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What began as a routine knee injury in high school resulted in 11 years of constant pain and anguish for Tonya Domenico. At age 15, Ms. Domenico was participating in a band practice in a parking lot when her foot became stuck in a hole. Her knee locked and the trauma caused damage that required orthoscopic knee surgery. While most people recover fully from this type of minor trauma and surgery, Ms. Domenico became one of the few people who suffer permanent damage. She developed a condition called Reflex Sympathetic Dystrophy Syndrome (RSD), which involves a dysfunction of the nervous system, resulting in chronic pain. With most patients, as an injury heals, pain decreases and then disappears. With RSD, the injury heals but the debilitating pain persists. In 2002, after close to 25 visits to physicians in the tri-state area, Ms. Domenico finally found permanent relief with the help of David Conyack, D.O., attending anesthesiologist and pain specialist at the Center for Pain Management, part of The Pain Management Institute at the Saint Barnabas Ambulatory Care Center. "When you have something as painful as RSD and have to go to as many physicians as I have, you start to feel hopeless," says Ms. Domenico. "Then someone comes along like Dr. Conyack and gives hope by fixing the problem more than you ever imagined was possible. I am just ecstatic." A Tragic Condition RSD, a neurological disease, is a malfunction of the sympathetic nervous system in which nerves misfire, sending constant pain signals to the brain. "This is a very rare condition that occurs in less than one percent of all neurological injuries," says Dr. Conyack. "Our goal is to calm down or shut off the signals from sympathetic nervous system with a multidisciplinary approach, including oral and I.V. medications, physical therapy and nerve blocks." The most universal symptom of RSD is neuropathic pain, usually as a burning sensation. Other symptoms abnormalities. "In the winter, the RSD would cut off my circulation and I would not be able to walk," says Ms. Domenico. "My foot would turn blue." From epidural spinal blocks, which gave only temporary pain relief, to five hours of physical therapy per day, she endured many treatments without success. Relief Found Ms. Domenico came to Dr. Conyack's office in the winter of 2002. He told her about a new anti-convulsant that might be successful in blocking her pain. The neurolyptic agent is used because it soothes the sympathetic nervous system. "This is a very difficult disease and you don't always know which medication or combination of agents will work for a patient," says Dr. Conyack. "We were very pleased that it worked on the first attempt with this patient. She has had almost resolution of the condition. Since she first began using the medication about a year ago, Ms. Domenico has been pain and symptom-free. "It was incredible," she says with a smile. "Last winter I could go outside, even in the snow, without feeling any pain. I haven't felt this good since before the accident when I was 15." As for her thoughts on the physician who finally helped her, Ms. Domenico says Dr. Conyack is "truly amazing" and she feels grateful to have her life back. Dr. Conyack is equally pleased to have brought this patient some needed relief. "When you have this kind of success it is a great field in which to practice," he relates. "It is very rewarding to change the life of someone in that kind of pain."
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