THE USC PAIN UPDATE
from the USC Pain Center
I smiled, calmed myself, and examined his arm which had been injured mildly in a fall a month earlier. The elbow and forearm were swollen and red and he would yelp with pain even when I touched the arm lightly. The neurologic examination revealed normal motor and sensory functions of the nerves.
In those days, we were taught that pain would affect specific nerves, and that any pain beyond those specific nerves was considered psychological. We would treat what we could physically, and ship them off to counseling. I had doubts that counseling would help this patient so I gave him some pain medicine and scheduled him for evaluations in the neurology and orthopedic clinics. At that time, I, like most doctors, had never even heard of RSD. It was not taught in medical school.
Today, we know that pain can affect regions of the body beyond what is expected from a given injury. RSD is one of the classic syndromes that can produce such pain. Now, we have many tricks up our sleeves to treat this terrible syndrome. RSD is one of the most confusing diagnoses both for the patient and for the medical team. Much remains unknown about RSD, but there is a greater understanding of RSD than ever before. The problem is not nearly as rare as we initially thought, complicating as many as 5% of all injuries. We hope that the added focus on this misunderstood diagnosis will help to improve patient care.
Other signs of RSD might include abrupt temperature and color changes of the affected area (redness, pallor, blue mottling). The patient may have swelling and sweating changes, dry, flaky or shiny skin, local growth hair loss, and brittle or slow growth nails. Muscles in the area may also become weak and stiff, and jerks and twitches may occur in the affected hand or foot. (Recognition of the difficulty in diagnosing RSD led to the official name change to Complex Regional Pain Syndrome, but it is still most commonly referred to as RSD.)
Physical therapy is crucially important to maintain the mobility and
strength of the area, (as well as to desensitize the patient to touch,
pressure, and movement). It is also important to note that stress triggers
activation of the sympathetic nervous system and increases muscle tension
which unfortunately increases the pain of RSD. Stress management and
biofeedback techniques have been very effective at reducing these reactions
and significantly decreasing pain. Occupational therapy also helps the
patient to get back to a more functional life.
RSD treatment is still in its infancy, but thankfully, we can now reduce
the suffering of many patients.
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