REFLEX SYMPATHETIC DYSTROPHY
Report #7228
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).
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/ and 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. We used to think that the pain came from a damaged nerve, but now we think that the pain may come from weakened bones. Patients with reflex sympathetic dystrophy are treated with the osteoporosis drug, pamidronate, injected one mg per Kg intravenously for three straight days or, daily alindronate or calcitonin (3). See report #G160.
By Gabe Mirkin, M.D., for CBS Radio News
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.
Reported 9/30/97; Checked 9/5/05