Wednesday, February 15, 2012

Tuesday, September 23, 2008 bill5martin asks

Q: What exactly is RSD and it's treatments? Related Questions

My mom had a stint put in her artery 7 months ago. After they did it. She had severe pain in her right arm and they couldn't figure out what it was. They think it is RSD. They said it was part of the risk of any surgery or for the procedure she had done.

 

Can anyone explain what it is and how it is caused? Also, what are the best treatment?

 

She was taking OxyContin 40 mg 3 x a day and it worked, but stopped due to SEVERE depression and mood changes. She stopped taking the drug cold turkey(She did have some Dilaudid 2 mg, but those were for break through pain and she didn't have many). She is a very strong woman, but I have seen her in so much pain, she has tears coming down her face, she can't get any good sleep. She barely eats anything now. She is currently taking Dilaudid 4 mg every 4 hours around the clock. She can take 6 mg, if the pain gets to intense. The drug doesn't stop the pain, but helps. She has a lot of breakthrough pain, but can't do much about it. She is depressed and says she feels like her life is just slipping away. She needs help with a lot of stuff and it bothers her.

 

I have noticed something about the pain. If you hold her arm a certain way. You can't always find the spot and it does hurt to touch her arm sometimes, but the pain drops almost 70-80% she said. She was in pain one day and I held her arm for about 30 seconds ( she had to move and I helped her). During that time she fell asleep, because the pain was lowered and she was so exhausted. I gently put her arm down, but she woke up 3 minutes later in pain. I am thinking she may have RSD, but also a pinched nerve as well. Can a pinched nerve be fixed? Her Cardiologist said he has seen RSD before from doing this procedures, but never this bad (He is a great DR. and even apologized, which is rare with lawsuits these days). I think the pinched nerve is making it much worse.

 

She sees a Neurologist today. He can diagnose the RSD. I am hoping he can help her. He helped my cousin with severe back pain. He used Cymbalta, which doesn't help my mom. She has been on 30 mg for two months and it hasn't helped. They are upping her dose to 60 mg. I read there can be withdraws from Cymbalta, is this true? She is on a lot of medications right now. She takes Ambien CR which has helped a little with sleep. She said she thinks two would help her sleep better, but wants to talk to the Dr. first. She can only get 15 a month through insurance. The rest is out of pocket. She had a script for 20 and was charged $35 for the extra 5 of them. I know doctors have samples. So I am hoping she can get some samples, because my parents don't have the money to pay that each month. Any information would be appreciated. You can PM me, if you have any questions or need something clarified. Thanks in advance for any information you provide.

 

I would appreciate any info on Alternative Treatment too.

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Answers (1)
9/23/08 10:18pm

Reflex Sympathetic Dystophy (RSD) actually started to be called Complex Regional Pain Syndrome (CRPS) some years back. Compared to what your mom is going through, the words don't really matter though. Typically, the diagnosis of RSD/CRPS means that there has been an alteration in the normal pain responses. Imagine that the pain system in your body is like an alarm system. During normal circumstances, like light touch, the alarm does not go off. But, then something happens, like a surgery, all the sudden the alarm system becomes too sensitive and signals a painful alert even with a light breeze. Talk about faulty wiring.

 

Normally, the pain from a overly sensitive nervous system is unrelenting. This type of pain does not quit if the limb is held in a certain position. So, I am not convinced that your mom has RSD, CRPS or a sensitized nervous system. Pain that is relieved mechanically is due to a mechanical problem, not faulty wiring. Maybe the nerve is pinched or maybe the artery is blocked. Mechanical problems can be fixed. More tests need to be done because CRPS is a diagnosis of exclusion ( everything else is excluded first, before being thrown in the waste basket of CRPS).

 

Seeing a neurolgist is a great first step. Keep supporting you mom like you are and the two of you can continuing walking towards a solution.

Dr. Christina Lasich, MD

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