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How RSD is trreated

I think many of us are used to a specific illness having a specific treatment. An ear infection or strep throat gets antibiotics, a broken ankle gets a cast or surgery, etc... My perception of medicine is that it's rarely that precise, and from the numerous stories I've read, RSD/CRPS treatment isn't that precise at all. The hard thing is that RSD doesn't always respond in the same way in each patient, and even when it does, it seems that we don't understand why RSD does what it does.

That said, there are several types of treatments which do help enough people, or give the perception of helping enough people that they are relatively standard attempts with RSD. I'm going to give some references at the end of this piece, because they frequently overlap and citation would be tricky. I'd also refer you to my paper
CRPS: The Condition of Hell
which appears in the blog and in the book. I broke down a lot of the treatments there, too. So without further procrastination, here are just some of the treatments used with RSD.

Physical therapy: Almost every person with RSD seems to go through this at one point or another. For some, it is successful, and for others, it isn't. What seems to be most successful is re-establishing normal movement, working on techniques to strengthen the RSD-affected area, desensitization, movement, movement and more movement. The trick is that the maxim of "no pain, no gain", doesn't work. The best I understand it is that because the nervous system is already overloaded with pain, physical therapy which is too intense only increases the nervous system's response, and thuse compounds the problem But physical therapy which gently makes the limb regain normal function is much more effective. The trick, as I understand it, is to use things which help the RSD pain in combination with the more challenging tasks.

Nerve blocks: Nerve blocks are basically injections of anesthetic into nerves which are believed to be causing or contributing to the pain. In RSD, that's usually a sympathetic nerve block. So for a foot or leg, the injection is actually next to the spine in the lower back (lumbar) area. Interestingly, sympathetic nerve blocks cause the blood vessels to dilate, and the limb gets warmer. IThis is sometimes used to help doctors understand how much a nerve or group of nerves contributes to the pain.It can't really completely diagnose RSD, because sometimes the sympathetic nerves aren't the problem. Nerve blocks can give great relief for some people. I used to be one of those people. But it seems like I've reached the point where the effort of the nerve block doesn't come back in enough long lasting pain relief.

Medications: There are tons of meds which are used in RSD. I really couldn't go into them all without writing a really huge post, but there is some great information out there on the
How to Cope with Pain blog
RSD Hope
site. Medications can be highly charged topics, especially in treating chronic pain. Perhaps that's something for a future post, but I know I've written about meds before, and the emotional choices around them.

Complementary treatments: We have a lot of complementary treatments available to us. Acupuncture, biofeedback, psychological counseling, meditation, guided imagery, massage... The list goes on. But none of them is a complete cure for RSD. Still, they are available, and they can significantly help our quality of life.

I think this is enough about the availability of treatments for RSD for now. The important thing to know is that there are treatment options, but there isn't one which is completely perfect.


CRPS Treatment Options Continuum
How to Determine the Effectiveness of Treatments for RSD/CRPS
Reflex Sympathetic Dystrophy Clinical Practice Guidelines


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Nov. 4th, 2007 12:32 am (UTC)
Graded Motor Imagery and Mirror Therapy
Great post. 2 other treatments that I'm excited about using and have begun to use with patients are Graded Motor Imagery and Mirror Therapy. In particular, because they're not medication, nor invasive. Graded motor imagery is a progressive movement series, first imagining, then actually doing movements. Mirror Therapy is re-training your brain to get off the pain track, through your vision.

I've written a bit about them on my site, How to Cope with Pain (http://www.howtocopewithpain.org/blog/35/interview-with-dr-moseley-graded-motor-imagery-treatment/).

I'd be curious if any of your readers have tried them.
Nov. 4th, 2007 04:33 am (UTC)
Re: Graded Motor Imagery and Mirror Therapy
You have a great point. I forget frequently about those as viable options, because they don't seem to be possibilities for someone who can't see. Which is pretty short sighted of me, I know. I'll post about that soon, though, or add that link to the references section of this post.

Thanks so much for reading and reminding me about that. Also, I will definitely be emailing you soon. I'm just incredibly behind on email right now.
Nov. 5th, 2007 12:48 am (UTC)
Re: Graded Motor Imagery and Mirror Therapy
After I interviewed Lorimer Moseley on my How to Cope with Pain site, a reader wrote in to ask how to modify the treatment for those with limited sight. He mentioned that imagining your body moving, e.g. what it feels like jogging, bowling, or any specific movement, would be great therapy too. It's an interesting challenge.

For those who're interested, the link: http://www.howtocopewithpain.org/blog/41/follow-up-about-graded-motor-movements/
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