Reflex sympathetic dystrophy syndrome (RSD)

Specialty of Pain medicine

What is it?

Reflex sympathetic syndrome is a condition that affects the sympathetic nervous system. It is a painful chronic condition that tends to last more than six months, it causes stiffness and discolouration in the affected area.  

The nerves affected by reflex sympathetic syndrome are located either side of the spinal cord and are responsible for certain bodily functions, such as opening and closing blood vessels.  

This condition tends to affect hands and feet, although it can also affect arms and legs.    

Reflex sympathetic syndrome is also known as complex regional pain syndrome, Sudeck’s atrophy, reflex neurovascular dystrophy, causalgia, or shoulder girdle syndrome.  

Condition prognosis

This can greatly vary, it is thought that in young people disease prognosis is better. In some cases, despite treatment, the person affected will still have pain and disability.     

If treatment is started early, it is believed that the condition can be halted, although not enough information is known about the disease progress.  

What are the symptoms?

The most defining symptom of reflex sympathetic dystrophy is severe and long lasting pain, it can sometimes be chronic, which affects the sufferers’ life and ability to rest. Sometimes the pain is described as a feeling of pressure, tingling, or even burning on the affected area.     

Even though this condition normally only affects one limb, the pain can extend along the limb or to the opposite limb.    

The affected area tends to be particularly sensitive to pain, with skin contact being extremely painful. This is known as allodynia. 

People affected by this condition may experience body temperature changes as well as changes in skin tone.    

The main symptoms are:

  • Prolonged pain
  • Skin texture changes in the affected area
  • Excessive sweating in the area
  • Stiffness and difficulty moving the affected joints
  • Muscle coordination issues
  • Muscle pain
  • Skin colour changes, these could be red or blue patches.

Medical tests

There isn’t a specific medical test that diagnoses this condition. Diagnosis is based on medical history, as well as signs of the condition.     

The main sign is an issue with an injury in the affected area. An MRI may be requested to confirm the diagnosis.   

Causes of reflex sympathetic dystrophy           

The specific cause of the condition is still unknown, but it is known that in a lot of cases the condition appears due to an injury, the most common ones are:    

  • Fractures
  • Soft tissues injuries, such as burns or blows
  • Sprains and/or strains
  • Immobilization of the limb

In these cases, it can be said that the condition is an abnormal bodily reaction that amplifies the effects of the injury or trauma. It can be compared to an allergic reaction in that some people will have an adverse reaction while others won’t be affected.  

Blood vessels may leak fluid into the surrounding area, making the skin redden and swell. The muscles in the surrounding area may be starved of oxygen and could tighten or stretch.

How can it be prevented?           

This condition is still under investigation, the only way that is known so far to prevent it is to avoid or prevent the injury that causes it.

What is the treatment?

The most common treatments for this condition are:

  • Rehabilitation and physical therapy: series of exercises to keep the affected area mobile. It aims to improve blood flow and decrease symptoms related to poor circulation.    
  • Psychotherapy: this condition quite often causes psychological issues such as; anxiety, depression, or post-traumatic stress disorder.    
  • Medication: some anti-inflammatory medications for pain can help.  
  • Blocking sympathetic nerves: many patients have claimed that this has given them some pain relief.  
  • Surgical sympathectomy: this is a controversial treatment that destroys nerves.
  • Spinal cord stimulation: electrodes are placed on the spine, minor surgery is needed for this procedure.  
  • Neurostimulation: is used in the area of pain or discomfort.  
  • Intrathecal drug infusion pump: is used to relieve pain by administering pain relief medication, there is no evidence that it improves RSD.

What specialist should I see?

Reflex sympathetic dystrophy is treated by specialists in pain management.  

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