RSD(S)/CRPS Summary Description

Reflex Sympathetic Dystrophy (RSD), also known as Complex Regional PainSyndrome (CRPS) Type I (here called RSD/CRPS), is a chronic condition characterized by burning pain and abnormalities in the sensory, motor andautonomic nervous systems. The syndrome typically appears after an acuteinjury to a joint or limb, though it may occur with no obvious precipitatingevent. In most cases, regardless of the site of injury the symptoms begin andremain most intense in the distal most extremity. In the initial stages of RSD/CRPS, pain and swelling from the injury do not subside but actuallyintensify, spreading from the site of the injury to other parts of the limb, to thecontralateral limb or to remote regions of the body. The skin in affected areasand particularly deep somatic tissues are painfully sensitive to touch, often red and abnormally warm due to alterations in regional blood flow. Changesin sweating patterns, hair growth, subcutaneous tissues, muscles, joints orbones and difficulty moving the joint or limb are other hallmarks of thedisorder. In addition to the evidence of inflammation and abnormalautonomic nervous system function, there are changes in motor systemsincluding tremor, weakness and dystonia, which strongly suggest a centralnervous system component to the disease in a subgroup of patients. The syndrome may evolve through three stages (acute, dystrophic, atrophic), although this is very much debated, each marked by progressive pain andphysical changes in the skin, muscles, joints and bones. RSD/CRPS can affect both genders and all ages (including children). The cause of RSD/CRPS is unknown, and current treatments are not effective for many patients. Reflex sympathetic dystrophy syndrome, or RSDS, is known by many names. These include causalgia, Sudeck’s atrophy, shoulder-hand syndrome and regional complex pain syndrome. The cause of this disorder is unknown but appears to involve abnormalities of the sympathetic nervous system. This network of nerves, located alongside the spinal cord, controls important body functions; in particular, the opening and closing of blood vessels that regulate blood flow and the control of sweat glands that regulate temperature. Reflex sympathetic (REE-flecks SIM-pah-theh-tick) dystrophy syndrome, or RSDS for short, involves a disturbance in the sympathetic nervous system which is the network of nerves located alongside the spinal cord and controls certain bodily functions, such as opening and closing blood vessels or sweat glands. It primarily affects the hands and feet. What Are the Symptoms? First Stage Affected area is painful and swollen. Changes in temperature and color of skinRapid nail and hair growth Stiffness. The second stage occurs after weeks or months, and includes the following symptoms: Burning painCool skinBrittle nails Swelling Muscles spasms. The third stage may result in permanent changes such as: Severe pain. Skin may become drawn. Muscles and other tissues become wasted and contracted (tight). Joint movement and limb function are reduced.What Causes It? Although the cause is unknown it can occur as a result of injury to nerves, bones, joints, occasionally muscles, tendons or ligaments. Other triggers may include: Infections Cancer Diabetes Disorders of neck/lower back Thyroid disorders Lung diseaseStroke/heart attack. Use of certain medicationsTreatment Options. An early diagnosis and treatment can help reduce or prevent permanent damage.Treatments may include: Biofeedback Exercise Medications: alpha-blocking drugs, calcium channel blockers, local anesthetic blockers, Bien block, Physical therapy, Surgery TENS unit (transcutaneous electrical nerve stimulation). Who Is At Risk? RSDS frequently occurs between the ages of 40 and 60 but also can occur in children and the elderly. It is more common among women. How Is RSDS Treated? Early treatment of RSDS is very important. Your doctor will design a treatment program based on the duration and severity of your symptoms. Muscle relaxants may help, especially when there are painful muscle spasms. A formal physical therapy or occupational therapy program with stress-loading and limited range-of motion exercises should be started immediately to help maintain flexibility and strength. Your doctor may prescribe corticosteroid (cortisone-like) medications. These are powerful drugs that require very careful monitoring by your doctor and may have a variety of side effects. In patients with increased blood flow to the affected extremity as determined on a bone scan, corticosteroids given in high doses for two to three weeks can be very effective. The use of medications such as alpha-blocking drugs or calcium channel blockers or procedures such as local anesthetic sympathetic blocks to increase blood flow to the involved area frequently relieve most of the pain, particularly when used early. With sympathetic blocks, a numbing agent (local anesthetic) is injected into the spinal canal (for epidural blocks) or alongside the spinal column (for paravertebral blocks). Sometimes medications are injected into the veins of the foot or hand. This form of block (called a Bier block) may produce similar relief. Sometimes a single injection is all that is required, but it may be necessary to repeat this several times depending on the response. Sympathetic blocks may relieve and sometimes cure RSDS, especially when given early and coupled with an appropriate exercise program. Sometimes blocks produce temporary relief for hours or days but do not provide permanent relief. Treatment with transcutaneous electrical nerve stimulator (TENS) unit or biofeedback may also be tried. A TENS unit is a small, battery-operated device that can relieve pain by blocking nerve impulses. Biofeedback is a technique that can help control pain, blood flow and skin temperature. Acetaminophen, aspirin and other nonsteroidal anti-inflammatory drugs (NSAIDs), including COX-2 inhibitors, or narcotic analgesics (pain relievers) containing codeine-like medication may be tried to relieve pain. Other treatments have been used in RSDS. They include medications that affect bone growth (calcitonin and leukotriene inhibitors). Anti-depressants and anti-seizure medications (neurontin) can provide additional relief.