WINGS OF HOPE
REFLEX SYMPATHETIC DYSTROPHY
SYNDROME AWARENESS
JESSICA FEDERICO
“There is no cure, but there is always hope”
MY STRUGGLE
• October 7th, 2004
• 15 months of searching
• I visited numerous Dr’s
on the island, yet no one
knew the reason why I was still in so much
pain.
• Dr John Saroyan at Columbia Presbyterian
Hospital’s Pediatric Pain Management Center
R.S.D.S.A.
• Promotes public and professional awareness of
RSD.
• Educates those afflicted with the syndrome, their
families, friends, insurance companies,
healthcare providers, and others.
• Encourages those with RSD to offer emotional
support to others through affiliate support
groups.
• Supports research and has funded $1,243,371 in
fellowships and research grants since 1992.
RSD – WHAT IS IT?
• Reflex Sympathetic Dystrophy Syndrome, also
known as Complex Regional Pain Syndrome or
Causalgia, is a chronic neurological syndrome that
usually develops at the site of a minor or major
trauma injury.
• Best described in terms of an injury to a nerve or
soft tissue that doesn’t follow the normal healing
path.
• Development doesn’t appear to depend on the
magnitude of the injury.
WHAT ARE THE CHARACTERISTICS?
• After an injury, the
sympathetic nervous
system seems to assume
an abnormal function.
• Severe burning pain
• Pathological changes in
bone and skin
• Excessive sweating
• Tissue swelling
• Extreme sensitivity to
touch
• Rash
RSD TYPES 1 & 2
• Type 1 occurs where cases in which the nerve
injury cannot be immediately identified
• Type 2 occurs where cases in which a distinct
“major” nerve injury has taken place.
– The presence of an initiating destructive event, or a
cause of immobilization.
– Continuing pain and allodynia with which the pain is
disproportionate to any inciting event.
– Evidence at some time of edema, changes in skin
blood flow, or abnormal sudomotor activity in the
region of the pain.
THE SCIATIC NERVE
In this illustration, the pain
pathway of RSD originates in
the leg, coursing through the
sciatic nerve. This then
connects with the spinal cord
and makes its way to the
brain, triggering a
sympathetic inflammatory
response in the leg, resulting
in pain and swelling. It could
also result in losing mobility
to the limb.
TREATMENTS
• Seeing as there is no cure for RSD, treatment is
aimed at relieving the pain.
• Different medications doctors have prescribed
include topical analgesics, antidepressants,
corticosteroids, and opioids.
• Other treatments include physical therapy,
sympathetic nerve block, spinal cord stimulation,
and morphine pumps to deliver opioids and local
anesthetic agents via the spinal cord.
FACET JOINT BLOCK
INJECTION
• Each vertebra in the spine is
connected by two facet
joints.
• Facet joint blocks can be both
diagnostic and therapeutic.
• This injection can confirm
whether the facet joints are
in fact the source of the pain.
• Helps to relieve the pain and
inflammation
KETAMINE TREATMENT
• Manipulates the NMDA receptors which might
reboot unusual brain activity.
• 2 different treatments.
1) IV line with low dose (25-90 mg) per day, over a five to ten
day infusion, either as an outpatient or in the hospital.
2) Medically-induced coma with extreme dose (600-900 mg).
This is not available in the USA, but is mostly done in
Germany, and recently in Monterrey, Mexico.
• Ketamine treatment is the first known
treatment to show lasting results and even
place patients into remission.
Dr. H. Hooshmand, M. D.
“Remember, it is not all in your head. It is all over
your body. It starts from one extremity or one
part of the body and if not properly treated, it
spreads to the other parts of the body. Don't let
anybody convince you to be treated exclusively
by a psychiatrist or to "learn to live with your
pain". Just remember you are not crazy. The pain
of RSD is enough to drive anybody out of their
mind but what I admire is the fact that RSD
patients still keep their sanity.”
WORKS CITED
•
"Complex Regional Pain Syndrome Information Page:." National Institute of Neurological
Disorders and Stroke (NINDS). Web. 01 Dec. 2009.
http://www.ninds.nih.gov/disorders/reflex_sympathetic_dystrophy/reflex_sympathetic_dystr
ophy.htm#Is_there_any_treatment
•
"Ketamine -." Wikipedia, the free encyclopedia. Web. 02 Dec. 2009.
http://en.wikipedia.org/wiki/Ketamine
•
"Opioid -." Wikipedia, the free encyclopedia. Web. 02 Dec. 2009.
http://en.wikipedia.org/wiki/Opioid
•
"RSD / CRPS English Index." Reflex Sympathetic Dystrophy (RSD), Complex Regional Pain
Syndrome (CRPS) - International Research Foundation for Reflex Sympathetic Dystrophy. Web.
01 Dec. 2009. http://www.rsdfoundation.org/en/index.html
•
"RSD Puzzle #086." RSD/CRPS. Web. 30 Nov. 2009.
http://www.rsdrx.com/rsdpuz4.0/puz_86.htm
•
"RSDSA :: What is CRPS?" RSDSA :: Home. Web. 24 Nov. 2009.
http://www.rsds.org/2/what_is_rsd_crps/index.html