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Injections, Medication, Therapy Can Help With CRPS

Dear Dr. Roach: Could you please give any insight into CRPS, formerly known as RSD? My 17-year-old daughter was diagnosed with this condition three months after an arm injury. She is currently under the care of several doctors and therapists. This has been very traumatic for my daughter and our family. We are trying to obtain as much information and knowledge about the condition as possible. Very few people seem to know anything about this. My daughter may look well and healthy, but she is in extreme pain. Thank you! — L.C.

Answer: Complex regional pain syndrome is the new name for reflex sympathetic dystrophy. It is a syndrome characterized by pain following an injury — not just the regular pain after an injury, but a burning, throbbing pain, often with intense sensitivity to touch or cold. The injury that starts the process often is minor, sometimes surgical and sometimes can’t even be identified. It’s noteworthy that the pain doesn’t follow the usual path of a nerve. Physicians who don’t know about CRPS sometimes think that the patient is making it up, but treatment (including physical therapy) in this early stage is important and may prevent or reduce the symptoms in later stages.

Later stages of CRPS include thickening of the skin and development of muscle atrophy. In the worst cases, movement can be limited, muscles can shrink further and bone loss can occur.

CRPS is best treated by an expert, often an anesthesiologist or pain-medicine specialist, and there are several different types of treatment, including oral medication (many different types), topical medications and physical therapy. Injections to block the nerve sometimes are helpful. Trigger-point injections also are often helpful.

Dear Dr. Roach: I read that if one is taking a statin drug (like Simvastatin) for cholesterol management, one also should take the supplement CoQ10. If so, why, and in what daily dosage? I also read that one should take it twice daily rather than once, as it passes through the system quickly. Is this true? — S.D.

Answer: The body uses the vitamin-like coenzyme Q10 (CoQ10) to metabolize statin drugs. In some people, the levels in the body can become depleted, and this is thought to be one reason why people can develop muscle aches during treatment. I have had some success in treating muscle aches with CoQ10.

However, since the risk of developing muscle aches is low, I wouldn’t recommend using it unless you develop problems. If you decide to try it, the dose would be 150-200 mg daily. Taking half the dose twice daily is OK, but so is taking the full dose at the time of the statin. Both pravastatin and fluvastatin have less risk of muscle aches than the other statins.

Dear Dr. Roach: My doctor of the past 11 years had to close his practice. He had told me that women over 70 years of age should have a mammogram only every five years.

My new doctor suggests a mammogram annually. Could you please tell me what the current recommendation is in this area? Many thanks. — M.O.

Answer: The guidelines aren’t clear for women over 70. Most data show benefit up to age 75; for patients older than that, the data are mixed. I personally recommend continuing to screen with mammography for healthy older women annually until age 80, or until she doesn’t want to screen anymore.

Dr. Roach regrets that he is unable to answer individual letters, but will incorporate them in the column whenever possible. Readers may email questions to ToYourGoodHealth@med.cornell.edu or request an order form of available health newsletters at P.O. Box 536475, Orlando, FL 32853-6475. Health newsletters may be ordered from www.rbmamall.com.