The Basics of Reflex Sympathetic Dystrophy (RSD) and Complex Regional Pain Syndrome (CRPS)


rsd21Reflex sympathetic dystrophy (RSD), also called complex regional pain syndrome (CRPS), is a nerve disorder characterized by chronic, severe pain, a burning sensation, excessive sweating, extreme sensitivity to touch, and tissue swelling. RSD type I is triggered by tissue injury without nerve injury, whereas type II RSD refers to a high-impact injury, such as a bullet wound.

According to researchers, approximately 5% of patients who experience an injury to the upper extremity develop RSD. In addition, RSD is seen in around 15% of people who have a hemiplegic stroke. RSD affects both sexes and all races, with the age of onset in most people 30 to 60 years. Although rare, RSD can occur in children, who have a better prognosis than adults.

Symptoms of RSD

The symptoms of RSD includes continuous intense pain that is more severe than what is usually seen with this type of injury. The pain of this syndrome also affects the arms, hands, legs, and feet. This pain is accompanied by:

  • Changes in skin temperature
  • Increased skin sensitivity
  • A burning sensation
  • Changes in skin color (purple, red, pale, or blotchy)
  • Motor disability and decreased movement
  • Changes in hair and nail growth patterns
  • Changes in skin texture (thin, shiny, and sweaty)

Causes of RSD

The exact cause of RSD is unknown, but the syndrome is preceded by an injury in most cases. Experts believe RSD is the result of malfunctioning of the sympathetic nervous system. This condition occurs due to sprains, damaged blood vessels, fractures, surgery, injured nerves, and certain brain injuries.

Treatment Options for RSD

Early treatment is key to controlling the symptoms of RSD. Treatment must be individualized because what works for one patient may not work for all. Measures include:

 

  • Medications – Pain medications and anti-inflammatory agents are used for the first few weeks, and depending on response of the patient, gradually reduced after this. High doses of prednisone pain relief3(corticosteroid) is often an initial therapy. In addition, beneficial medicines include amitriptyline, Lyrica, and clonidine.

 

  • Physical therapy – To avoid muscle atrophy, the doctor may order physical therapy. The therapist works with the patient to perform exercises and stretching techniques.

 

  • Stellate ganglion block – Injection of a long-acting local anesthetic into the specialized areas of involuntary nervous system near the cervical spine. This treatment will improve blood flow to the hand and/or arm in many cases. The doctor uses x-ray guidance and contrast dye to confirm exact needle placement.

 

  • Spinal cord stimulation – The doctor implants a small device with a wire that delivers electrical current to the spinal cord. This allows the brain to perceive pleasant sensations over the painful ones.

 

Lumbar Sympathetic Block

  • Intrathecal pump implantation – The doctor implants a small unit near the spine, which delivers a strong medication directly into the cerebrospinal fluid. This allows for the avoidance of unpleasant side effects.

 

  • Lumbar sympathetic block – This is used for RSD pain in the leg. The doctor injects a long-acting anesthetic into the sympathetic nerve chain of the lumbar spine. This procedure is performed under x-ray guidance with contrast dye to assure correct placement.

 

Resources

Goebel A. Complex regional pain syndrome in adults. Rheumatology (Oxford). Oct 2011;50(10):1739-50.

Cimaz R, Matucci-Cerinic M, Zulian F, Falcini F. Reflex sympathetic dystrophy in children. J Child Neurol. Jun 1999;14(6):363-7.

Badri T, Ben Jennet S, Fenniche S, Benmously R, Mokhtar I, Hammami H. Reflex sympathetic dystrophy syndrome in a child. Acta Dermatovenerol Alp Panonica Adriat. Jun 2011;20(2):77-9