An Overview of Reflex Sympathetic Dystrophy/Complex Regional Pain Syndrome

Reflex Sympathetic Dystrophy (RSD) is frequently referred to as Complex Regional Pain Syndrome (CRPS). RSD is a multi-symptom syndrome that usually affects the extremities, but may affect virtually any part of the body. The best way to describe RSD is an injury to a nerve or to soft tissue that does not heal normally, and it can be caused by even the slightest of injuries. If left untreated, RSD can spread to all extremities which makes the rehabilitation process difficult. The treatment of RSD is challenging and it can become extremely expensive due to permanent deformities and chronic pain. Patient’s suffering from advanced RSD may have significant psychological and psychiatric problems, and risk developing dependency to narcotics. However, if diagnosed early, doctors can use physical therapy and nerve blocks to cure or lessen the effects of the disease. The incidence of this syndrome is higher in women, especially among the young. A number of factors have been associated with causing RSD, including trauma, heart disease and heart attack, cervical spine or spinal cord disorders, cerebral lesions, infections, surgery, repetitive motion disorder or cumulative trauma.

Clinical Features of RSD
Pain: The first and primary complaint occurring in one or more extremities is described as severe, constant, burning, and/or deep aching pain

Skin Changes: The skin may appear shiny, dry, or scaly. Hair may grow coarse and thin. Nails in the affected extremity may be more brittle, grow faster and then slower. RSD is associated with a variety of skin disorders including rashes, ulcers, and pustules.

Swelling: Pitting or hard edema is usually localized to the painful and tender region.

Movement Disorder: Patients with RSD have difficulty moving because they hurt when they move. Patients describe difficulty in moving, as though they have stiff joints. Tremors and involuntary severe jerking or extremities may be present. Psychological stress may exacerbate these symptoms. Sudden onset of muscle cramps can be severe and completely incapacitating.

Spreading Symptoms: Initially, RSD symptoms are generally localized to the site of the injury. As time progresses the pain and symptoms tend to spread. Typically, the disorder starts in an extremity.

Bone Changes: X-rays may show wasting of bone or a bone scan may show increased or decreased uptake of a certain radioactive substance in bones after intravenous injection.

Duration of RSD: The duration of RSD varies. In mild cases it may last for weeks followed by remission, but in many cases the pain continues for years and in some cases, indefinitely.

Treatment

The most important aspect of treating RSD is education. The doctor defines the potential benefits, risks, and alternatives. The therapeutic goals must be to educate the patient about therapeutic goals, encourage normal use of the limb, minimize pain, and determine the contribution of the sympathetic nervous system to the patient’s pain. The cornerstone in the treatment of RSD is the normal use of the affected part as much as possible through physical therapy. The goal of physical therapy should be to create independence from the health care system in the shortest period possible. Although psychiatric illness or personality disorder does not cause RSD it is likely that personality contributes to the disease. A formal psychological evaluation should be initiated early in the course of treatment. Medications are generally prescribed according to various characteristics of the pain including constant pain, pain causing sleep problems, inflammatory pain or pain due to recent tissue injury, spontaneous jabs, sympathetically maintained pain, and muscle cramps.