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 NERVEIn 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.

• 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

FACET JOINT BLOCK INJECTION

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_dystrophy.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