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12/13/2012 06:59 AM

Dystonia, Movement Disorders, and RSD

revvanbus
revvanbus  
Posts: 2032
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Papers and videos about muscle cramping and ligament and tendon shrinkage that can lead to joints becoming distorted. What medicines and treatment can help and hurt?

Thanks to Jenny who started giving information on this Topic.

Rev.

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12/13/2012 07:06 AM
revvanbus
revvanbus  
Posts: 2032
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This first paper is actually just page 3 of the paper. The whole paper will be links on a general RSD topic because it has information on many areas of RSD. There is so little information in papers on RSD on dystonia I am including this info here.

http://www.rsdfoundation.org/en/ en_clinical_practice_guidelines.html

Correction of link: (jp 9-1-13):

http://www.rsdfoundation.org/en/ en_clinical_practice_guidelines.html

Post edited by: jpcrps, at: 09/02/2013 05:49 AM


12/13/2012 07:07 AM
revvanbus
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Dr. H The Management of CRPS, see item (v), page 3

http://www.rsdrx.com/THE%20MANAGEMENT%20OF%20CRPS% 20TEXT.pdf

"Treatment with muscle relaxants: The constant component of CRPS is hypertonicity of the muscles in the form of vasoconstriction, flexion spasm, or movement disorder(8,12-20). It is imperative to treat the patient with muscle relaxants. The use of addicting muscle relaxants such as Soma should be avoided. Soma is metabolized in the

body and is transformed to meprobamate which is quite addicting and causes withdrawal with recurrence of muscle spasms. Flexeril which some hoe has the reputation of being an antidepressant, is quite depressing and aggravates fatigue. It is quite effective in somatic type of muscle spasm, but not the sympathetic type.

"The ideal muscle relaxant which works quite selectively on anterior lateral horn cells of the spinal cord is Lioresal(Baclofen). This medicine should be started in small doses and gradually increased to a larger dose. The limiting factor is nausea. Once the patient develops nausea, then the dosage should be cut down by 5-10 mg and not increased any further.

Another effective muscle relaxant is Norflex. If the patient has muscle spasms along with jerky movement and dystonic motion of the extremity, the use of anticonvulsants such as Klonopin, Neurontin, Tegretol, Depakene and Trileptal may be beneficial.

After achieving enough relaxation of the muscles in the extremity, the use of assistive devices such as crutches, wheelchair, braces, canes, and walkers should be discontinued. As long as the extremity is inactive due to the use of assistive devices or due to the application of a cast, the “sleeping nociceptive nerve fibers” become activated causing more inflammation and deep pain.


12/13/2012 07:09 AM
revvanbus
revvanbus  
Posts: 2032
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A research article on baclofen for dystonia

Abstract:

a b s t r a c t

Dystonia in complex regional pain syndrome (CRPS) responds poorly to treatment. Intrathecal baclofen (ITCool may improve this type of dystonia, but information on its efficacy and safety is limited. A singleblind, placebo-run-in, dose-escalation study was carried out in 42 CRPS patients to evaluate whether dystonia responds to ITB. Thirty-six of the 38 patients, who met the responder criteria received a pump for continuous ITB administration, and were followed up for 12 months to assess long-term efficacy and safety (open-label study). Primary outcome measures were global dystonia severity (both studies) and dystonia-related functional limitations (open-label study). The dose-escalation study showed a dose effect of baclofen on dystonia severity in 31 patients in doses up to 450 lg/day. One patient did not

respond to treatment in the dose-escalation study and three patients dropped out. Thirty-six patients entered the open-label study. Intention-to-treat analysis revealed a substantial improvement in patient and assessor-rated dystonia scores, pain, disability and quality-of-life (Qol) at 12 months. The response in the dose-escalation study did not predict the response to ITB in the open-label study. Eighty-nine adverse events occurred in 26 patients and were related to baclofen (n = 19), pump/catheter system defects (n = 52), or could not be specified (n = 18). The pump was explanted in six patients during the followup phase. Dystonia, pain, disability and Qol all improved on ITB and remained efficacious over a period of one year. However, ITB is associated with a high complication rate in this patient group, and methods to improve patient selection and catheter-pump integrity are warranted."

 2009 International Association for the Study of Pain. Published by Elsevier B.V. All rights reserved.

Source:

http://www.rsds.org/pdfsall/vanRijnMA_MuntsAG_MarinusJ.pdf

------------------


02/28/2013 11:28 AM
jpcrps
jpcrps  
Posts: 1661
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I'm an Advocate

The National Institute of Health has published a new page on Dystonia on their website called: Medline Plus at:

http://www.nlm.nih.gov/medlineplus/dystonia.html

This is a condition which begins in CRPS/RSD patients with muscle spasms and contractions. It should not be ignored as it can lead to permanent distortion of the body. Here is the text:

Dystonia is a movement disorder which causes involuntary contractions of your muscles. These contractions result in twisting and repetitive movements. Sometimes they are painful.

Dystonia can affect just one muscle, a group of muscles or all of your muscles. Symptoms can include tremors, voice problems or a dragging foot. Symptoms often start in childhood. They can also start in the late teens or early adulthood. Some cases worsen over time. Others are mild.

Some people inherit dystonia. Others have it because of another disease. Either way, researchers think that a problem in the part of the brain that handles messages about muscle contractions might cause dystonia. There is no cure. Instead, doctors use medicines, surgery, physical therapy and other treatments to reduce or eliminate muscle spasms and pain.

National Institute of Neurological Disorders and Stroke

Post edited by: jpcrps, at: 02/28/2013 11:29 AM

Post edited by: jpcrps, at: 02/28/2013 11:32 AM

Post edited by: jpcrps, at: 02/28/2013 11:42 AM


02/28/2013 11:56 AM
jpcrps
jpcrps  
Posts: 1661
Senior Member
I'm an Advocate

I am going to try to attach some images of dystonia in crps. Wish me luck!

http://www.biomedcentral.com/1471-2377/11/53/figure/F2[/img]

Post edited by: jpcrps, at: 02/28/2013 11:57 AM


02/28/2013 11:58 AM
jpcrps
jpcrps  
Posts: 1661
Senior Member
I'm an Advocate

Image of Dystonia common sites in CRPS

[/img]

http://www.biomedcentral.com/1471-2377/11/53/figure/F2

Post edited by: jpcrps, at: 02/28/2013 12:03 PM

Post edited by: jpcrps, at: 02/28/2013 12:04 PM


03/02/2013 07:35 AM
reruho
 
Posts: 76
Member

This is great information and explains the pain in my shoulders. I developed tennis elbow 3 years ago and thought it was from overuse, now I know it probably was a combination of the RSD and overuse. This also explains why if has never fully healed.I think it is about 80=90%, so I have to watch how much fine motor activities I do or I am in pain.

Thank you for this information.

Reta


04/21/2013 10:50 PM
cfthb
cfthb  
Posts: 872
Group Leader
I'm an Advocate

Dystonia is extremely common in CRPS, and seems to become more of a problem as the disease progresses.

The Library associated with my RSD site currently lists about two dozen papers on dystonia, including its diagnosis, new treatment approaches, etc. Here's a link right to the correct section:

http://www.thblack.com/links/RSD/library2.htm#dystonia

However, if you're not up to wading through so many articles, here are a few highlights that I think are particularly good:

- Fixed Dystonia in Complex Regional Pain Syndrome (http://www.thblack.com/links/RSD/ BMCNeurology2011_11_53_CompModelingDystonia.pdf)

- Motor cortex dysfunction in complex regional pain syndrome (http://www.thblack.com/links/RSD/ ClinNeurophys2010_121_1085_MotorCortexDysfunction-in- CRPS.pdf)

- Onset and progression of dystonia in Complex Regional Pain Syndrome (http://www.thblack.com/links/RSD/ Pain2007_130_287_dystoniaInCRPS.pdf)

I hope these provide a good background for this terrible part pf CRPS.

Howard


09/24/2013 07:24 AM
LEFTWRIST
 
Posts: 69
Member

Hi Howard, great info. The trouble is getting Docs to believe that you have Dystonia. I started right hand shaking( opposite to my left hand actually having the CRPS) and stomach spasms( LIke Hic cups only around the navel area)When I asked my p[ain specialist if it was Dystonia he said no as Dystonia caused the muscles to contract and stay that way. It was only from getting the right links here that I found out there were 10 other forms of Dystonia and mine was intermittent Dystonia. When I saw him again and told him this he just had a shocked look on his face as he had misdiagnosed me. His comeback was I should not be finding info on the net or going to chat rooms (MD Junction) as it was not good for me. My answer was if you cant help me then I have to help myself. Seriously it is getting so that I know more then the doctors I see because I do the research that they don't.

So thanks Howard, keep stirring the pot.

Leftwrist

W00t

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