Recent studies from France and Italy report a new treatment for reflex sympathetic dystrophy, severe pain and swelling that is associated with nerve pain in an arm or leg that may be caused by a weakening of bones (1, 9, 10). All people have two separate nervous systems in their bodies: a voluntary nervous system in which they decide to move an arm, leg or anything else and an involuntary nervous system over which they have little direct control, such as contraction of intestinal muscles, the opening and closing of the brown spot in the front of the eye to let in light, sweating and so forth. Damage to the involuntary nervous system on one arm or leg can be caused by a stroke, spinal cord injuries, shingles, heart attacks, surgery or trauma such as broken bones following an auto accident.
First, you develop severe pain, swelling, sweating and excessive warmth of an extremity, followed by a later phase characterized by cool skin, loss of hair, severe pain forcing a person to avoid any movement of the extremity and then osteoporosis or loss of bone in that extremity. Until recently, the only treatment was to inject cortisone and an anaesthetic into the nerve roots of that extremity. Doctors never cured anyone with this treatment, but they still continued to do this. In 1989, researchers from Japan showed that the pain of reflex sympathetic dystrophy comes from weakened bone, not from nerves, so the cortisone injections really have no place in the management of this condition.
Now we have a cure. A recent report from France shows that 86 percent of patients were cured by injecting a drug to strengthen bones, called pamidronate, into the veins. The pamidronate is injected one mg per Kg intravenously for two straight days or daily alindronate or calcitonin (3). A study from Italy shows that RSD can be cured with intravenous clodronate 300 mg daily for 10 consecutive days.
1) B Cortet, RM Flipo, P Coquerelle, B Duquesnoy, B Delcambre. Treatment of severe, recalcitrant reflex sympathetic dystrophy: Assessment of efficacy and safety of the second generation bisphosphonate pamidronate. Clinical Rheumatology 16: 1 (JAN 1997):51-56. APD was administred intravenously (perfusion) to a dose of 1 mg/kg/day during 3, 2 or one day. Adverse events were noted in 14 patients: transient fever (n=6), venous inflammation (n=2), transient symptomless hypocalcaemia (n=3), nausea (n=1), lymphopenia (n=1), transient hypertension (n=1). Address B Cortet, Ctr Hosp Reg & Univ Lille, Dept Rheumatol, 2 Ave Oscar Lambret, F- 59037 Lille, France.
2) S Adami, V Fossaluzza, D Gatti, E Fracassi, V Braga. Bisphosphonate therapy of reflex sympathetic dystrophy syndrome. Annals of the Rheumatic Diseases 56: 3 (MAR 1997):201-204. (7.5 mg dissolved in 250 mi saline solution or placebo saline infusions daily for three days.)
3) J Arlet, B Mazieres. Medical treatment of reflex sympathetic dystrophy. Hand Clinics 13: 3 (AUG 1997):477.
3) Lauwerys, B.R.; Dufour, J.P.; Noel, H.; Berg, B.V.; Devogelaer, J.P. Osteopenia, bone fragility and reflex sympathetic dystrophy syndrome in a man with ureterosigmoidostomy","Osteoporosis International. 1997;7(4):359-362. JP Devogelaer/Univ Catholique Louvain/Rheumatol Unit 5390/Ave Hippocrate 10/B-1200 Brussels, Belgium.
4) Lancet OCt 18, 1997.
5) Diabet Med 1994;11:28-31. 6) J Bone Miner Research 1988;3(Suppl):S122(abstr 213).
6) Bone 1992;13:116 abstr.
7) Arch Rheum Dis 1995;54:687. 8) Clin Rheumatology 1997;16:51-56.
8) Ann Rheum Dis 1997;56:201-204.
9) Acta Oncol Suppl 1996;35:550-54. See Review in Lancet October, 1997 page 1117.
10) M Varenna, F Zucchi, D Ghiringhelli, L Binelli, M Bevilacqua, P Bettica, L Sinigaglia. Intravenous clodronate in the treatment of reflex sympathetic dystrophy syndrome. A randomized, double blind, placebo controlled study. Journal of Rheumatology, 2000, Vol 27, Iss 6, pp 1477-1483
11) Treatment of reflex sympathetic dystrophy with pamidronate: 29 cases. Rheumatology, 2001, Vol 40, Iss 12, pp 1394-1397. I Kubalek, O Fain, J Paries, A Kettaneh, M Thomas. Fain O. Checked 8/9/05
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