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Reflex Sympathetic Dystrophy (RSD) (CRPS) Message Board

Reflex Sympathetic Dystrophy (RSD) (CRPS) Board Index

Re: Vitamin B & RSD
Dec 14, 2003
Hi Pran,
The amitriptyline make me a little groogy in the morning. It also helps me sleep. I take 1200 mg of neurontin a day & do okay on that. My PM doc tried to increase it to 2400 mg a day (I was showing signs of spread to my other hand) but that made me too groogy. I take 1/2 a lortab at a time. If the pain is still too bad in half an hour, I take the other half. With the new TENS unit, I have been taking only 1 and half per day. I still have pain but try to find a happy medium between the pain and the drugs. We are different in what helps us and what we can tolerate. Some people can't stand the neurontin because of the ringing in the ears and other side effects. I do have some ringing but it's okay with me because I don't have any other side effects. You have to find the drugs that work for you.
Are you doing any physical therapy? My new physical therapist has specific exercises for RSD. She has seen people go into remission after doing these. What about never blocks? I have had 5 and took a break two weeks ago to see what would happen. I see my PM doc tomorrow. I hope he gives me more because they were helping & there has been no improvement during the break.
I have had RSD since August 14th and am trying everything I can to kick this nasty disease into remission.
Good luck & let us know how you are doing.
Best wishes & hugs, :wave:
Re: Vitamin B & RSD
Dec 14, 2003
Guys...I wish i could cut and paste the article, but it was given to me by David's first Pain Consultant and I have never been able to access the site it came from. So here comes another episode. LOL

" Each subset acts quite differently and is treated differently. Only one of these subsets is what is called RSD, which is why we have so many different symptoms and presentations even though we have all been dignosed as having RSD.

Now I want to back up and follow the lecture given by Dr Robert Schwartz when he described how the different syndromes cause different symptoms and how to treat each syndrome. Remember there are two different nervous systems: The somatic system and; the autonomic system. The somatic is controlled by our thoughts. We tell a muscle to move and it does. The Autonomic system controls the functions that our mind cannot or doesn't control (the size of our blood vessels, sweating, etc ). A good example is when your bladder needs emptied, your brain doesn't tell you to empty it, you just feel you need to go.

The sympathetic nerves come from the spinal cord, they join the nerve root and they end in the blood vessels, hair follicles, the brain and muscles. They interact at the ganglion which is near the spinal cord and they go to the limbic system of the brain which moderates endorphins and emotions. The sympathetic reaction is the fight or flight response.

A nerve fibre has negative ions inside and positive outside. A stimulus allows the unions to move back and forth. When the system doesn't work right the ions don't go back. When it doesn't recharge it will refire more easily. Nerve membranes can be irritated by a virus, lack of oxygen, or something pushing on it.

RSD is what the text books call it. RSD is what we have all been diagnosed with, but what exactly is RSD. The text books describe RSD by it's symptoms. The latest definition is CRPStype1. This more general description doesn't speak about RSD coming from the sympathetic nervous sysytem because many of those who are diagnosed with RSD have sympathetically independant pain. ( Edna interrupts here to say that David now has SIP, and blocks and scs are no longer of use to him ) Let's review the five syndromes and the way in which Dr Schwartz feels they should be treated.

The RSD Syndrome.
RSD occurs because the sympathetic system reacts to an injury and the nerves continue to fire, long after the original injury has healed. The nerves never return to a normal state after reacting properly to the signal that part of the body is in danger. The pain is described as burning, achey, and cold. Movement and touch causes excessive pain(hyperalgesia). The limb wll suffer from vasomotor changes causing the skin to become bluish. Sudomotor changes cause either too much or too little sweating and usually some swelling in the beginning but none once the RSD advances to a higher stage. A limb may be cold even although it is sweaty. If left untreated contractures may occur and there is loss of movement and muscle atrophy. Bone begins to lose calcium and the RSD may spread. As one nerve misfires so the one next to it is caused to misfire. This causes an effect throughout the body's nervous system.

The treatment of RSD includes: Sympathetic Blocks which will stop the symptoms by allowing the nerves to return to resting stage. A few years ago the Nobel prize was given to a physician who discovered that all drugs given by mouth cause an electrical change. Vasodilators increase blood flow by relaxation or dilation of blood vessels. Antidepressants work on the brain itself to make you less aware of pain, anxielytics decrease the effects of stress and anxiety on the body, and physical therapy increases mobility and maintains muscle tone of the injured limb.

That's all for tomight guys.

Edna xx
Re: Vitamin B & RSD
Dec 18, 2003
Here we go again guys. Glad you are gaining more knowledge about the different syndromes. Hope it is of some help.
The Dystonic Syndrome.

The dystonic syndrome is another subset of RSD. This syndrome involves movement disorder. It used to be thought that RSD was just a painful condition and that it didn't affect movement at all. In the 1980's Dr Schwartzman and Dr Kerrigan showed that the sympathetic nervous system dysfunction of RSD caused different kinds of movement disorders. The disorders include: Decreased co-ordination and dexterity; decreased ability to initiate movement (the brain will think , "move foot" but the message is delayed in reaching the foot. It will move, but it doesn't happen immediately. If a person is walking and there is a delay in one foot moving, the forward movement of the body will cause this person to fall, because there is a delay in the foot moving forward; balance may be affected. Dystonia may occur causing the limb to contract or get stiff while the muscles are extended; a motor dystrophy may occur ( constant contraction and relaxation of large muscle groups )

These movement disorders cannot be stopped. Remember that Dr Schwartz said that people with classic RSD would not get contractures if they used their limbs? If a person suffers with a dystonic syndrome no amount of physical therapy will prevent or reverse the movement disorder. I spent 5 hours a day, 5 days a week in hand therapy for 6 months because I was told that if I worked hard my contracture and my RSD would get better. I worked so hard and yet my contracture went from 3 degrees to 90 degrees.

It is believed that the movement disorders are caused by the wide dynamic range neurons transmission (the static between two nerves). It is like having a broken traffic light when lots of signals are reaching the brain at the same time. Static that is caused when one or more nerve fibres fire so often and erratically that it causes the nerve fibres next to them to fire also.and/or it is in the feedback between the peripheral muscle spindle and the sympathetic efferent nerve fibres. I described the way it felt, as if metal wires had been put in the tip of my fingers and they ran through my fingers and hand, out above the wrist, back in at the elbow, then ran through my shoulder, and out through the centre of my head. Then it felt as if someone was pulling so tight that it pulled my fingers into my palm and my wrist to 90 degrees.

Treatment of the Dystonic Syndrome may include: Muscle relaxers to help decrease muscle spasm/tension; NSAIDS to help with the pain response; Parkinson agents to help decrease muscle spasm/ tension; Anxielytics which help control the brainstem which controls muscle and tone; Botulinum Toxin may be injected directly into the contracture in minute amounts which makes the overtight muscles a little weaker to decrease tone and increase movement. Edna interrupts to remind you that Botox ( Botulinum Toxin ) is now becoming popular in the treatment field.

Only one more to go guys. Thank goodness !!! Sorry about all the typing errors. LOL.

Edna xx[B]

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