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Reflex Sympathetic Dystrophy



Reflex Sympathetic Dystrophy

Reflex Sympathetic Dystrophy (RSD), also known as Complex Regional Pain Syndrome (CRPS), is a complicated pain problem. It is characterized by severe pain and progressive physical changes that persist long after the original injury has healed.

The original injury may have been as severe as a bullet wound or as simple as a sprained ankle. The syndrome can also sometimes occur after routine surgery.

Victims of RSD usually describe the pain as burning or shooting with extreme sensitivity to touch. For example, an article of clothing rubbing the affected area will often cause severe, extraordinary discomfort.

RSD usually occurs in an extremity (leg and foot or arm and hand), but can occur almost anywhere, including the chest, breast or abdomen. It is impossible to predict who will develop RSD. RSD is suspected when pain and other physical changes persist after healing appears complete and other causative factors have been ruled out.

Stages and physical changes
RSD develops slowly, in stages, over several months or years. Initially the area may appear swollen and feel warm to touch due to both inflammation and spasms of the surrounding blood vessels.

In the second stage, the blood supply to the area diminishes and the area becomes cool to touch. The skin becomes shiny and waxy and there is a loss of hair and skin tone. The pain increases and there can be weakening of the underlying bone.

In the third and final stage, there is wasting of the affected muscles and disabling pain. Left untreated, the area can develop contractures from disuse which can become permanent. Bone scan and thermography are sometimes using in diagnosing RSD.

Treatment
Because of the complicated and progressive nature of this potentially devastating pain syndrome, treatment must be aggressive and must focus on rehabilitation as well as pain management. The doctor will prescribe treatment for the causative factors as well as the resultant physical, psychological and emotional side effects.

Nerve blocks are used to break the pain cycle and prevent progression of symptoms. These are most effective in the earlier stages and may need to be repeated several days in a row. Hospitalization for continuous nerve block is sometimes necessary.

Narcotic medications will decrease the pain of RSD but do not impact the underlying problem. In the early stages, it is preferable to use pain medicines that are also anti-inflammatories. Steroids may be prescribed short term to relieve symptoms and arrest their progression. Anti-depressants are used to improve sleep and inhibit pain pathways. Anti-convulsants and oral anesthetic agents may also be helpful for this type of pain.

Physical therapy is very important for pain relief and to maintain muscle strength and mobility. Massage, ultrasound and whirlpool may be employed for comfort, while aquatic or land exercise and mobilization prevent muscle wasting and disability.

The intensity of pain and muscle weakness often make compliance with prescribed treatment difficult for the patient. It is extremely important that all medicines be taken as directed and that exercises be performed regularly despite the pain. Education and counseling related to coping with and managing pain are available and may be helpful. In addition, biofeedback can assist individuals in learning to control blood flow and muscle tension to lessen symptoms.

For more information about treatments for RSD, call Baptist Health Louisville's Center for Pain Management at (502) 896-7246.