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Gary Davidoff

Publications and source records attributed to Gary Davidoff.

6 recordsLinked to original sources
PubMed1989

The reflex sympathetic dystrophy syndrome associated with traumatic myelopathy: report of 5 cases.

Pain is a frequent problem following recent traumatic spinal cord injury (SCI). Of specific concern in the rehabilitation setting is function-limiting hand pain which prevents optimal participation in therapy and limits independence. A treatable etiology of function-limiting hand pain in SCI is the reflex sympathetic dystrophy syndrome (RSDS). The presentation of RSDS in patients with recent SCI can be easily confused with that of dysesthetic (central origin) or radicular pain. Previous reports of RSDS associated with recent traumatic SCI have not been based on specific clinical criteria outlined in recent literature, and treatment has not been evaluated by objective outcome measures. This report describes 5 cases of RSDS associated with recent traumatic SCI that are identified by specific clinical criteria and are confirmed by a 3 phase bone scan. It is suggested that aggressive early intervention is necessary to obtain optimal functional outcome and minimize length of hospital-based rehabilitation.

Adult↗
PubMed1988

Pain measurement in reflex sympathetic dystrophy syndrome.

The reflex sympathetic dystrophy syndrome (RSDS) consists of a triad of pain, edema and sympathetic dysfunction of an extremity following trauma, peripheral nerve injury or central nervous system disorder. Reflex sympathetic dystrophy syndrome is a difficult and costly pain syndrome to treat. One of the difficulties in evaluating treatment efficacy is the objectification and quantification of patient findings. The purpose of this investigation was to develop a simple, reproducible and systematic evaluation of pain and neurologic impairment in RSDS. The protocol evaluation included the following measures of pain and impairment: (1) objectification of distal joint pain by palpation (0-4 scale); (2) volumetric measurement by water displacement of the distal limb; (3) skin temperature measurement; (4) active range of motion assessment of the affected limb (AROM); (5) McGill Pain Questionnaire (MPQ); and (6) visual analogue pain scale (VAS). Seventeen subjects with definite or probable RSDS were evaluated. The mean age of patients was 35.6 years +/- 8.0 years (+/- 2 S.E.M.), and the mean duration of symptoms was 11.8 +/- 4.8 months. There were an equal number of subjects with upper and lower extremity involvement. The VAS had significant correlations with limb volume, AROM-lower extremity and joint pain indices (P less than 0.0005). The MPQ subscales had robust correlation with the joint pain indices alone (P less than 0.0001). Skin temperature was not predictive of changes in joint pain score, AROM, limb volume or subjective pain measures. However, there was internal consistency between volumetric and AROM measures and joint pain indices. This protocol is recommended for use in therapeutic trials for the treatment of the RSDS.

Adult↗
PubMed1987

Function-limiting dysesthetic pain syndrome among traumatic spinal cord injury patients: a cross-sectional study.

Diffuse burning dysesthetic sensations distal to the level of spinal injury are the most common and disabling painful sequelae of traumatic spinal cord injury (SCI). In a cross-sectional study of 19 SCI patients, clinical characteristics and results of 3 validated pain measurement instruments (McGill Pain Questionnaire, Sternbach Pain Intensity and Zung Pain and Distress Scale) were used to develop a profile of function-limiting dysesthetic pain syndrome (DPS). Compared to a cohort of 147 patients admitted to the Midwest Regional Spinal Cord Injury Care System during the time period of the study, subjects were more likely to have paraplegia, incomplete sensory myelopathy, gunshot wounds to the spine and non-surgical spinal stabilization. Most patients described the pain as 'cutting,' 'burning,' 'piercing,' 'radiating' and 'tight.' The majority of patients located the pain internally and in the lower extremities. Values obtained from 6 McGill Pain Questionnaire subscales, 2 Sternbach Pain Intensity ratings and the Zung Pain and Distress index equalled or exceeded those reported for other pain syndromes. Use of these validated pain measures resulted in a systematic comprehensive assessment of function-limiting DPS following SCI.

Adult↗
PubMed1987

Trazodone hydrochloride in the treatment of dysesthetic pain in traumatic myelopathy: a randomized, double-blind, placebo-controlled study.

Dysesthetic pain following traumatic myelopathy is characterized by diffuse burning and tingling sensations distal to the level of spinal injury. The dysesthetic pain syndrome (DPS) can compromise performance of functional abilities and inhibit participation in rehabilitation programs. Recent laboratory evidence suggests that antidepressant medications with selective inhibition of serotonin reuptake in the brain may be associated with superior analgesic effect compared to such non-selective agents as amitriptyline. Trazodone hydrochloride is a potent presynaptic serotonin reuptake blocker with few anticholinergic and cardiovascular side effects. This study was a randomized, double-blind, placebo-controlled trial of trazodone hydrochloride for the treatment of DPS. Following a 2-week placebo lead-in period, patients were randomized to a 6-week course of 150 mg trazodone hydrochloride/day or placebo. Evaluations of pain quality and intensity were performed at 2-week intervals, utilizing the McGill Pain Questionnaire, Sternbach Pain Intensity Scale, and Zung Pain and Distress Index. Neurologic examination and assessment of side effects were performed at each evaluation session. No significant changes were noted in reported pain measures between patients allocated to the active drug group and those given placebo during the course of the protocol. However, significantly more patients randomized to trazodone complained of side effects and prematurely terminated their participation in the study. The results of this investigation are consistent with those of other earlier trials which indicate that such antidepressant medications as trazodone hydrochloride which selectively inhibit presynaptic reuptake of serotonin, may not be effective in the control of certain pain syndromes. These results do not preclude the possible utility of these agents in the treatment of other pain syndromes or at higher doses than previously studied.

Adult↗