Raynaud's Disease and Phenomenon
In my previous blog post, I described why fingers and toes hurt so badly after cold exposure and upon warming. Let's talk a little bit about some of the conditions that contribute to this unique kind of cold weather pain and treatment options.
The symptoms and the treatment of cold exposure vary dramatically from person to person. For many of us, cold weather exposure means just that; we're going to get cold and shiver. But for many people, cold exposure results in significant pain. The most common diagnosis used to describe this condition is Raynaud's disease. When discussing Raynaud's disease, the terms disease and phenomenon are often used interchangeably. Raynaud's disease described a person who has been diagnosed with the condition while Raynaud's phenomenon describes a single instance of Raynaud's disease.
My hiking buddy has Raynaud's disease. When we go on a multi-day trip in the spring or fall, he always brings gloves to help. It's not necessarily severe cold that affects his hands, but in backcountry conditions, it's often hard to get out of the elements. It's remarkable to see his fingers blanch white with temperatures that don't even get below 50F. And they hurt. Other than his Raynaud's disease, he's essentially healthy. He is a previous smoker but has not smoked in years.
Raynaud's disease - causes
What causes Raynaud's phenomenon and Raynaud's disease? A review of the literature may result in more confusion than be of help. Many authors associate Raynaud's disease with connective tissue disorders such as lupus, rheumatoid arthritis, and scleroderma. Medications, including birth control and beta-blockers, are often cited. Anxiety and mood disorders are also cited as contributing causes. Tobacco use, whether traditional cigarettes, vape pens or snuff, becomes a potent vasoconstrictor. A single cigarette can reduce blood flow to the toes by 30% for up to 1 hour.
Treatment of Raynaud's disease
The most common pharmaceutical approach to treating Raynaud's disease is the use of a blood pressure medication called a calcium channel blocker that works by dilating the peripheral arteries, in many cases preventing peripheral vasospasm and easing the symptoms of Raynaud's Disease. Mood stabilizers such as Prozac are also used. Patients are also instructed to avoid smoking and use of beta-blockers.
For many patients with Raynaud's disease, the single best solution is to move to a warm climate. Even in these cases, exposure to the freezer chest at the grocer or air conditioning at a restaurant may trigger an episode of Raynaud's phenomenon.
Jeffrey A. Oster, DPM