Summated Responses: Sleep Problems, Hormones, and Healing Outcomes

Summated Responses: Sleep Problems, Hormones, and Healing Outcomes

Custom Prosthetic Services Ltd.

2/3/2006

Original Posting:

I read with interest Tony Barr's posting regarding the importance of a trouble-free residual limb and the benefits of the Ertl procedure. Regrettably the Ertl procedure or reconstruction technique is quite rare in Canada and surgeons here have not been quick to embrace it.

I have a number of patients who received trans tibial amputations secondary to traumatic ankle injury and fusion failure , with long-standing pain issues. Their regional pain did reappear after a few years in their residual limbs. Further surgery ( even the Ertl Reconstruction) is not currently viewed as the answer to their pain problems, now managed with strong analgesics.

I wonder if anyone has information related to research or investigations into the relationship between the presence (or lack thereof) of hormones regulating tissue growth and repair and the development of Complex Regional Pain Syndrome (Reflex Sympathetic Dystrophy)? Many of these hormones (e.g. Human Growth Hormone) are secreted mostly during a particular (Delta) phase of sleep, which I suspect is not enjoyed by people under great stress or in pain. A destructive cycle of pain and greater disability can result.

Any comments or information is most helpful.

Kindest Regards,

Geoff Hall, B.Sc., C.P. ( c )

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Summated Responses:

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Referenced Commentary and Clinical Opinion:

R. Norman Harden,MD, Director, Center for Pain Studies, Addison Chair, Clinical Co-chair of the RSDSA Scientific Advisory Committee
Rehabilitation Institute of Chicago, Chicago, Illinois
<URL Redacted>
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I have only 1 patient with ertl reconstruction after 5 years of pain following traumatic ankle fractures and fixation failure...100% success and now 2 years post ertl...i am interested in your responses as there is so much to be learned.
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I agree with you Geoff. I worked with patients who under went the Bone Bridge amputation. They were patients with long standing pain. Many suffered over a 5 year with crippling pain. They often reported phantom
pain after amputation. Though there are many benefits to the surgery relief from phantom pain is not one. I believe that recent work using anti-inflammatories for the treatment of RSD suggest that phantom pain is a chronic inflammation problem.
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HI Geoff,
I humbly suggest this person consider taking a full compliment of vitamin, antioxidant, mineral supplement that gives the body the required fuel. Do this for 8- 12 weeks and feel the result. For what it's worth,
the body requires the precise blend of 54 nutrients daily - given that, the body just might recalibrate metabolic system and reach a state of homeostasis - thereby eliminating these symptoms. Tony Barr is not intelligent to this in any manner - he is more interested in advancing his own agenda. The Ertl Procedure is indeed the most physiologic reconstruction of a limb, but cannot alter centralized neuro-biochemical pain that has been realized for more than ~ 6 months. I believe providing the body with required nutrients, and resistance exercises is the next evolutionary step in treatment for these patients.
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Thank you to all who responded and are interested in this significant problem.

Geoff Hall, B.Sc., C.P. ( c )