A difficult case of reflex sympathetic dystrophy(RSD) in the differential diagnosis from psychogenic pain.

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This article is a RSD case report. The patient was a 54 year old woman who had complianed of severe pain in the right mandibular region over the past 13 years. Prior to a visit to our hospital, she had undergone various medical treatments, including trigeminal nerve block, gangliongasselectomy, micro-vascular decompression operation, rhizotomy, trigeminal spinal nucleotomy, etc., on the diagnosis of trigeminal neuralgia at many medical institutes. However, none of the treatments lead to an improvement of her condition.<BR>At the start of the treatment in our hospital, we regarded her pain as psychogenic pain, because of her abnormal personality and psychological state and the lack of evidence of remarkable organic change on a clinical and X-ray examination. After one and a half years, we at last realized that her pain was due to RSD which was brought on after the nerve block treatment for trigeminal neuralgia and the pain was modified and accentuated by psychogenic overlay.<BR>So far, we have been performing stellate ganglion block, regimen of antidepressants and indomethacin, under a brief psycho-therapy. Although the pain still continues, the patient hasbecome remarkably settled in her mind.<BR>We also discussed in this article the difficulty of differential diagnosis among RSD and psychogenic pain and the need for consideration of psychogenic overlay and polysurgery in this case.
社団法人日本口腔外科学会の論文