapies strive to achieve that.

# Sympathetic nerve block: This will give significant pain relief to 95 percent of patients. One technique involves intravenous administration of phentolamine to block sympathetic receptors. Another involves placement of an anesthetic next to the spine to block sympathetic nerves.
# Physical therapy: Isometric strengthening and active or active-assisted range of motion are emphasized. Gentle weight-bearing exercises promote healing. Whirlpools, massage or moist heat may relieve muscle pain and spasm. A TENS unit — a noninvasive electrical device that stimulates the surface of the skin — may decrease pain.
# Aquatic therapy: Imp-roves movement through buoyancy, while water resistance challenges muscles and balance.
# Biofeedback: Teaches deep relaxation techniques to increase blood flow, which will increase the temperature and decrease the pain.
# Occupational therapy: Desensitization techniques and contrast baths normalize sensation.
# Medications: Medications commonly used to treat RSD include nonsteroidal anti-inflammatory agents, analgesics, steroids, antidepressants, hypnotics, anti-convulsants and muscle relaxants.
# Trigger-point injections: Injection of a local anesthetic into the muscle trigger point for pain relief.
# Removal of trigger areas: Neuromas — tumors of nervous-system cells — may need to be removed for successful treatment of RSD. Injection of phenol or alcohol, or application of radio frequency, can be effective.
# Sympathectomy (nonsurgical): Sympathectomy is a procedure that destroys nerves in the sympathetic nervous system. Chemical, radio frequency and cryogenic sympathectomies are temporary measures; their targets will regrow in three to four months.
# Epidural injections/infusions: Local anesthetics are placed into the epidural space, either with single injections or over a period of weeks.
# Surgical sympathectomy: Destroys the nerves involved in RSD. Some feel it makes RSD worse. Others report a favorable outcome. It’s used only when pain is temporarily but dramatically relieved by sympathetic blocks.
# Spinal cord stimulation: The placement of electrodes next to the spinal cord provides a tingling sensation in the painful area. It also increases blood flow.

The prognosis for RSD varies. For some, complete recovery occurs and symptoms are minor. Some people experience spontaneous remission, while others can have unremitting pain and crippling, irreversible changes.

PAUL J. MACKAREY, P.T., D.H.Sc., O.C.S., is a doctor in health sciences specializing in orthopedic and sports physical therapy. He is in private practice and is an affiliated faculty member at the University of Scranton Physical Therapy Department. His column appears every Monday. E-mail:

Guest contributor: Janet M. Caputo, P.T., O.C.S.

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