Treating Reflex Sympathetic Dystrophy (RSD)

Life is infinitely stranger than anything which the mind of man could invent.

– Sherlock Holmes

 

Treating Reflex Sympathetic Dystrophy (RSD)

There are many treatments available for this disease. These include physical therapy, occupational therapy, medication therapy, sympathetic blocks, spinal cord stimulator, intrathecal pumps, and most recently Ketamine infusion therapy. Additionally, it is important to educate the patient on diet, nutrition, lifestyle change, stress reduction (with meditation, prayer, yoga, etc.) to facilitate a coordinated approach of mind and body to the treatment. Additionally, familial support is extremely helpful and family members should be brought in to the treatment plan both in terms of comprehension and understanding of the symptoms as well as ways to assist the patient. Each of the aforementioned treatment entities has a place in RSD/CRPS therapy and the benefits and risks of each one should be weighed by the clinician on a case by case basis. Certainly, however, continued movement and mobilization of affected limbs is imperative to whatever degree the patient can tolerate.

I have been treating Reflex Sympathetic Dystrophy since the mid-1990s. To date, I have evaluated and treated more than 750 patients with this disorder. I continue to work with other experts in the field to search for new ways to help patients and there are many innovative studies ongoing and many planned to hopefully affect a better treatment regimen.

I am frequently asked how it is that I came to become involved in the evaluation and treatment of these patients. The story is an interesting one and bears repeating.

In the early 1990s I had a patient in my practice who was complaining of pain with other symptoms. Quite frankly, I had no idea what was wrong with the patient as all of the diagnostic tests were normal and I was confused. Being an admitted mystery buff, I was intrigued by the fact that not only did I not have a diagnosis but the four or five specialists to whom I referred her were similarly at a loss to explain her problem.

I went to a local medical school library on a Saturday morning and spent the entire day going through medical texts. (Remember this was before the age of the Internet.) Having failed in my attempt to come to a conclusion as to the source of her pain, I returned the following day. By midday I had come upon references to causalgia (the precursor term for RSD and one that has returned in today’s terminology) and Reflex Sympathetic Dystrophy. I realized that I had found the answer to her problem and was able to move forward in helping her. I had “solved the mystery”! I later realized that I had two additional patients in my practice with the disease who were being treated for pain without recognizing the full extent of the underlying problem.

At that point in time, I embarked on a journey to learn as much as I could about the disease. I read extensively much of what was written although at that time it was not nearly as voluminous as it is currently. I went to lectures all around the country and met experts in the disorder, most notably Dr. Robert Schwartzman, head of neurology at Hahnemann Hospital (now Drexel University Hospital). We developed a friendship and a working relationship and collaborated on many patients and different conceptual ideas. At his urging, I gave my first lecture to the RSD Association of America in 1998.

Since that time, we have continued our relationship establishing protocols in 2004 for Ketamine infusion therapy. Dr. Schwartzman was kind enough to ask me to join the teaching staff at Drexel University Hospital as an Assistant Professor of Medicine in the Department of Neurology (I am the only non-neurologist so honored) because of my extensive work with patients with RSD/CRPS.

To date, I have treated over 100 patients with Ketamine infusion therapy and am pleased to report that while official statistics are still being compiled better than 80% of those treated have reported improvement. My office was the third center in America to begin the treatments using this modality of therapy and we continue to do so at this point in time. For additional information regarding Ketamine treatment please see the other articles on this website.

Did You Know?

that RSD can cause intermittent hoarseness by affecting the branchial plexus? The hoarseness is NOT allergies or "getting sick" - it is a manifestation of the disease!

 
 

Featured In

The Pain Practitioner, December 2016. CRPS is underdiagnosed. Estimates of the number of people diagnosed with CRPS range from 250,000 to 2 million, and it is estimated that at least 50,000 new cases are diagnosed every year. Click here to read this article.

 
 

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