Having problems with message search?
|
-------Original Message-------
> RSD And Spread
> Controversy has developed on the question of whether RSD can, or does
> spread. One side of the camp, usually patients, feels quite strongly that
> spread is a common occurrence. The opposite polarity, usually physicians,
> feel that not only does it not spread, but that it is a localized syndrome
> that affects primarily the hand or upper extremity. Like most debates that
> have extreme points of view, the truth probably lies somewhere in the
> middle.
>
> There is no doubt that many patients with RSD experience new symptoms in
> different body parts then where the RSD originated. While these new
symptoms
> may share similar characteristics with the initial injury it is certainly
> not a universal truth. In fact, distinct characteristics of these new
pains
> often exist.
>
> Nonetheless, since they were never there before, the patient perceives
these
> new symptoms as spread of the original problem. The clinician on the other
> hand looks warily for objective findings such as vasomotor or sudomotor
> instability, edema, contracture, or at least hyperalgesia that is weather
> sensitive. In the absence of convincing evidence in this regard, the new
> symptoms, while noteworthy, do not necessarily represent spread.
>
> Probably more important then the debate of whether this is true spread of
> RSD is the discussion of why these new symptoms occur to begin with. A few
> notable explanations include neuro-humeral mechanisms (via transmitters
such
> as epinephrine from both the nervous system and the adrenals), up
regulation
> of both central and peripheral NMDA receptors and immune response to
hidden
> infection (that once activated has no reason to stay localized to the
injury
> site)1.
>
> More controversial then somatic spread (new symptoms in different
> musculo-skeletal body parts), is somato-visceral spread to the internal
> organs. I have published on this and believe in a minority of cases, most
> likely involving the cardiac, cardio vascular and urogenital systems, that
> it does occur1.
>
> New symptoms in different body parts should not automatically be assumed
to
> represent spread, however an aggressive and objective assessment of the
> situation, without prejudice one way or the other, should occur. A
> significant minority of RSD patients can be proven to have bonifide spread
> of their dystrophy. More often new complaints represent co-morbid medical
> disease rather then a true spread of the RSD itself however2.
>
> Robert G. Schwartz, M.D.
> ___________________________________
>
> 1. "Somatovisceral Reflexes: The Effect of Somatic Pain on Viscera Organs
in
> Reflex Sympathetic Dystrophy", The Pain Clinic, June 1002, 18-22.
>
>
> Links:
> Piedmont Physical Medicine and Rehabilitation
>
> RSD, Fibromyalgia and
>
>
> Fibromyalgia <http://www.wehelpwhathurts.homestead.com/fibromyalgia.html>
>
>
>
> --
>
>
> [Non-text portions of this message have been removed]
>
>
>
| |||
|
|
Offline 
Send Email