Ask the Doctor
Pain can linger long after a broken bone heals
BY PAUL G. DONOHUE, M.D.
May 12, 2005
DEAR DR. DONOHUE: I fractured my wrist in 2003, and I still have pain to this day. The problem is said to be reflex sympathetic dystrophy. I have never heard of it, and I am told there is nothing to be done for it. Now my fingers do not bend. Can something be done for this? — B.H.
ANSWER: Reflex sympathetic dystrophy is now called complex regional pain syndrome. It happens after an injury, sometimes one as insignificant as a minor sprain.
The sequence of events goes something like this. Even though the injury heals, the injured site becomes swollen and develops burning, throbbing or aching pain weeks to three months after the injury originally occurred. The skin is warm and tender to the touch.
In another three months, the skin cools, but pain remains.
After three more months pass, the skin and tissues in the injured area shrink, and the adjacent joints can become stiff.
The situation is not without treatment. Pain medicines can generally control that aspect of this condition. Capsaicin cream or a lidocaine skin patch applied to the involved site can ease discomfort. Nerve blocks are another approach to pain control. In resistant cases, a device called a spinal-cord stimulator delivers a mild electric current to the spinal cord and blocks the transmission of painful signals to the brain.
Most important is physical therapy. You need a supervised program to improve the flexibility of your wrist, hand and fingers. A physical therapist can devise such a program for you, and you should see about one quickly.
You might also want to visit the Reflex Sympathetic Dystrophy Syndrome Association’s Web site, at www.rsds.org. It has a good deal of useful information.