Reflex sympathetic dystrophy

Unlabeled Uses Cerebral vasospasm, migraines, Raynaud s syndrome, reflex sympathetic dystrophy, refractory depression, tardive dyskinesia, thyrotoxic crisis. 

Reflex sympathetic Dystrophy Conscious sedation for procedures Gabapentin Chloral hydrate Midazolam 25-100 mg/kg po or rectally 0.05-0.15 mg/kg IM or IV 0.3-0.5 mg/kg rectally 0.2-0.75 mg/kg po 11-year-old girl with refractory reflex sympathetic dystrophy Also available in a nasal spray Tong and Nelson, 2000 Kennedy and Luhmann, 1999 Ljungman et al., 2000... 

Pathological conditions in which capsaicin itself is not sufficiently active, but more potent vanilloids are expected to be of greater therapeutic value. For example diabetic neuropathy (Ross and Varipapa, 1989), postherpetic neuralgia (Watson et al., 1988 Bernstein et al., 1989), chronic distal painful polyneuropathy (Low et al., 1995), post-mastectomy pain syndrome (Watson et al., 1989), Guillain-Barre syndrome (Morgenlander et al., 1990), reflex sympathetic dystrophy (Cheshire and Snyder, 1990), vulvar vestibulitis (Friedrich, 1988). 

Cheshire, W.P. and Snyder, C.R. Treatment of reflex sympathetic dystrophy with topical capsaicin. Case report, Pain 1990, 42, 307-311. 

Karakuram G, Pirbudak L, Oner U, et al. Sympathetic blockade and amitriptyline in the treatment of reflex sympathetic dystrophy. IntJ Clin Pract. 2003 57 585-587. 

Reflex sympathetic dystrophy, in which there is an excessive or abnormal sympathetic nervous system response in a limb, has been associated with rhabdomyo-lysis secondary to heroin abuse (18). 

Lee BF, Chiu NT, Chen WH, Liu GC, Yu HS. Heroin-induced rhabdomyolysis as a cause of reflex sympathetic dystrophy. Clin Nucl Med 2001 26(4) 289-92. 

These include postherpetic neuralgia, phantom limb pain, peripheral neuropathies of various causes, central pain, e.g. following a stroke, compression neuropathies, and the complex regional pain syndromes (comprising causalgia, when there is nerve damage, and reflex sympathetic dystrophy, when there is tissue but no nerve injury) they present the most challenging problems. 

The efficacy and safety of amidronate in recalcitrant reflex sympathetic dystrophy have been assessed in 10 women and 13.men, mean age 44 years (20). Amidronate was given intravenously in a dose of... 

Cortet B, Flipo RM, Coquerelle P, Duquesnoy B, Delcambre B. Treatment of severe, recalcitrant reflex sympathetic dystrophy assessment of efficacy and safety of the second generation bisphosphonate pamidronate. Chn Rheumatol 1997 16(l) 51-6. 

Falasca GF, Toly TM, Reginato AJ, Schraeder PL, O Connor CR. Reflex sympathetic dystrophy associated with antiepileptic drugs. Epilepsia 1994 35(2) 394-9. 

Thalidomide was formerly used as a sedative/hyp-notic. It was approved in 1998 by the US Food and Drug Administration for use as an immunosuppressant in the treatment of erythema nodosum leprosum. It is also used in the treatment of graft-versus-host disease (Orphan drug status in the United States), macular degeneration, oral ulcers in AIDS patients, and reflex sympathetic dystrophy associated with chronic pain syndromes. 

Multiple sclerosis Causalgia or reflex sympathetic dystrophy Spinal cord injury... 

Poehling GG, Pollock FE Jr, Koman LA (1988) Reflex sympathetic dystrophy of the knee after sensory nerve injury. Arthroscopy 4(l) 31-35... 

Bonica JJ (1990a) Causalgia and other reflex sympathetic dystrophies. In Bonica JJ (ed) The management of pain, 2nd edn. Lea and Febiger, Philadelphia, pp 220-243... 

Mellick GA, Mellick LB. Gabapentin in the management of reflex sympathetic dystrophy. (Letter) J Pain Symptom Manage 1995 10 265-266. ... 

Schwartzman RJ, Popescu A. Reflex sympathetic dystrophy. Curr Rheumatol Rep 2002 4 165-169. 

Fractures are part of the cause in a majority of cases of reflex sympathetic dystrophy and limbs are affected in most. The symptoms can be unilateral or bilateral. There appears to be hypersensitivity of the sympathetic libers. These accompany arteries and directly influence their diameters through increased stimulation. There appears to be a mix of both chronic and acute appearance to the condition. Prolonged constriction leads to ischemia and this can bring about inllammatoiy changes in the release of other vasoactive substances and increased reactivity, similar to migraine. 

Addressing the components of reflex sympathetic dystrophy appears to ameliorate the condition. However, given the nature of the condition, there may not be a full reversal or return to previous function. Improvement without resolution may be an acceptable goal. This also requires that the patient and the osteopathic physician come to an understanding regarding expectations. 

Reflex sympathetic dystrophy (RSD) manifests unstable vasomotor activity in the distal extremities. Although it is most common in the upper extremity (hand), it can occur in the lower (foot) as well. The cause is poorly understood, but RSD seems often to follow a painful condition involv-... 

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