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What is Reflex Sympathetic Dystrophy?

Reflex Sympathetic Dystrophy Syndrome or RSD (also known as Complex Regional Pain Syndrome) is a neurological syndrome characterized by disabling pain, usually following some sort of neurological or bone injury (particularly fractures). Other symptoms may include pathological changes in bone and skin, excessive sweating, tissue swelling, and extreme sensitivity to touch.

While the clinical syndrome of RSD is distinct, there is no specific laboratory test to diagnose RSD/CRPS. As a result, the diagnosis depends upon the physician's assessment of the patient's complaints (medical history) as well as any objective findings upon physical examination.

While RSD is not a rare disorder, it is rarely discussed. As a result, RSD is generally poorly understood by patients, their families, and healthcare professionals. Cases can range significantly in severity. RSD may affect millions of Americans. It occurs after 1 to 2 % of various fractures and after 2 to 5% of peripheral nerve injuries. It may also occur following surgery. The injury need not be a major one; RSD can even develop as the result of sprains. In 10-20% of cases, however, no causal event can be identified. Regrettably, the diagnosis is often missed or delayed. While some mild cases may resolve without treatment, the usual pattern of spread is up the affected extremity and then may continue to spread on the same side of the body or to the opposite extremity. RSD may even spread to a distant site.

While RSD predominantly affects adults, it can start as young as 3 years old. Too often, the complaints of chronic pain in children are not taken seriously, or are treated as if they are affected by a purely psychological condition. Affected children may develop psychological problems as a consequence of RSD, however, especially if physicians, parents, teachers, and other children do not believe their complaints of chronic pain.

One popular misconception about RSD is that there are no effective treatments. While there is no one particular gold standard of therapy, the good news is that there are many treatment options including various medications, sympathetic nerve blocks, physical therapy, psychological support, and possibly sympathectomy, or dorsal column stimulator. Patients may be best served with an individual patient treatment plan, ideally supervised by a chronic pain clinic.

Created: 4/12/2004  -  Donnica Moore, M.D.

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