What is Reflex Sympathetic Dystrophy (RSD) Syndrome?
RSD is described as a chronic pain disorder that usually effects but is not limited to an extremity [arm or leg]. RSD is an older term used to describe Complex Regional Pain Syndrome (CRPS). RSD/CRPS is a nerve disorders characterized by severe burning pain, pathological changes in bone on X-rays, skin discoloration and inflammation, excessive sweating, tissue swelling and extreme sensitivity to touch. RSD is sometimes called Type I CRPS, which is triggered by tissue injury where there is no underlying nerve injury, while Type II CRPS refers to cases where a high-velocity impact (such as a bullet wound) occurred at the site and is clearly associated with nerve injury. Type II used to be called “causalgia” and was first documented over 100 years ago by doctors concerned about the pain that Civil War veterans suffered even after their wounds had healed. RSD affects the nerves, skin, muscles, blood vessels and bones at the same time.
The intensity of the pain is almost always out of proportion when compared to injury or pathological changes.
Patients complain of:
- burning pain
- throbbing pain
- increased skin sensitivity
- skin changes
(discoloration, temperature changes, texture changes)
- skin over affected area may be excessively sweaty
- changes in nail and hair growth patterns
- swelling and stiffness in affected joint
- motor disability, with decreased ability to move affected body part
- Muscle spasms
- muscular atrophy
- muscle weakness
The cause of RSD/CRPS is unknown but the following can be common TRIGGERS of onset
- a previous injury or trauma to the limb is a common cause
- gun shot wound
- motor vehicle accident
- infection or illness
- emotional stress may also be a precipitating factor
It’s not well understood why these may trigger CRPS but it may be due to an inappropriate inflammatory process resulting from the above illnesses.
A patient may avoid using his/her limb due to the severity of pain and sensitivity; This may lead to wasting and loss of the muscles and tissues in that limb. The muscles of the limb may appear smaller and the patient may complain of loss of strength in affected limb. Patient may need physical therapy.
A muscle contracture is stiffness caused by prolonged position held by patient due to the pain caused by CRPS.
How is RSD treated?
Various medications are used according to patient response
Ibuprofen (Motrin, Advil)
Vicodin (Hydrocodone with Acetaminophen)
Other treatments that can be used alongside medications include:
Applying heat & cold in alternation may easy the pain
Sympathetic Nerve blocks
This injection is done under fluoroscopy.
We inject a combination of Lidocaine and corticosteroids to numb the affected nerves which relief the pain and sensitivity.
Spinal Cord Stimulation
(Link for SCS website)
Electrical currents sent to the affected nerves by a stimulator that is implanted in the spinal cord may be a great long term option.
A multi-day low dose ketamine infusion has proven a significant reduction in pain in RDS/CRPS patients.
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