es
en
fr
it
ru
ar
zh-hans
“The advancement in medical technology and in the knowledge of the own physicians has a proportional relationship with the decline of diagnoses of reflex sympathetic dystrophy ” (Dr Francisco del Piñal).
A conversation about reflex sympathetic dystrophy with Dr Francisco del Piñal leaves no one indifferent. His questioning of the very existence of the also known as Sudeck’s dystrophy is controversial among the medical profession and leaves patients with such diagnostic with certain feeling of helplessness.
However he holds that the reflex sympathetic dystrophy is an “obstacle to the advancement of medical research”, together with “a form of neglecting patients for which real solutions exist; they must always be our top priority, above anything else”. A thesis he will defend soon in international fora.
Dr., you not only consider that reflex sympathetic dystrophy is a misdiagnosis in almost all cases, but that it is a risk for the patient and the medicine itself (…).
That’s right, the vast majority of reflex sympathetic dystrophies are but a mask of underlying problems. We can not forget that our true objective, our real commitment with the patient is not to offer a diagnosis that closes the clinical process, but the cure; a cure that, necessarily, has to come improving the quality of the medicine that we offer.
In our work there is an expression -‘satisfaction of search- which, in essence, refers to the point when finding a first problem the doctor stops looking for other causes of the ailments that afflict his patient. This generates errors such as attributing to a single factor clinical situations of multiple origin.
Well, but what’s the link between this practice and the dystrophy?
In some way this process is the one that is replicated in the diagnosis of RSDS (reflex sympathetic dystrophy syndrome), to the detriment of a systematic analysis that identifies the causes – sometimes very diverse – of the patient’s condition.
Myriad of people with a diagnosis of reflex sympathetic dystrophy twenty years ago, for example, today have their real pathology perfectly identified.
But that initial mistaken diagnosis, Dr, probably has created difficulties for the patient, I guess
Of course. It has negative effects at two levels, both clinically and from a psychological point of view.
The combination of pain and repeated negative medical tests is a tremendous emotional burden. How is it not going to be? (…) Therefore, labeling a person as a patient of dystrophy is an invitation to give up, to conform to a misdiagnosis that closes the doors of possible solutions to your pathology.
Another factor to take into account is that the medication used in the treatment of Sudeck’s dystrophy is not harmless, but may end up generating a pathology per se.
In fact, in the dozens of cases in which I have been able to rule out dystrophy, finding the underlying causes, one of my biggest challenges is getting the patient to abandon a medication that is not necessary and that has created an addiction.
We can not overlook the implications of continued use of analgesic medication – to mitigate discomfort – and / or neurological, in order to raise the pain threshold. Especially, it’s obvious, in people who do not have to do that.
Nonetheless, my grounds don’t end here.
May you explain yourself, Dr, please
I suggest you a reasoning that may not seem overly technical, but I urge readers to take it into consideration: the criteria that lead to a diagnosis of reflex sympathetic dystrophy are so broad that anyone can suffer from it and, therefore, anyone can leave it behind.
I reiterate that for years I have worked with dozens of patients diagnosed with RSDS and we have been able to find, and treat, their true pathology.
Which are the most common pathologies hidden behind such a diagnosis?
On many occasions, the diagnosis of reflex sympathetic dystrophy hides subclinical nerve compressions or other pathologies not yet identified.
Going to the detail. After a traumatism, inflammation is very common. Simplifying, the nerves run through ‘tunnels’ with limited space, with which the inflammatory process quickly leads to pain.
A common example is that of a patient with a wrist fracture of a certain severity, in which either direct damage to the nerve has occurred or it is the subsequent inflammation itself that has caused such damage.
In this situation – and going back again to the idea of ‘satisfaction of search’ – one tends to treat the obvious, that is, the fracture itself, while the subclinical nervous compression that is what causes the continued suffering remains unaddressed
On numerous occasions, the erroneous diagnosis of reflex sympathetic dystrophy masks subclinical nerve damage linked to fractures in the wrist area. In the video above: Dr Francisco del Piñal performs a reduction of fragments of the radius that are causing an articular step..
That is when the question “how can a person feel pain if the fracture has healed correctly?” arrives. On too many occasions this question ends in a wrong diagnosis.
And your answer is (…)
At least partially the answer lies in the limitations of our current diagnostic tests and instruments. We have a spectacular range compared to two decades ago, for example, but that will be overcome in the next twenty years with possibilities that we can not even imagine now.
The other part, which we have already mentioned, is in certain knowledge gaps or just conformism of some professionals. As in any workplace, not all doctors perform at the same level.
Any final recommendation for the people with this diagnostic?
Only one, clear and concise: rebel yourself, don’t give up and seek a second opinion. And they must do it – I beg them to do it, in fact – because one of the great falsehoods behind the RSDS is that a patient in the ‘dystrophy phase’ gets worse when is operated on. This statement lacks scientific support.
There are things that can be shocking for the reader outside our environment, but in medicine the say that ‘customs make laws’ is usually followed. Too many times doctors are not able to break with the established.
Reflex sympathetic dystrophy does not exist, it is a huge burden on medical research and the hopes of tens of thousands of patients. In short, a false diagnosis, in all the sense of the term, from which we have to liberate ourselves. Those who practice medicine, the first ones (…).
Related content: