RSD Opinion????

  1. 0
    I have two issues regarding RSD that I would like imput on:

    1) Has anyone else noticed that the diagnosis is given in work comp injuries almost all the time but with motor vehicle the doctor's seem to go out of their way to rule this out? Why do you think this is?

    2) I am also curious about opinions as to the validity of RSD as a diagnosis. Do you believe their truly is such a condition? How much of the condition is influenced by the psych component?
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  4. 11 Comments so far...

  5. 0
    Hi,

    I am new to the field of Worker's comp. case management and wondered what RSD is? If you have any tips or resources that can enhance my learning of WC, I would be very grateful!
    Thank you,
    Sharon in CA
  6. 0
    Strange, my old doctor tried to diagnose me with RSD and I was work comp auto accident. If I'm not mistaken, it stands for Reflex Sympathetic Dystrophy. It was a long time ago that I researched it, but my first thought was that it was a "disease of the day" kind of thing. To some extent the symptoms could fit anyone. Making it hard to disprove, which is probably the appeal of it for work comp doctors.
    When I finally found a good doctor, he told me to go home, look up the meaning of "dystrophy" and then try to see if I could apply it myself in any way. Naturally, I couldn't. I was rather furious that I had spent months being treated with Neurontin, which made me sick, for a disease that I didn't have. Furthermore, I founf info online stating that Neurontin hasn't beeen proven safe or effective for treating RSD.
    I don't have a lot of faith in diseases or disorders that are vague and hard to prove or disprove. They seem made-up, just an excuse for billing insurance, prescribing meds, and getting money from work comp.
  7. 0
    Workers' Comp is very different from state to state. The comp board in your state should have some imformation. Talking to claims adjustors is also a great way to learn.

    RSD stand for Reflex Sympathetic Dystrophy. It is also know at CRPS or Complex Regional Pain Syndrome. It is a disorder of very vague symptoms such as mottling of the skin. temperature changes from one extremity to the other. shiny skin, exterme sensitivity to anything touching the area, just to name a few. People with this disorder almost always have a psych component but the patient may not have actually been diagnosed with any psych issues. The disorder always results from a very minor injury and there are NO definative diagnostic tests to diagnosis this. In fact most tests are negative when the diagnosis of RSD is given. The 2 main test are EMG and bone scan. The EMG will be negative with RSD but the bone scan usually shows uptake in the affected area, but a negative bone scan does not rule out RSD.
    Some people have gone as far as having limbs amputated to stop the pain but this is not the common case. Usual treatment is Neutontin and extensive physical therapy to make sure the patient doesn't stop moving the extermity.
    RSD does usually manifest itself only in the limbs but there have been some cases of doctos diagnosing the disorder in the back. There has also been some cases where patients say it moves from one limb to another. My personal opinion is that this is part of the psych component.
    There are some treatments out there involving lidocaine drips that involve daily trips to the hospital or actual hospitalization and run about $30,000. This disease can keep cases open for years longer then they should be and almost always carries a total disability with it. Sometimes leads to a permanancy.

    I hope this helps.
    Quote from sflohaug
    Hi,

    I am new to the field of Worker's comp. case management and wondered what RSD is? If you have any tips or resources that can enhance my learning of WC, I would be very grateful!
    Thank you,
    Sharon in CA
  8. 0
    This is my suspicion as well and what does that say about the thousand of physicians giving this diagnosis. It hinders treatment from those that actually do have this disorder (I have actually seen about 3) due to raised suspicions from every case manager that sees this diagnosis.
    Unfortunately due to its vagueness and difficulty to rule in or rule out we are at the mercy of the IME doctors to get us out of paying for years of treatment due to wrongful diagnosis.

    [TQUOTE=FutureNrse]Strange, my old doctor tried to diagnose me with RSD and I was work comp auto accident. If I'm not mistaken, it stands for Reflex Sympathetic Dystrophy. It was a long time ago that I researched it, but my first thought was that it was a "disease of the day" kind of thing. To some extent the symptoms could fit anyone. Making it hard to disprove, which is probably the appeal of it for work comp doctors.
    When I finally found a good doctor, he told me to go home, look up the meaning of "dystrophy" and then try to see if I could apply it myself in any way. Naturally, I couldn't. I was rather furious that I had spent months being treated with Neurontin, which made me sick, for a disease that I didn't have. Furthermore, I founf info online stating that Neurontin hasn't beeen proven safe or effective for treating RSD.
    I don't have a lot of faith in diseases or disorders that are vague and hard to prove or disprove. They seem made-up, just an excuse for billing insurance, prescribing meds, and getting money from work comp.[/QUOTE]
  9. 0
    Thanks for the info--I haven't dealt with this dx yet,but I'm fairly new to workers comp. too!
  10. 0
    I know of a nurse who developed this after injuring her shoulder from a patient. She lost a year from her life because of being heavily medicated, etc. My sister, who has Andersen's Syndrome that entails temporary hypokalemic paralysis with prolonged QT - has a defibrilator (?sp) and pacemaker, developed rsd after a botched carpal tunnel surgery. She is in a life of hell. She was a radiology tech and lost her job because her hand/arm is useless. It is shriveled, mottly, cold and she cannot tolerate anything touching her hand, etc. She has had an epidural in her neck, they almost OD'd her on meds. Because of her pacemaker and defib. she cannot due some of the other remedies. Yes there is a psych component, because of the lack of medical doctors that take this seriously and lack of compassion. I could go on and on. She is very interested in speaking with people regarding this. She wants to tell her story. We live in Grand Rapids MI, and she has had to go to Cleveland Clinic for treatment and even they have failed her to a certain point. Her story is a nightmare. And she does talk to psych that is involved with the pain clinic. If you heard her whole story, you would be appalled. If anyone is interested pleae pm me. Thanks
  11. 1
    This is one that means a great deal to me. My daughter had several sore throats on and off until Feb.11 of this year when her voice was gone and the pain was severe. The doctor noticed a goiter to she had u/s that showed the r lobe was larger. All other thyroid tests normal. Then we went to an endocrin. who said it wasn't her thryroid. This whole time the pain is spreading to encompass her whole neck and she's losing weight because it is too painful to eat. ENT admits her to Children's Hosp and does laryngoscope after which I am told "she has selective mutism. She could talk if she wanted to" They kept her 8 more days and when the MRI and labs showed clean we were out the door. Problem was, she was literally in a ball on the floor screaming in pain. Sometimes she would get a rash there and sometimes not. We packed her back in the car for the five hour dirve (hell for her) to a large teaching hospital. Almost upon presentation they said RSD. Normally it's in the arms or legs, but hers was in the neck. She ended up having to be on a feeding tube for her weight loss, they worked on her endurance and then lots of PT, but the pain still hasn't gone away. We are in the process of investigating many other options. My sweet little girl became a monster. She said she was going to kill herself. The psych people were interested until I told them that if I was in her position I would be the same way. They told her she wasn't talking because she didn't want to (further labs showed her muscles were locked and could not move until voice/speech worked with her.)Nobody took her pain seriously and when they did, no medication could treat it. She was in hospitals for 48 days- who wouldn't be a little unbalanced? RSD is real and it is devestating for the patient and the family.
    tricia22 likes this.
  12. 0
    I worked on a unit that had pain management patients and RSD clients getting TENS units. They was definately a psych component; the patients were obsessed with their pain. I remember one patient's arm was atrophied and she guarded it from anything and everything. The slightest movement and she would hold it and cry. She was terrified of anything that would cause an increase in pain. The pain doc said it was a chronic problem resulting from a type of nerve damage brought on by a crushing injury; it could actually even initally have been a minor injury as the precipitating event.
  13. 1
    before you "jump" on "its psych" wagon, remember when Crohn's was considered psych and autism was considered psych
    NickiLaughs likes this.


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