Reflex Sympathetic Dystrophy Pain Relief

Also known as RSD, Reflex Sympathetic Dystrophy Syndrome (RSDS), Complex Regional Pain Syndrome (CRPS), Causalgia, Sudeck’s Atrophy, and Hand-shoulder Syndrome.

Definition: Reflex Sympathetic Dystrophy (RSD) is a chronic, painful, and debilitating condition, usually involving the extremities, caused by an abnormality of the sympathetic nervous system characterized by severe burning pain, swelling, discoloration, temperature changes of the skin, increased sweating, muscle and skin atrophy, frozen joints, increased hair growth, and extreme sensitivity to light touch.

Reflex Sympathetic Dystrophy Information

The nervous system may be roughly divided into two important categories: the somatic or voluntary system, and the sympathetic or involuntary system. The somatic nervous system is what is generally responsible for sensation and muscle activity, while the sympathetic system controls many of the body’s functions such as heart beat, blood flow, sweating and resting muscle tension. The sympathetic nervous system is activated involuntarily, usually in response to changes in the environment to protect us. Injuries of any type normally cause an activation of the sympathetic nervous system. These injuries may be minor such as a sprained ligament or a small cut, or may be a severe injury such as a crush injury to the extremity or a broken bone. The sympathetic nerves do not normally carry messages regarding pain. However, in certain injuries the sympathetic nerves may be recruited to augment the painful response. Normally, the sympathetic nervous system returns to normal function after the acute phase of the injury when the healing begins.

Sometimes the sympathetic nerves are not so sympathetic:
However, in rare cases, the sympathetic nervous system does not return to normal after the injury. Instead, the injury actually induces a cascade of physiological changes in the sympathetic nervous system. The sympathetic nervous activity continuously increases resulting in extreme burning pain and sensitivity, swelling, discoloration, skin temperature changes, muscle and skin atrophy, and joint stiffness. Severe muscular contractures and even deterioration of the bones may occur. This process is called reflex sympathetic dystrophy or RSD and was first identified by a physician treating soldiers after wounds to the nerves during the Civil War. The painful area may become so sensitive that even the touch of clothing or a breeze may stimulate severe pain. This sensitivity is called allodynia. While RSD may involve any area of the body, including the face, the most common areas involved are the extremities. RSD may progress like a fire. These changes usually progress frequently until the involved extremity becomes functionless.

Almost any type of injury may precipitate RSD including brain injuries such as strokes, sprains, broken bones, nerve injuries such as with carpel tunnel syndrome, minor surgeries, and some medications. RSD may even develop spontaneously, without any apparent cause. In many cases, RSD occurs as a result of damage to somatic nerves, such as in carpel tunnel syndrome. In these cases, it is often difficult to differentiate when the pain is coming from, the somatic nerves or the sympathetic nerves. In most cases, the pain is due to a combination of abnormalities in both types of nerve. For this reason, the designation of RSD has been changed to complex regional pain syndrome (CRPS). RSD is now rarely used as the primary diagnosis.

RSD and CPRS Symptoms

Diagnosis of RSD is not easy:
The diagnosis of RSD is often difficult and is often overlooked by many physicians until the condition has become very severe. Since there are no tests which specifically diagnose RSD, this condition is determined by clinical examination by an experienced physician, usually a pain specialist. The diagnosis of CRPS or RSD is usually made when the initial pain and swelling after an injury or surgery does not improve in the anticipated time. Instead of improving, the pain, sensitivity, swelling and other symptoms spread beyond the area of the original injury. For example, after a minor sprain of the wrist, the symptoms may spread up the arm, into the shoulder and neck. Sometimes, the condition may spread to the other extremities. RSD may occur in the face after dental injury or RSD or CPRPS usually occurs in young adults and sometimes even teenagers. Rarely, this condition occurs in younger children and seniors.

Reflex Sympathetic Dystrophy Treatments

There is no known cure for RSD or CRPS and the success of current treatments are dismal. The first course of treatment is aggressive physical therapy to avoid stiffness and loss of function. Sympathetic nerve blocks have also been part of the mainstays of treatments. Some newer medications have improved the outcome of RSD such as gabapentin (Neurontin), pregabalin (Lyrica), which are anticonvulsant medications, or duloxetine (Cymbalta), which is an antidepressant.

Still, the standard treatment for RSD and CRPS is still over-the-counter (OTC) and prescription narcotic and non-narcotic medications. As most patients who suffer with this type of pain soon realize, these treatments are usually not sufficient and many, especially the oral medications, are associated with serious side effects such as sedation, nausea, constipation, and even addiction. Extended use of some over-the counter (OTC) medications such as ibuprofen, naproxen, and acetaminophen may even result in stomach ulcers, kidney failure, heart failure, and liver failure. Many sufferers of pain due to RSD often search for alternative solutions to the usual over-the-counter and prescription medications.

Sudden severe pain, especially in the chest, arms, or head, or pain in any area of the body that does not resolve after a couple of weeks, should always be evaluated by a physician to be certain that other medical conditions, including heart disease, infections, or even cancer is not the underlying cause of pain.

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