Ask Dr H
By Dr. Mitchell Hecht
Knight Ridder News Service

Surgery eased RSD pain, but only temporarily

In 2001, I was diagnosed with reflex sympathetic dystrophy (RSD) due to a tibia-fibula (lower-leg) break in 1999. In 2002, I had a lumbar sympathectomy to relieve the pain going down my left leg. It worked until late 2002. Could you please describe RSD and what might have caused the reversal of remission? I see the orthopedic surgeon monthly. Will I ever be pain-free?

For those of my readers unfamiliar with RSD, it's a chronic-pain syndrome that typically, but not always, involves a limb that has sustained some sort of trauma, such as a broken leg, arm or collarbone. Spinal-cord injury also can result in RSD. While it may sound similar to peripheral neuropathy from a condition such as diabetes, RSD is different. For one thing, it may result from injury to the central nervous system (i.e., the spinal cord). And more important, there's more than the usual peripheral nerve injury when a limb or collarbone break traps a nerve.

The sympathetic nervous system gets involved, resulting in the production of norepinephrine (it's like adrenaline) in response to injury. That's why folks with RSD suffer not only pain, but also dramatic changes in the color and temperature of the affected limb or body part, as well as increased sweating and swelling. There may be burning pain at the site of injury for weeks, months or even years after the original wound has healed. Brittle, broken nails and decreased hair growth in the affected limb may be seen. Blood circulation is affected in RSD. You don't see this in typical peripheral-nerve disorders such as carpal-tunnel syndrome or diabetic neuropathy.

RSD is not considered curable, since it's a chronic condition whose symptoms wax and wane. Treatment options include physical therapy to restore range of motion and function; psychotherapy and possible antidepressant use (antidepressants do help in chronic-pain syndromes, since the brain interprets all that is painful); pain medications and muscle relaxants; nerve blocks for the sympathetic nerve; and pumps that can administer pain and numbing medication into the spinal fluid. Sympathectomy to cut the overactive sympathetic nerves can provide lasting relief, but it has been known to make RSD worse.

I'd recommend seeing a pain-clinic specialist and a neurologist for treatment options. The RSDSA is a great resource to contact at www.rsds.org or 1-877-662-7737.

March 29, 2004