REFLEX SYMPATHETIC DYSTROPHY SYNDROME (RSDS)

49

Reflex sympathetic dystrophy syndrome (RSD), once commonly used by doctors, now falls under the umbrella of Complex Regional Pain Syndrome (CRPS), specifically Type I CRPS. This condition brings about persistent pain, often in an arm or leg, following an injury, stroke, or heart attack. Remarkably, the pain experienced can surpass the intensity of the initial trauma. While the precise cause remains elusive to medical experts, many cases can be effectively managed.

Previously known as RSD, Type I CRPS arises from tissue injury without associated nerve damage. Though the term “reflex sympathetic dystrophy syndrome” has fallen out of medical favor, its recognition within the broader spectrum of CRPS facilitates better understanding and management of this debilitating condition.

Causes

RSD, or Complex Regional Pain Syndrome (CRPS), is believed to stem from disruptions within the sympathetic nervous system, responsible for regulating blood flow and various bodily functions like heart rate and blood pressure.

Typically, when you sustain an injury, your sympathetic nervous system prompts blood vessels to constrict to prevent excessive bleeding. Later, it signals for them to dilate, facilitating blood flow to the injured area for healing. However, in RSD, this system gets confused. It remains activated after the injury, causing persistent pain and swelling.

Interestingly, RSD can develop without a specific injury, though it’s less common. Moreover, while it can affect individuals of any age, it tends to be more prevalent in women and often manifests between the ages of 30 and 60. Even children can be affected by this condition, albeit less frequently.

Symptoms of Reflex sympathetic dystrophy syndrome

Reflex Sympathetic Dystrophy (RSD) symptoms often develop gradually. Pain might be the first sign, worsening over time. You might not even realize it’s abnormal at first.

Triggering Injuries:

RSD can be triggered by various injuries, including:

• Amputations
• Bruises
• Burns
• Cuts
• Broken bones (fractures)
• Minor surgeries
• Needle pricks
• Radiation therapy
• Sprains

Common Locations:

RSD most commonly affects arms, shoulders, legs, or hips. The pain usually spreads beyond the initial injury site. In some cases, it can even spread to other body parts.

Immune System Effects:

RSD can impact your immune system, causing:

• Redness
• Warm skin around the injury
• Swelling

RSD Pain:

The pain itself is often constant and severe. People often describe it as:

• Aching
• Burning
• Cold
• Deep
• Throbbing

Skin Sensitivity:

Your skin might become hypersensitive to everyday activities, like showering or wearing clothes.

Other Symptoms:

RSD can also cause:

• Changes in hair, nail growth, or skin texture
• Excessive sweating in certain areas
• Muscle weakness or spasms
• Stiff joints
• Difficulty moving the affected area
• Skin discoloration (white, mottled, red, or blue)

Diagnosis of Reflex sympathetic dystrophy syndrome

Diagnosing RSD can be challenging, often requiring time and careful consideration by medical professionals. Persistent or unusually severe pain, disproportionate to the type of injury sustained, may raise suspicions of RSD.

There isn’t a single definitive test for RSD diagnosis. Instead, doctors rely on a combination of physical examination and medical history evaluation. Several tests may offer insights into the presence of certain signs associated with the condition:

1. Bone scan: This diagnostic tool can identify any bone abnormalities, such as erosion at the ends of bones or irregularities in blood flow.
2. MRI (Magnetic Resonance Imaging): By providing detailed images of internal tissues, an MRI helps doctors detect any noticeable changes that may indicate RSD.
3. Sweat test: This examination can reveal if there’s an imbalance in sweating between different parts of your body, which can be a sign of RSD.
4. Thermography test: By assessing temperature and blood flow variations between the injury site and other areas of the body, this test can provide valuable information about the functioning of the sympathetic nervous system.
5. X-rays: Typically employed in later stages of the syndrome, X-rays help identify mineral loss in bones, aiding in the diagnostic process.

While each of these tests offers valuable insights, the diagnosis of RSD often hinges on a comprehensive evaluation of multiple factors by healthcare professionals.

Treatment

Treatment for RSD focuses on early detection and intervention, as prompt diagnosis improves treatment outcomes. While some cases may not respond effectively to treatment and RSD itself lacks a cure, many symptoms can be managed effectively.

Medications are often prescribed to alleviate symptoms, including:

• Anesthetic creams like lidocaine
• Antidepressants
• Nonsteroidal anti-inflammatory drugs (NSAIDs)
• Anti-seizure medications for pain management
• Nasal spray targeting bone loss
• Nerve blocking injections

Over-the-counter options such as aspirin, ibuprofen, or naproxen may also be recommended for pain relief.

Less commonly used treatments, due to associated risks and limited evidence of efficacy, include:

• Corticosteroids to address swelling
• Opioids for pain management

Other therapeutic approaches include:

• Spinal cord electrodes deliver mild electric shocks to alleviate pain
• Physical therapy to improve mobility and alleviate pain
• Psychotherapy to teach relaxation techniques
• Splints to ease hand discomfort

In cases where pain persists despite conservative measures, surgical intervention such as sympathectomy may be considered. This procedure involves the removal of certain nerves around blood vessels to enhance blood flow and alleviate symptoms. Effective treatment of RSD often involves a combination of approaches tailored to individual needs, emphasizing early detection and comprehensive management strategies.

Sources

• National Institute of Neurological Disorders and Stroke: “Complex Regional Pain Syndrome Fact Sheet.”
• RSDSA: “Telltale Signs and Symptoms of CRPS/RSD.”
• New York State Department of Health: “Reflex Sympathetic Dystrophy Syndrome.”
• National Organization for Rare Disorders: “Reflex Sympathetic Dystrophy Syndrome.”
• Medscape: “Reflex Sympathetic Dystrophy.”
• Mayo Clinic: “Complex regional pain syndrome.”