Now the life in me trickles away,
–Job
Last September a doctor at a pain clinic told her the source of the pain in her feet and legs was RSD–reflex sympathetic dystrophy–a scary-sounding term she was not familiar with. He recommended a series of nerve blocks: anesthetic injections into the affected areas or into a central nerve ganglion. Since then Aavang has had some 15 blocks. Several halted the pain for up to two days; most gave relief for only about six hours, and then it was “back to square one,” she says. She also had a catheter implanted in her back that allowed her to inject pain killer directly into the spinal area when her suffering was intense, but the catheter kept slipping out of place and reimplanting it required minor surgery. So for the time being she’s abandoned that procedure.
Best of Chicago voting is live now. Vote for your favorites »
Ever since it was first identified, RSD has confounded the medical community. The generally acknowledged discoverer is Silas Weir Mitchell, a Civil War surgeon who reported on a peculiar condition he observed in some of his patients. In his 1864 book Wounds and Other Injuries of Nerves he wrote: “We met with a small number of men who were suffering from a pain they described as ‘burning’ or as ‘mustard red-hot’ or as ‘red-hot file rasping the skin.’ . . . Its favorite site is the foot or hand. . . . Its intensity varies from the most trivial burning to a state of torture which can hardly be credited, but which reacts on the whole economy, until the general health is seriously affected. The part itself is not alone subject to an intense burning sensation, but becomes exquisitely hyperesthetic [supersensitive], so that a touch or a tap of the finger increases the pain. Exposure to the air is avoided by the patient with a care which seems absurd. . . . As the pain increases . . . the temper changes and grows irritable, and the face becomes anxious, and has a look of weariness and suffering. The sleep is restless, and the constitutional condition . . . exasperates the hyperesthetic state so that the rattling of a newspaper, a breath of air, the step of another across the ward, the vibrations caused by a military band, or the shock of the feet in walking, gives rise to increase of pain.”
Since then the phenomenon has been observed and reported on by thousands of doctors, acquiring over the years a bewildering collection of names, including causalgia (Greek for “burning pain”), Sudeck’s atrophy, shoulder-hand syndrome, and the unpronounceable algoneurodystrophy. In recent decades “RSD” has been widely accepted, though scholarly arguments still flare up. Some specialists today insist the condition should be called “sympathetically maintained pain” (SMD), because that term is more true to possible psychological causes. Medical journals report regularly on the name debate, which is of course tied to the general disagreement about RSD.
“The system just goes haywire,” says Dr. Biba M. Sihota, an anesthesiologist and former director of the Pain Control Clinic at the University of Illinois Hospital in Chicago. “It seems to recruit other parts of the nervous system, and there’s no predicting how it will move.” The human body, she notes, contains an extensive network of interconnected nerves, like a complex system of railroad tracks: a malfunction in one area can move through the system and pop up somewhere else. Sihota, who has many RSD patients in her current private practice, stresses the importance of identifying and treating the syndrome early, before it becomes “centralized.”
