Wednesday, July 27, 2011

Symptom of Reflex Sympathetic Dystrophy Syndrome (CRPS/RSD) Insomnia

Complex Regional Pain Syndrome (CRPS) is also known as Reflex Sympathetic Dystrophy Syndrome (RSD) which is a chronic neurological disease causing a malfunction of part of the nervous system and the immune system as it responds to tissue damage resulting from trauma due to an accidental injury or medical procedure. It is estimated that 1.5 to 6 million Americans are affected by this disease. The large gap in the estimate is a result of a reported misdiagnosis or unreported cases. The International Association for the Study of Pain has defined two types of CRPS. CRPS Type I (RSD) is defined by the presence of an initiating event or injury with a continuous pain resulting from stimuli that normally doesn’t cause pain, such as a light breeze or clothing. Signs of CRPS Type I include swelling, change in blood flow, variations in skin color, higher skin temperature and abnormal sweating around the area of pain. CRPS Type II (Causalgia) is the presence of continued pain like CRPS Type I but also associated with pain due to hyperalgesia after nerve injury. Symptoms of both are pain, muscle spasm, loss of motion, swelling, circulatory changes and skin changes. As result of these symptoms the person makes lifestyle changes which cause an additional symptom of reflex sympathetic dystrophy syndrome (CRPS/RSD) insomnia.

[caption id="attachment_1397" align="alignright" width="219" caption="Mechanisms of RSD"][/caption]

RSD cause changes to the Limbic System of the brain. The limbic system is that part of the brain that controls insomnia. RSD causes insomnia by not allowing the body to drift into REM, or rapid eye movement, sleep. This is the sleep that allows the body to use its own healing abilities. Without it, the patient’s pain cycle continues and becomes more intense. As the body cannot heal itself, it becomes harder to achieve the ability to fall asleep easy and sleep deeply, which makes the pain worse and so the cycle continues. Many doctors recommend that you don’t push yourself too hard and take a nap when you need one.

Who can get CRPS/RSD? Anyone, but reports have shown it is more common between the ages of 25 and 55. It is more frequent in women than men and very rare in children under the age of 11. Known as a physical disease, symptoms are not usually visible and a doctor must make his diagnosis using the patient’s history, a thorough physical exam and numerous tests. There is no single test for CRPS/RSD, but early diagnosis and treatment can result in a remission from this disease. Some Doctors will try X-Rays, Bone Scans, thermograms and others methods of testing to confirm a diagnosis of CRPS/RSDS. Understand that while these tests MAY show the presence of CRPS/RSDS, they are rarely conclusive and they should not be used as the sole determining factor in whether a patient does or does not have CRPS/RSDS. The only positive way of diagnosing CRPS/RSDS is a physical exam by a Doctor knowledgeable in CRPS/RSDS.

There are four stages of RSD:

Stage One: or the acute stage can last one to three months and some symptoms include; burning pain, stiffness in joints, increased sensitivity to touch. A person might feel their extremities are very hot, but cool to the touch, a result of lack of blood flow.

Stage Two: or the Dystrophic Stage can last three months to a year. The pain is constant like stage one but it is increased with stimuli. Skin changes are present as the affected area may be discolored or a different shade. Muscle wasting begins and an X-Ray may show signs of osteoporosis. There are also short term memory problems, the inability to focus, they may start to repeat themselves or unable to find the right words when speaking.

Stage Three: of the atrophic stage can last an unlimited amount of time and though pain is constant the severity increases and decreases. RSD may spread to other areas of the body and irreversible tissue damage may occur. Skin becomes cool, thin and shin. Loss of mobility may also occur as a result of decreased joint movement and skin atrophies. In this stage the majority of pain signals are in the brain and not at the original RSD site.

Stage Four: Most people will never advance to stage four as this stage involves the internal organs and is resistant to many forms of treatment. Not all Doctors agree on the existence of a fourth stage.

Treatment may include medications, nerve blocks, nerve stimulation, physical therapy and psychological support. Treatment is individualized as many patients can suffer from symptoms in more than one stage of the disease. Some RSD patients find relief in alternative medicine such as acupuncture, or in relaxation therapy and hypnosis. Psychological counseling can also help patients cope with the frustration and depression that often accompany the disease. A healthy diet is especially beneficial to people with RSD. Avoid coffee, processed foods, sugar and fried foods. Also, leave off foods containing nitrites, such as bacon, sausage and hot dogs. Eat lots of fresh fruits and vegetables, fish and poultry, and drink six to eight glasses of water a day. Some RSD patients also find nutritional supplements beneficial.

Beneficial Nutritional Dietary Supplements for RSD:

Boswellia is a natural anti-inflammatory agent.
Astragalus Root stimulates the immune system and enhances adrenal function.
White Willow Bark is an effective pain killer and fever reducer.
Turmeric is an effective anti-inflammatory.
Stevia is effective in treating RSD.

Doctors are studying the effectiveness of using ketamine, a drug that blocks the N-methyl-D-aspartate (NMDA) receptors in the brain to treat RSD. When activated, these receptors contribute to the pain response. By blocking NMDA receptors, however, ketamine can help to provide pain relief. When ingested Ketamine has a wide range of side effects, including analgesia, anesthesia, vivid hallucinations, elevated blood pressure, and bronchodilation. As part of a cream, gel, or liquid for topical application for nerve pain—the most common mixture is 10% ketoprofen, 5% Lidocaine, and 10% ketamine.

Low-dose ketamine is recognized for its potential effectiveness in the treatment of (CRPS), but only should be administered by a trained professional to assess potential adverse effects on patients. There are two procedures with low-dose Ketamine one is an outpatient infusion and the other is done in the hospital. There is also a Ketamine infusion that puts a patient into a coma for five to seven days. During that time they are administered high doses of Ketamine intravenously. This procedure is not done in the U.S. and is very expensive.

[caption id="attachment_1399" align="alignright" width="274" caption="Drug Side Effect Cartoon"][/caption]

Ketamine hydrochloride, or "Special K," is a powerful hallucinogen widely used as an illicit drug and frequently used with other drugs, such as ecstasy, heroin or cocaine. Users sometimes call the high caused by Special K, "K hole," and describe profound hallucinations that include visual distortions and a lost sense of time, sense, and identity. The high can last from a half-hour to 2 hours. The Drug Enforcement Administration reports that overt effects can last an hour but the drug can still affect the body for up to 24 hours.

Amy Winehouse’s tragic death has emerged, with claims that she bought a cocktail of narcotics including cocaine, ecstasy and ketamine in her final hours. Although police has not yet released the exact cause of her death, it is claimed she was seen buying drugs

In conclusion, falling asleep can be difficult because pain keeps you awake, or pain can wake you up in the middle of the night. Treating insomnia due to RSD/CRPS involves medications to control pain. The type of medication prescribed is determined by the type of pain experienced by each, individually.

If you think you have RSD due to an injury that isn’t healing causing pain and swelling, contact your doctor. Is there a cure? No, but there is hope. For more information contact: RSDSA at rsds.org. The content provided in Symptom of Reflex Sympathetic Dystrophy Syndrome (CRPS/RSD) Insomnia is for information purposes only, intended to raise the awareness of different solutions for you or your families sleep problems and should not be considered medical advice. For medical diagnosis and treatment, please see your qualified health-care professional.

 
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