Reflex Sympathetic Dystrophy (RSD)
A Cause of Complex Regional Pain Syndrome and Causalgia
Reflex sympathetic dystrophy, complex regional pain syndrome and causalgia are terms which relate to chronic pain usually associated with some type of nerve injury. There are different mechanisms which may be related to causing the different conditions. The conditions may develop after minor injuries or fractures of a limb or after major injuries to a nerve. Events causing this condition include fracture or minor soft tissue injury, infection, frostbite, burns, stroke and myocardial infarction.
Symptoms of Reflex Sympathetic Dystrophy
Symptoms may include swelling and pain at a site remote from the initial injury. There may be a burning type of pain and patients may experience extreme hypersensitivity of the skin to light mechanical touch. Movement, loud noises and strong emotions may trigger the pain. The affected limb may be cold and sweaty. Abnormal nail growth, increased or decreased hair growth, thin glossy skin and osteoporosis may develop. Weakness of the muscles of the distal extremity is often present. On occasion, multiple extremities may be affected.
Causes
The most common cause is trauma which affects the distal part of an extremity. This may be a result of a fracture, postsurgical condition, contusions and strain or sprain. Less common causes include spinal cord injuries and stroke and cardiac ischemia.
Diagnosis
Typically the pain occurs in an area of the limb which is not limited to the territory of a single nerve. The pain level and intensity is disproportionately greater than the inciting event. At some point, swelling and changes in blood flow occur. Changes in bone density such as osteoporosis may be present. Other tests such as skin temperature measurements may be performed.
Treatments
Nonsteroidal anti-inflammatory medications and narcotics may provide some relief. Antidepressants such as the tricyclic antidepressants may produce some pain relief. Gabapentin is often effective.
Interventional therapy aimed at blocking the sympathetic nervous system may also be effective, or a block of the sympathetic ganglion may be of great benefit. Surgical sympathectomy may have a role as well.
Transcutaneous Electrical Nerve Stimulation (TENS), as well as epidural spinal cord stimulation may improve the pain.
Physical therapy and occupational therapy may be beneficial to maximize recovery of function. Lastly, psychological counseling may also be beneficial.
Prognosis
The prognosis can be quite variable. The severity of the symptoms correlates with the likelihood of improvement. Those with more minor symptoms may have a 75% chance of improvement while those with more severe symptoms may have a much lower chance.
For more information on Reflex Sympathetic Dystrophy (RSD) or for a consultation at the Kraus Back and Neck Institute please call:
281.44.NEURO (281.446.3876)
