Reflex Sympathetic Dystrophy

Reflex sympathetic dystrophy (RSD), also known as complex regional pain syndrome (CRPS), is a complex disorder that may develop as a result of injury (most common), surgery, or disease. It consists of unexplained intense pain in a part of the body which has been injured, and includes altered sensation and reduced motion in the body part affected. Once thought to be a rare disorder, reflex sympathetic dystrophy occurs in people of all ethnic backgrounds, with women affected twice as often as men. RSD/CRPS most commonly occurs in adults ages 40-49, but may occur at any age.

Symptoms
Symptoms of reflex sympathetic dystrophy often begin days or weeks after an injury, usually in an arm or leg which has been injured. The symptoms may include:

• unexplained intense pain
• swelling
• altered skin temperature, either warm or cold
• altered skin color
• reduced motion of the affected part, and movement makes the symptoms worse
• reduced sensitivity to touch and/or pain when touched
• abnormal sweating

Diagnosis
Diagnosis of reflex sympathetic dystrophy is mainly based on the symptoms present. There is no specific blood test for RSD, but blood tests can exclude other disorders. Some specialized diagnostic tests may be helpful in confirming the diagnosis of RSD in some individuals.

Treatment
Early diagnosis and treatment of reflex sympathetic dystrophy is recommended. Steroid medications such as prednisone or methylprednisolone can provide good pain relief. Opioid pain medications such as morphine are also effective. Studies have examined the use of calcitonin intranasal spray, antiepileptic drugs, antidepressants, and creams applied to the skin for treatment of the pain. A pain specialist should be part of the treament team for an individual affected by RSD. Some individuals may have pain relief with injection of local anesthetic around nerves to the affected area (nerve block).

Physical and occupational therapy are also important in the treatment of RSD to improve the movement of the affected part of the body.

Future research
When treated early, many individuals with RSD have relief of symptoms within 18 months. Others individuals, unfortunately, develop chronic pain and disability. Researchers do not know why some people improve while others do not. It is also not known exactly what causes reflex sympathetic dystrophy. Future research will no doubt discover how and why RSD begins, how it develops, and identify those individuals at risk for chronic disease.

Information for this article was taken from:
Hord, E.D. (2004). Reflex sympathetic dystrophy. eMedicine, accessed at http://www.emedicine.com/neuro/topic627.htm.