THIS IS A WORK VERY MUCH IN PROGRESS.

Treatments can be broken down by modalities, which include pharmacologic, nerve blocks, surgical or chemical sympathectomy, physical therapy and psychology.

This list is by no means complete or comprehensive. It also lacks detail -- something we hope to remedy as soon as possible. This document is a work in progress, but it has always been our desire to make as much information available on this Web site as possible.

• Medications
  
• Antidepressants

  Tricyclic antidepressants work on sedation, analgesia, and mood elevation, The analgesic action of the tricyclics may be related to the inhibition of serotonin reuptake at nerve terminals of neurons that act to suppress pain transmission, with resultant prolongation of serotonin activity at the receptor. [Hollister L: Tricyclic Antidepressants. N Engl J Med 99, 1978] If this is true, amitriptyline (Elavil) should be the most effective of the tricyclics because it has the most potent effect on the amine production. Other antidepressants are used for their varying anticholinergic properties as well as their promotion of weight gain and effectiveness in treating sexual dysfunction (which can be a side effect of RSD and other chronic pain syndromes). [Abrams SE: Pain of Sympathetic Origin in Raj PP (ed) The Practical Management of Pain. St. Louis: Mosby, 1986. Oxman T, Denson D: Antidepressants and adjunctive psychotrophic drugs in in Raj PP (ed) The Practical Management of Pain. St. Louis: Mosby, 1986. ]

• Narcotic Analgesics

  Systemic narcotics, such as morphine, fentanyl and methadone are used. There is much controversy over the use of opiates and other narcotics for treating chronic pain.

• Oral Nifedipine

  This is a calcium channel blocker. It relaxes smooth muscle, increases peripheral blood flow, and antagonizes the effect of norepinephrine on arterial and venous smooth muscle thereby inducing peripheral vasodilation. The dosage is in the 10-30mg TID PO range. Some people taking this medical experience headaches and other side effects.

• Systemic Corticosteroids

  Corticosteroids such as prednisone and methylprednisolone (Medrol) has some postive effect on some symptoms of RSD. They do not effect the burning pain, however. [Kozin F et al: The reflex sympathetic dystrophy syndrome (RSDS) III Scintigraphic studies, further evidence for the therapeutic efficacy of systemic corticosteroids, and proposed diagnostic criteria. Am J Med 70:23-30, 1981.]

• Adrenergic Blocking Agents

  Limited success. One study showed moderate improvement in pain, swelling and vasocontriction with oral Prazosin treatment. Intravenous phentolamine appears to be useful in predicting a favorable response to Prazosin. Propranolol has been reported to be effective for RSD. [Sison G. Propranolol for causalgia and Sudeck's atrophy. JAMA 227-307, 1974. Visitunthorn U, Prete P: Reflex Sympathetic Dystrophy of the lower extremity. A complication of herpes zoster with dramatic response to propranolol. West J Med 135:62-66, 1981.]

• Some Drugs Commonly Used to Treat RSD
  • antidepressants
  • sedative-hypnotics
  • anxiolytics
  • anticonvulsants
  • muscle relaxants
  • narcotic analgesics
  • nonnarcotic analgesics
  • NSAIDs (nonsteroidal anti-inflammatory drugs)
  • corticosteroids
  • local anesthetics
  • sympathetic blocking agents
  • vasodilators
  • neurolytics

• NERVE BLOCKS

  Lumbar Sympathetic Blocks

  Cervical Blocks

• INTRAVENOUS REGIONAL BLOCK (BIER BLOCK

  Guanethidine

  Bretylium

  Reserpine (older)

• SURGICAL SYMPATHECTOMY

• RADIOFREQUENCY ABLATION

  Also known as:

  percutaneous radiofrequency sympathectomy

  radiofrequency lesion

  radiofrequency neurolysis

  radiofrequency ablation

  radiofrequency sympatholysis

• CHEMICAL SYMPATHECTOMY

• PHYSICAL THERAPY

  This area is quite diverse in what is supposed to work.

  Immobilization and elevation of the extremity.

  Vigorous mobilization and physical therapy (some believe that overly vigorous physical therapy can cause a backlash reaction).

  Gentle mobilization and physical therapy.

• TENS

  Transcutaneous electrical nerve stimulation. This is a small battery-operated device, about the size and shape of a pager, that consists of a set of electrodes that are placed on the skin around the site of the pain and through which a low-voltage electrical stimulus is passed. The low-voltage electrical charge acts on nerve fibers to interrupt pain signals. It is a form of external peripheral nerve stimulation and may reduce pain by acting as a counterirritant, stimulating sensory nerve fibers, closing the gate on the pain signals and acting as a distractant. TENS has been effective in reducing pain and improving physical function. It is often used in conjunction with drug therapy.

  Nerve stimulation may decrease muscle spasm, increase relaxation, increase the ability to exercise and perform range of motion movements, increase blood flow and metabolism, and decrease pain. The medical literature suggests a trial (especially for patients who do not respond promptly to blocks) even though only a few patients attain long-term analgesia.

  TENS is commonly used to treat neuropathic pain, such as a RSD and causalgia, low-back pain, arthritis, phantom limb pain, cancer pain, headache and post-op pain.

  
  

• PSYCHOTHERAPY

• MORPHINE PUMPS

• SPINAL CORD STIMULATORS

  also known as Dorsal Column Stimulators

• NEURONTIN (gabapentin)

• ACUPUNCTURE

  Acupuncture is not believed to have any long term positive effects on RSD.

• HYPERBARIC OXYGEN THERAPY

  Full-text reprint of a hyperbaric oxygen case study

• AMPUTATION

  DISCARDED as a treatment, though some doctors still suggest it. Amputation only made matters worse.

• OTHER

  beta-adrenergic antagonists

  injections of calcitonin

  anticonvulsants

  vasodilators

  nerontonin (gabapentin)