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Reflex sympathetic dystrophy (RSD)
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Reflex sympathetic dystrophy (RSD), also
called complex regional pain syndrome (CRPS), is a chronic, painful
and progressive neurological condition that affects the skin, muscles,
joints, and bones.
The syndrome usually develops in an injured limb, such as
a broken leg, or following surgery.
However, many cases of RSD involve only a minor injury, such as a
sprain. And in some cases, no precipitating event can be identified.
It's
not well understood why these injuries can trigger complex regional pain
syndrome. It is thought to be caused by a dysfunction of the sympathetic
nervous system, which is involved in the regulation of blood supply to the
affected part. The condition is often not diagnosed until sometime after the
initial symptoms begin.
RSD/CRPS is characterized by various degrees of severe burning
pain, excessive sweating, pathological changes in bone and skin, (skin color
changes, skin temperature changes more than 1.1°C difference from the
homologous body part), swelling and extreme sensitivity to touch. Pain may
begin in one area or limb and then spread to other limbs. In some cases,
symptoms of RSD/CRPS diminish for a period of time and then reappear with a
new injury.
The main symptom of complex regional pain syndrome is intense pain, which
gets worse over time. Additional signs and symptoms include:
 | "Burning" pain in your arm, leg, hand or foot.
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| Skin sensitivity.
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| Changes in skin temperature, color and texture. At times your skin may
be sweaty; at other times it may be cold. Skin color can range from white
and mottled to red or blue. Skin may become tender, thin or shiny in the
affected area. |
| Changes in hair and nail growth.
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| Joint stiffness, swelling and damage.
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| Muscle spasms, weakness and loss (atrophy).
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| Decreased ability to move the affected body part.
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Symptoms may change over time and vary from person to person. Most
commonly, swelling, redness, noticeable changes in temperature and
hypersensitivity (particularly to cold and touch) occur first. Over time,
the affected limb can become cold and pale and undergo skin and nail changes
as well as muscle spasms and tightening. Once these changes occur, the
condition is often irreversible.
Types
Two types of RSD/CRPS have been defined:
| Type 1—without nerve injury
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| Type 2 (formerly called causalgia)—with nerve injury
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Both types of RSD/CRPS share the same signs and symptoms.
Incidence and Prevalence
Millions of people in the United States may suffer from RSD/CRPS. This
chronic pain syndrome affects both men and women, and also occurs in
children. It can occur at any age, but usually affects people between the
ages of 40 and 60 years.
The National Institute of Neurological Disorders and Strokes (NINDS)
reports that 2–5% of peripheral nerve injury patients and 12–21% of patients
with paralysis on one side of the body (hemiplegia) develop reflex
sympathetic dystrophy as a complication. The Reflex Sympathetic Dystrophy
Syndrome Association of America (RSDSA) reports that the condition develops
after 1–2% of bone fractures.
If complex regional pain syndrome isn't diagnosed and treated at an early
stage, the disease may progress to more disabling signs and symptoms. These
may include:
| Muscle wasting (atrophy). If you avoid moving an arm
or a leg because of pain or if you have trouble moving a limb because of
stiffness, your skin and muscles may begin wasting. |
| Contracture. You may also experience tightening of
your muscles. This may lead to a condition in which your hand and fingers
or your foot and toes contract into a fixed position. |
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Complex regional pain syndrome occasionally may spread from its source to
elsewhere in your body in these patterns:
| Continuity type. The symptoms may migrate from the
initial site of the pain — for example, from your hand to your shoulder,
trunk and face. |
| Mirror-image type. The symptoms may spread from one
limb to the opposite limb. |
| Independent type. Sometimes, the symptoms may leap to
a distant part of your body. |
Diagnosis of complex regional pain syndrome is based on a physical exam
and your medical history. There is no single test that can definitively
diagnose complex regional pain syndrome, but the following procedures may
provide important clues:
| Bone scan. A radioactive substance injected into one
of your veins permits viewing of your bones with a special camera. This
procedure may show increased circulation to the joints in the affected
area. |
| Sympathetic nervous system tests. These tests look
for disturbances in your sympathetic nervous system. For example,
thermography measures the skin temperature and blood flow of your affected
and unaffected limbs. Other tests can measure the amount of sweat on both
limbs. Dissimilar results can indicate complex regional pain syndrome.
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| X-rays. Loss of minerals from your bones may show up
on an X-ray in later stages of the disease. |
| Magnetic resonance imaging (MRI). Images captured by
an MRI device may show a number of tissue changes. |
Dramatic improvement and even remission of complex regional pain syndrome
is possible if treatment begins within a few months of your first symptoms.
Often, a combination of various therapies is necessary. Your doctor will
tailor your treatment based on your specific case. Treatment options
include:
Medications
Doctors use various medications to treat the symptoms of complex
regional pain syndrome. Over-the-counter nonsteroidal anti-inflammatory
drugs (NSAIDs), such as aspirin, ibuprofen (Advil, Motrin, others) and
naproxen sodium (Aleve), may ease pain and inflammation. In some cases,
doctors may recommend prescription medications. For example,
antidepressants, such as amitriptyline, and anticonvulsants, such as
gabapentin (Neurontin), are used to treat pain that originates from a
damaged nerve (neuropathic pain). Corticosteroids, such as prednisone, may
reduce inflammation.
Your doctor may suggest bone-loss medications, such as alendronate (Fosamax)
and calcitonin (Miacalcin). Opioid medications may be another option. Taken
in appropriate doses, they may provide acceptable control of pain. However,
they may not be appropriate if you have a history of substance abuse or lung
disease.
Some pain medications, such as COX-2 inhibitors (Celebrex), may increase
your risk of heart attack and stroke. It's wise to discuss your individual
risks with your doctor.
Therapies
| Applying heat and cold. Applying cold may relieve
swelling and sweating. If the affected area is cool, applying heat may
offer relief. |
| Topical analgesics. Various creams are available that
may reduce hypersensitivity, such as lidocaine or a combination of
ketamine, clonidine and amitriptyline. |
| Physical therapy. Gentle, guided exercising of the
affected limbs may improve range of motion and strength. The earlier the
disease is diagnosed, the more effective exercises may be. |
| Sympathetic nerve-blocking medication. Injection of
an anesthetic to block pain fibers in your affected nerves may relieve
pain in some people. |
| Transcutaneous electrical nerve stimulation (TENS).
Chronic pain is sometimes eased by applying electrical impulses to nerve
endings. |
| Biofeedback. In some cases, learning biofeedback
techniques may help. In biofeedback, you learn to become more aware of
your body so that you can relax your body and relieve pain. |
| Spinal cord stimulation. Your doctor inserts tiny
electrodes along your spinal cord. A small electrical current delivered to
the spinal cord results in pain relief. |
See The
Reflex Sympathetic Dystrophy
Syndrome Association (RSDSA)
for information and support.
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Disclaimer: These statements have not been evaluated by the Food and Drug
Administration. The products and information contained herein are not
intended to diagnose, treat, cure or prevent any diseases
or medical problems. This is not intended to replace your
doctor's recommendations. The information is provided for educational
purposes only. Nutritional benefits may vary from one person to another.
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