Pain from injury can linger long

DEAR DR. DONOHUE: I got hurt at my place of work in May of last year. I had surgery on my left ankle in which a tendon from my foot was moved to my ankle. After the surgery I got what they call reflex sympathetic dystrophy. My whole leg from hip to foot burns with throbbing pain. It seems to be getting worse. I’ve been on five different medicines. Any information will be appreciated. — S.V.

ANSWER: Reflex sympathetic dystrophy has a new name: complex regional pain syndrome. Two varieties exist. You have the more common kind, the kind that comes after an injury or major illness like a sprain, a break, a stroke or even a heart attack.

Stage 1 is the stage that appears weeks to three months after the inciting event. Burning, throbbing or aching pain arises. The site where trouble started swells. The skin is red. Even the brushing of clothes on the involved area increases the pain tremendously.

In another three to six months, stage 2 sets in. The skin turns brown and becomes cool. Pain persists.

When stage 3 arrives, the skin begins to thin, and so do muscles in the areas adjacent to the injury. If a joint is involved, it might become immobile.

Why all this takes place isn’t understood with great clarity. Everyone agrees that early mobilization of the injured site with physical therapy is important. Moreover, occupational therapists teach a patient how to manage the daily tasks of life by demonstrating special maneuvers and providing gadgets that help the patient deal with pain and immobility.

Pain medicines are a prime concern. I’m sure your five medicines were for pain. It’s often a matter of trial and error until the medicine specifically for you is found. Amitriptyline, an antidepressant, often is chosen not for its properties to relieve depression but for its pain-relieving properties. Gabapentin is another example. Opioid medicines may have to be prescribed. Nerve blocks might be helpful. Most people eventually recover.

Contact the Reflex Sympathetic Dystrophy Syndrome Association at 877-662-7737 or online at www.rsds.org for the latest information on treatment.

DEAR DR.DONOHUE: My husband, 73, puts salt on almost all his food. He insists it’s OK because he has low blood pressure. I disagree. Who is correct? — P.M.

ANSWER: Many, if not most, people are salt-sensitive. Their blood pressure rises when they take in too much salt. A few people are salt-resistant. Salt doesn’t raise their blood pressure. Such people don’t have to limit their salt intake. Your husband, however, also should consider the fact that a high salt intake encourages the loss of calcium into the urine. If your husband is at risk for osteoporosis, he ought to limit his salt intake for that possibility.

DEAR DR. DONOHUE: I’d appreciate if you would explain what a foreign growth under the skin is. Some call it a Bible-bump. I don’t know the actual medical term. — R.C.

ANSWER: I never heard of that term.

The Internet informs me that a Biblebump is a ganglion — a small, somewhat soft lump found in many places but most often on the wrist.

Ganglions are growths originating from the tissue that lines a joint or that covers a tendon. Most often, they are not painful and don’t interfere with function of the joint they’re near. If one does become painful or does interfere with motion, they are easily removed.