Imagine living every day with a constant, searing type of pain that starts in the hands and spreads to the legs. This pain may occur even without a specific cause, but it is unresponsive to any over- the-counter pain medication and persists enough to interfere with daily life. Reflex sympathetic dystrophy is just this sort of pain. Here’s what you need to know about this condition.

What is reflex sympathetic dystrophy?

Reflex sympathetic dystrophy (RSD) is also referred to as complex regional pain syndrome (CRPS). These two terms are used interchangeably for the same syndrome.

Reflex sympathetic dystrophy typically occurs in the upper or lower extremities. There are two types of reflex sympathetic dystrophy:

  • CRPS 1: Pain stems from an initial painful event that does not cause direct nerve damage to the affected limb
  • CRPS 2: Pain occurs as a direct result of an identifiable trauma or nerve injury

Both CRPS 1 and CRPS 2 have as their main symptom high levels of pain. The pain is continuous and intense and usually out of proportion to the severity of the injury. Other RSD symptoms include:

  • Drastic changes in the temperature and color of the skin over the affected limb or body part
  • Severe burning pain
  • Skin sensitivity
  • Sweating
  • Swelling
  • Changes in the texture of the skin
  • Stiffness, swelling, and damage in the joints
  • Limited mobility in the painful area

People who experience CRPS may also be extra sensitive to pain, a condition known as hyperalgesia. They may also respond to non-painful stimuli with pain sensations (referred to as allodynia). These symptoms can change over time, appearing and disappearing in phases.

What causes reflex sympathetic dystrophy?

The cause of reflex sympathetic dystrophy is still unclear, especially when it has no known trauma or injury. Some researchers believe this condition is caused by damage to the peripheral or central nervous systems.

Another theory is that CRPS is caused by an immune response that leads to the inflammatory symptoms of redness, warmth, and swelling in the affected area.

CRPS 2 may also have its roots in traumatic injury radiation therapy, cancer, surgery, soft tissue injuries, or paralysis in the body.

Towards an RSD diagnosis

It can take a long time to receive a reflex sympathetic dystrophy diagnosis, especially if there is no identifiable trauma or root cause.

There are no specific tests to diagnose CRPS. Diagnosis is a process of exclusion.

Blood testing can be done to rule out other inflammatory or rheumatologic conditions. Nerve conduction studies rule out peripheral neuropathy or nerve entrapment conditions. Your doctor might also recommend an MRI to rule out any soft tissue injury that might be causing symptoms.

A RSD diagnosis is generally made in the absence of other possible causes for your pain.

What are reflex sympathetic dystrophy treatments?

This is a very complex pain disorder that can be incredibly difficult to treat. It often begins in the hand or the foot before spreading to the affected arm or leg. Then, however, it can also spread to the opposite arm or leg.

Although treatable in the early stages, there are signs that the condition can become permanent. Once the skin begins to change, or the nails change in terms of growth, this condition may be irreversible. Early treatment is crucial.

In general, these reflex sympathetic dystrophy treatments may relieve symptoms:

  1. Desensitization treatments with a physical therapist
  2. Medications that help with neuropathic pain (e.g., gabapentin, pregabalin, duloxetine, and amitriptyline
  3. Stellate ganglion blocks
  4. Cervical epidural steroid injections
  5. Interscalene blocks
  6. Lumbar sympathetic nerve blocks
  7. Lumbar epidural steroid injections
  8. Femoral sciatic nerve blocks

If conservative or minimally-invasive treatments do not help relieve pain, spinal cord stimulation is an option. Spinal cord stimulation involves placing small electrodes within the epidural space of the spine. These small electrodes deliver a mild electrical current to the epidural space, interrupting the transmission of pain signals. The patient controls these currents directly.

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