Question
I fell down a storm drain about 6 months ago. One of my legs had been
hurting for quite awhile and was told to just wait out the pain, which I
did. I eventually went to the emergency room since my leg began to get
weak. Since then, things have gotten dramatically worse--it ws about a
month or two ago. The pain progressed to my upper leg then to my other
leg and then to my arms. Then uncontrollable shaking began. The shakign
affects my arms, head, and legs. I now have constant nausea and
dizziness. The pain is excruciating and I am not on pain pills. I did not want
to be red flagged, I wanted testing done, so I refused pain killers. My
arms and legs feel like they are being burned and cut at the same time
and now I feel like I am constantly in the middle of an earthquake. I
can no longer do normal everyday things. All of the symptoms are worse
when it is cold or even a breeze blows on me and the pain makes me feel
very cold and like I am being burned at the same time. Also, my feet
and hands are turning purple and swelling slightly. Sometimes, I can not
move my right arm or leg for a little while--the longest was an hour.
And severe pain in my head that shoots to my eyes. Eventually it feels
like my ears are goign to start bleeding and my eyes are goign to
explode. I am taking belladonna for that since it seems to help the swelling
better than advil or tylenol.

I just got an MRI a couple of days ago and have no results yet. I don't
know how long it will take and I have little faith since I have had to
fight for 6 months for this MRI--I am on medicaid. I am wondering what
can be causing these symptoms and how likely it is that this will be
permanant? Can the shaking be fixed? Is there anything I can do at home
that can help? I am getting really tired of staying in bed but it is the
only time the pain doesn't seem as bad and the shaking slows or stops.

Any other advice? Thank you.

Answer
Dear Angela,

First of all I must apologize for the lateness in response to your question.  I had a serious bout with food poisoning, and have been out of my office for over a week.

In relation to your injuries, I must say you have quite a bit of symptoms. It sounds to me like you have a complex and severe case of R.S.D. -Reflex Sympathetic Dystrophy.  This is a condition that occcurs following trauma and usually progresses throughout stages.  We normally see this in only one or two extremities though.  

RSD is a vasomotor dysfunction characterized by hyperesthesia, burning pain, edema, discoloration, and stiffness in the extremities.  It is believed to be caused by dysfunction in the S.N.S. -sympathetic nervous system...therories include:  abnormal connections between the sensory neurons and the SNS, hyperactivity of the SNS, nerve sprouting of pain fibers, and abnormal activation of nerve receptors.

EARLY STAGE - burning sharp pain.
MODERATE STAGE - sympathetic signs appear, including atrophic skin changes with cold, moist, mottled skin.  You may become hypersensitive to light stimuli, and the pain becomes chronic.
SEVERE STAGE - pain becomes throbbing and achy, visible changes in the skin continue and progress on into the nails of hands or feet.  Muscular atrophy and contracture may happen.
LATE STAGE - radiographic changes appear...osteoporosis on x-ray or dexa scan, bone scan will be hot, showing uptake.  Thermography will show temperature changes, but they are not specific.

Conservative management by a Chiropractic Physician would include manipulation of spinal regions, physical therapy, and elevation to decrease any swelling. Chiropractic care has been proven to increase peripheral circulation, but it is not specific to RSD. Early controlled mobilization of any limb affected by the pain is the preferred inital treatments...it is important to remain ambulatory. DO NOT STAY IN BED! Desensitization techniques and TENS- transcutaneous electronic nerve stimulation are also helpful.

Supplementation with high levels of omega III fatty acids to reduce inflamation and eicosanoid production will help - 5000mg to 7000mg daily for the first month.  Stress reduction techniques such as deep breathing, meditation, massage, stretching, yoga, pilates, and tai-chi will help gradually.  

Medically, sympathetic blockades, ganglion blocks,from injections may help pain. Some have reported good results with implanted neuro-stimulators, and alpha and beta-adrenergic drugs.  If you choose the medical route, you will need to consult with a Physician certified in pain management.

In relation to headache pain and ear pain, this may be due to the increases in stress and discomfort that goes along with RSD, or may have another associated cause with the trauma.  Bottom line is that you need to follow up with treatment immediately.  RSD can progress to a condition called CAUSALGIA, which may be resistant to treatment, and produces intactable pain and dysfunction resulting in permanent disability.  I also believe that you will benefit from the advise of a counselor specialized in dealing with individuals who have chronic pain.  This will help you with taking ownership of the pain and learning positive ways to alleviate any poor behaviors associated with pain.  This is important...people who react to pain poorly develop long term depression symptoms, poor immune function, and lose personal relationships as well as careers etc... You want to be serious and proactive about this process.

Please make sure to write me back with the results of your MRI as well as any further treatment.  I wish you all the best in your recovery.

Respectfully,
Dr. J. Shawn Leatherman