Allan M. Spiegel M.D. - RSD Therapy

Reflex sympathetic dystrophy is a disorder, which occurs following trauma to a nerve of the arm or leg. Researchers now believe that these symptoms occur because the nerves send a mixed signal to the brain. In effect, these inappropriate signals short circuit and interfere with the normal blood flow and sensory signals, thus generating symptoms of a reflex sympathetic dystrophy which includes severe burning pain, extreme sensitivity to even light touch, swelling, excessive sweating and change in bone and skin tissue.

Treatment modalities for this painful disorder have included various medications, physical therapy, sympathetic nerve blocks, placement of spinal cord stimulators, as well as the use of a morphine pump. Unfortunately these therapies have rarely offered the patient any significant long-term improvement. A study of 15 patients (11 men and 4 women) was performed using hyperbaric oxygen therapy as the sole means of treatment after failure to improve by other modalities. The clinical diagnosis was based upon the presence of pain, tenderness, swelling, vasomotor instability, joint stiffness lasting long after a trauma. Radiographic studies confirmed bone demineralization and osteoporosis commonly seen in patients with RSD. After the first week of HBOT, a marked reduction in pain and tenderness in the extremity was observed in 9 out of the 15 patients with discrete clinical improvement being recorded in 3 cases. Reduction of swelling and restoration of movement in the affected extremity progressed during the course of HBO therapy. At the completion of the first cycle of HBO therapy, complete recovery, i.e. the absence of pain and the restoration of normal joint movement, was noted in 4 of the 15 patients. Marked clinical improvement, i.e. occasional tenderness with minimal swelling occurring solely at night with almost normal movement of the affected joints, was noted in 5 out of the 15 cases. Moderate clinical improvement, i.e. reduction of pain and swelling with partial restoration of movement, was noted in 4 of the 15 patients. In 2 of the 15 patients there was reduction in swelling with some persistent pain. An additional 10 sessions of HBO was given to 4 cases in which there was a partial relapse of symptoms, only to afford the patient complete recovery. This demonstrates the significant oxygen therapy in the treatment of effectiveness of hyperbaric reflex sympathetic dystrophy.

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Other Case Studies

CASE STUDY 1

E.E, a 54 year-old woman, in 1993 was riding a motorcycle when a car door opened as she passed, thereby clipping her right leg. She developed a crush injury and compartment syndrome. Eighteen months following the trauma she developed an electric like jolt pain, with swelling, skin discoloration, change in temperature of that leg as compared to the opposite side with severe pain to light touch. The patient was evaluated by numerous neurologists and pain management specialists and was diagnosed with RSD. She underwent greater than 75 stelate ganglion blocks with no long term improvement.

On June 2002 when initially examined, she had severe swelling of the right leg, weakness of the right knee flexion and extension, severe pain to light touch, diminished hair with skin discoloration. The patient was on high dose oxycontin and percocet for pain relief.

Following 24 treatments of HBOT at 2.4 ATA for 90 minutes the patient had complete resolution of all the four mentioned symptoms, and was able to discontinue all narcotics and return to work as a nurse for the first time in 9 years.

CASE STUDY 2

A.L., a 24 year-old man, was involved in a motor vehicle accident in 1998 sustaining a left humerus fracture requiring internal fixation with repair of a lacerated radial nerve and closed head injury. The patient developed RSD involving the left arm progressing to the right leg. He was evaluated by numerous physicians and pain management specialists. Despite numerous stelate ganglion blocks, Oxycontin, and Demerol, he had an ongoing pain.

Intermittently there was swelling of arm, ankle and hands. In a moment's time, the skin could change from blue to normal pink and dry to sweaty. There were episodes in which the hair on his left arm would fall out in clumps then grow back again. There were changes in the texture of his nails.

The patient was examined on 11-29-04 at which time he had diffuse sweating and swelling of the left upper extremity which resolved by the end of the exam. There was moderate weakness to the left arm with severe pain to light touch and decreased sensation in the right leg with burning pain between the shoulder blades of the lumbosacral area.

Following the first four treatments of HBOT at 2.4 ATA for 90 minutes, the patient noted some return of sensation in the left arm with decreased sensitivity to light touch. Some improvement in strength was noted in the left arm with diminished swelling in the legs. For the first time in five years, he was able to sleep through the entire night.

Following 20 treatments of HBOT, the patient stated his RSD had nearly completely dissipated. Sensitivity to light touch, weakness, swelling, skin discoloration, and temperature changes ceased.

CASE STUDY 3

R.B., is a 51 year old female who sustained a work related injury in July 1998 while moving heavy furniture. Following lumbar laminectomy, the patient developed sensitivity to light touch and deep pain initially in one leg which progressed to the other leg and an arm with severe limb swelling, trophic changes in nail beds, intermittent limb cyanosis, excessive sweating and diffuse weakness of the lower extremities .She was assessed by several pain management specialists who diagnosed RSD and provided her with various oral and injectable narcotics as well as stelate ganglial blocks which offered mild temporary improvement. In 2004, an initial exam revealed trophic nail bed changes, blotchy skin color, cold feet, swelling of the right extremity, diffuse weakness of both legs and right arm with sensitivity to light touch. The patient also complained of headaches, and fibromyalgia involving the cervical, thoracic and lumbar region. Following 30 treatments of HBOT at 2.4 ATA for 90 minutes, the fibromyalgia of the cervical and thoracic region resolved. The strength and skin color returned to normal. Sensory findings returned to normal in the right arm and significantly improved in both legs.

CASE STUDY 4

K.S., is a 61 year old female who in 2002 was involved in a motor vehicle accident sustaining near complete amputation of the left foot at the ankle which was surgically reconnected. Over the subsequent 9 months the patient developed severe left foot pain radiating up the leg, tendency for the left foot to swell up to 2-3 time its normal size, frequent skin color changes, and sensitivity to light touch. She was assessed by pain management physicians who ultimately diagnosed her as having complex regional pain syndrome and treated her with stelate ganglion block and narcotics with temporary improvement afforded. Following 22 treatments of HBOT at 2.4 ATA for 90 minutes, there was no longer any temperature or color asymmetry and the skin sensitivity significantly diminished with restoration of the left foot strength.

CASE STUDY 5

M.T., a 66 year old female who fell and fractured her left wrist, was subsequently casted by an orthopedist. When the cast was removed she had severe weakness and stiffness of the left arm and hand with severe sensitivity to light touch. The hand was warm, swollen and very shiny. The patient was diagnosed as having RSD by her pain management physicians who treated her with numerous stelate ganglion blocks, and narcotics but to no avail. Following 20 treatments of HBOT at 2.4 ATA for 90 minutes the patient had complete resolution of all her symptoms with exception of a trace weakness of a left hand.

RSD, while initiating as a peripheral nerve injury, develops vasospasm and edema where there is impairment of blood supply and oxygen, propagating a vicious cycle of further edema and hypoxia. With increased edema there is an increase in pressure in the skeletal muscle compartments further reducing capillary perfusion resulting in tissue necrosis, much like what is seen in a compartment syndrome.

HBOT supersaturates the tissue with oxygen, causing vasoconstriction which diminishes the edema and allows normalization of tissue perfusion of blood, nutrients and oxygen thereby reducing muscle and nerve damage.

Review of the medical literature suggests a cost of about $20,000 a year to treat an average patient with RSD. This would include physician office visits, pain management assessments, stelate ganglion blocks various medications including narcotics , antidepressants ect. Intractable pain is frequently treated with either a morphine pump or spinal stimulator at a cost of $20,000 to implant and ongoing costs to maintain. Every 5 years these implants need to be replaced at a cost of an additional $20,000. To this you must add the cost of physical therapy, occupational therapy, psychiatric therapy and potential sympathectomy.

The above costs , along with the patient's loss of gainful employment, makes this a very expensive disorder to treat .Twenty treatments of HBOT would cost less than one years maintenance .In addition 40% of the patients in the above cases returned to gainful employment within 2 months of completing HBOT.

HBOT seems to offer a logical approach to treat this chronic disabling disease. It is far more cost effective with less potential risks than all other commonly employed methods.

To help you discover what Hyperbaric Oxygen Therapy can do for you, for a limited time, Dr. Spiegel will provide a free assessment to determine if you would benefit from this treatment. To schedule an appointment, click here.