What is Reflex Sympathetic Dystrophy?
Reflex sympathetic dystrophy (RSD), commonly referred to as complex regional pain syndrome (CRPS), is a condition characterized by a group of typical symptoms, most commonly severe pain in one or more extremities that lasts months or longer. Typically, the condition occurs after an injury or other medical condition. A variety of treatments are available for reflex sympathetic dystrophy, and it is important to get it treated as early as possible to prevent the worsening of symptoms.
Symptoms of Reflex Sympathetic Dystrophy
The main symptom of reflex sympathetic dystrophy is intense, chronic pain that feels much worse than the injury (if an injury occurred) and which gets worse over time rather than better. It most often affects the upper extremities, but it is possible to get it in your lower extremities as well. Specifically, you may experience RSD in your hands, arms, fingers, legs, feet, shoulders, hips, and knees, and is accompanied by a series of signs and symptoms, such as:
- Burning pain
- Changes to the skin in the affected region
- Sweating around the affected region
- Stiffness
- Swelling
- Sensitivity to cold or heat
- Sensitivity to touch
- Weakness
- Tenderness
- Skin redness
- Skin paleness with a blue tone
- Muscle spasms
- Muscle weakness
- Muscle atrophy
- Nail and hair changes
- Joint pain and stiffness
Causes of Reflex Sympathetic Dystrophy
The exact cause of reflex sympathetic dystrophy is not clear. However, physicians believe pain caused by RSD occurs when the body’s immune system and sympathetic nervous system malfunction as a result of nerve injury. The injured nerves misfire, conveying excessive pain signals to the brain from the affected region. Many underlying factors and disorders can cause reflex sympathetic dystrophy, including:
- Trauma, such as broken bones or amputation
- Soft tissue injuries such as cuts, bruises, and burns
- Surgery
- Sprains
- Radiation therapy
- Cancer
- Heart attack
- Stroke
- Emotional stress
- Nerve pressure
- Paralysis on one side of the body
- Inflammatory or autoimmune conditions
Diagnosis of Reflex Sympathetic Dystrophy
There is no definitive test to diagnose reflex sympathetic dystrophy. In general, your physician will review your medical history and symptoms and conduct a thorough physical examination to examine the affected areas such as upper and lower extremities. Individuals with reflex sympathetic dystrophy are unusually protective of the involved extremity. Even a slight touch may elicit expressions of severe pain. In addition, some imaging tests, such as X-rays, magnetic resonance imaging (MRI) scans, and bone scans may assist your physician to make a firm diagnosis.
Treatment for Reflex Sympathetic Dystrophy
In general, treatment plans for reflex sympathetic dystrophy are personalized and often incorporate several types of conservative (non-surgical) and surgical treatment.
Conservative Treatment
Some of the types of non-surgical treatment include:
- Physical Therapy: Physical therapy is typically a main component of treatment. Active exercise that stresses on normal use of the affected extremity is crucial for permanent relief of reflex sympathetic dystrophy. Physical and/or occupational therapy are essential to assist patients in improving the range of motion and strength of the affected area, as well as regaining normal use patterns. Medications and other treatment measures can alleviate pain, enabling the patient to engage in active exercise.
- Medications: There are several types of medications, such as pain relievers, oral corticosteroids, blood pressure medications, antidepressants, and anticonvulsants that are recommended to mitigate symptoms of reflex sympathetic dystrophy.
- Injection Therapy: Injecting an anesthetic (numbing medicine) close to the contributing sympathetic nerves can help provide relief from the pain and discomfort. This is typically recommended in the initial stage of reflex sympathetic dystrophy to avert progression to later stages.
- Cognitive Behavioral Therapy or Psychotherapy: This treatment method can teach patients relaxation techniques to help them cope better with the pain.
Surgical Treatment
If conservative treatment fails, there are surgical procedures that may assist in reducing symptoms. These include:
- Intrathecal Drug Pump: This technique uses a battery-powered device to deliver a regulated amount of medication into the spinal fluid. It involves the administration of medication via a pump that is implanted (placed) into a specific region of your spinal cord called the intrathecal space. This ensures medication reaches the cerebrospinal fluid and provides quicker relief.
- Spinal Cord Stimulation: This involves the placement of stimulating electrodes next to the spinal cord. The stimulator sends electrical impulses to the areas of the spinal cord causing the pain and interferes with the transmission of pain signals to the brain, thus relieving pain.
- Surgical Sympathectomy: It is a surgical technique that destroys the nerves involved in reflex sympathetic dystrophy.
