[LizaJane]

are we more likely than others to get RSD?

I injured my thumb over the weekend and a small but deep chunk was bitten off by a hinge. It's small, like half an inch diameter, but conical,like an upside-down volcano. I went to an ER and was given a tetanus shot and antibiotics and told to just put bacitracin on it and I'll be fine. Nothing to stitch because it was too wide.

But just changing the dressing tonight--this is day 3--had me, literally, in tears, sobbing in pain. I'm not a crybaby, but it was as if my thumb was stabbed down to the bone. It looks clean and all, but the pain is way more than I'd expect. It was just excruciating. Now it's calmed down and is just throbbing.

Does this sound normal for this type of injury--kind of a deep small bite of skin? Or is this because of neuropathy, and am i at greater risk of RSD? I googled preventing RSD and came up with Vitamin C.

If anybody has any suggestions, or knows if there's more prevention, I'd like to hear.

It's really pretty small, but deep. I'm on 5 days of Keflex.

[echoes long ago]

are you sure it isnt infected. i had a puncture wound in my finger which when it became infected throbbed and the pain was pretty bad.

[mrsD]

I accidently ripped a part of my nail off my thumb recently doing a "stupid" thing. It was a horrible pain for a WEEK.

RSD is a sympathetic neuropathy, where something activates the sympathetic nervous system. There are papers showing it can be prevented (trauma and surgical trauma RSD was blocked by simple Vit C treatments). It also responds to antioxidants, and seems to be some sort of biochemical signaling error. Also there are papers that calcium channel blocking drugs can help in the early stages. This suggests a malfunction of the NMDA receptor which is activated by calcium.

There are some patients over there with a crossover to PN but not as many as you'd expect.

I do think PNers feel pain more than other people when injured. This may be more of a link to Fibromyalgia than RSD.

I placed a small strong magnet over the nerve at the base of my thumb/wrist and the pain stopped. Without that little help that thumb was throbbing away and driving me nuts, especially at night. Certain positions in bed made it far more painful. I experimented with it some, since it has been a long while since I had an accidental injury of this magnitude!

[nide44]

In my line of work (locksmithing) I constantly injure thumbs & fingers.
I also have some sort of a condition where my skin splits along the fingerprint ridges and goes very deep. These injuries prevent me from playing the guitar or banjo for a month or so, every time. They hurt quite a bit. Sometimes its infection, others-just really hurts (fibro? RSD?).
I use anti-bacterial ointments, A&D ointment, and a dynamite herbal ointment I found in a health store (recommended by the owner) that really helps a lot in many instances.
But I always am exposed to dirty locks, dirt, cleansers, oils (WD-40), grease, etc.
This does not help the cleanliness of the hands.
I have to carry band-aids in my wallet all the time.

[mrsD]

Yes, those split fingertips occur in printers and masons too.

When the skin gets defatted by solvents, it cracks.

Aquaphor ointment is good, too. There are cotton gloves you can wear after putting on the ointments --they are called Dermal Gloves, and sold in most pharmacies. At least they can order them for you, if they are not on the shelf.

Making sure you eat enough good fats will also restore your skin faster and keep it more resistant. Flax oil, especially. Rubbing evening primrose on the skin also works. It will heal and also prevent.

[LizaJane]

I think this feels like a root canal without lidocaine, so I'm going to load up on Vitamin C to prevent RSD. Also, I'm seeing a surgeon this afternoon just to have it eye-balled. I don't think he'll say anything special, but I'll feel reassured to have read advice on how to care for something this deep. I don't have a lot of faith in the PA who saw me in the ER on Saturday, so I'll feel better with an MD looking.

I have strong magnets that someone on this site recommended years ago, so I will try them tonight and see if they help me get a good night's sleep.

Thanks, Folk.

[Mere]

Everything is very painful to me - even stimuli that most people would not find 'painful'. Sometimes referred to as the "Princess and the Pea" syndrome. No, it's not really called that...

Is it possible that you suffer from fibromyalgia? It is one of those nasty things that like to piggyback with other illnesses such as autoimmune disease, neuropathy, etc... It has a tendancy to "amplify" pain sensation.

I have that problem. Dental work always poses a problem with me - fortunately, my dentist administers nitrous oxide gas.

Hope you feel better.

Mere

[mrsD]

Nitrous destroys B12. I have read that just one treatment with it can disrupt B12 metabolism!

Nitrous oxide inactivates the cobalamin form of vitamin B12 by oxidation. Symptoms of vitamin B12 deficiency, including sensory neuropathy, myelopathy, and encephalopathy, can occur within days or weeks of exposure to nitrous oxide anesthesia in people with subclinical vitamin B12 deficiency.[citation needed] Symptoms are treated with high doses of vitamin B12, but recovery can be slow and incomplete.[57] People with normal vitamin B12 levels have stores to make the effects of nitrous oxide insignificant, unless exposure is repeated and prolonged (nitrous oxide abuse).[citation needed] Vitamin B12 levels should be checked in people with risk factors for vitamin B12 deficiency prior to using nitrous oxide anesthesia.

A study of workers[58] and several experimental animal studies[59][60][61][62] indicate that adverse reproductive effects for pregnant females may also result from chronic exposure to nitrous oxide.

http://en.wikipedia.org/wiki/Nitrous_oxide

http://www.ncbi.nlm.nih.gov/pubmed/17404524

Rev Neurol (Paris). 2007 Mar;163(3):362-4.
[Nitric-oxide triggered neurological disorders in subjects with vitamin B12 deficiency]

[Article in French]

Cohen Aubart F, Sedel F, Vicart S, Lyon-Caen O, Fontaine B.

Assistance Publique-Hôpitaux de Paris, Fédération des maladies du Système Nerveux, et Université Pierre et Marie Curie, Groupe Hospitalier Pitié Salpêtrière 47-83 boulevard de l'hôpital 75013 Paris, France.
Abstract

INTRODUCTION: Nitrous oxide is frequently used for anesthesia. It may cause spinal cord toxicity. CASE REPORTS: We report two patients who presented gait disorders after nitrous oxide anesthesia. Physical examination revealed arms and legs pyramidal syndrome and abnormal proprioception, consistent with subacute combined degeneration of the spinal cord. Serum vitamin B12 level was extremely low. The patients improved with parenteral treatment with hydroxycobalamin. CONCLUSIONS: The inactivation of methionine synthase and L methylmalonylcoA mutase by nitrous oxide has been previously demonstrated. Anesthesia-related exposure to nitrous oxide may induce neurologic disorders even in patients with no preliminary vitamin B12 deficiency.

PMID: 17404524 [PubMed - indexed for MEDLINE]

As time passes more and more articles appear on this subject, but they were available back in 2000 or so even then.

[nide44]

I always thought that nitrous oxide gas was found to be the cause of PN in many cases.
Documented traces back, to be the only element that preceded the onset
of PN in quite young patients.
I won't let a dentist use it on me.
I undergo all procedures with topical, injected numbness,
or in one instance of severe dental work about 30 yrs ago-twilight sleep.

[Raglet]

hands DO hurt horribly when injured, because of the high density of nerves in them which gives us excellent touch in our fingers. Sounds awful, hope the pain improves soon.

I think one of the definitions of RSD (someone correct me if I am wrong) is that the pain continues long AFTER the injury has healed, and is not linked to the severity of the pain of the actual injury. I used to have RSD, but mine eventually improved which I know is very unusual.

hope the pain eases up soon

raglet