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Reflex Sympathetic Dystrophy Syndrome
Complex Regional Pain Syndrome
RSD(S)-CRPS Advisory
Complex Regional Pain Syndrome
RSD(S)-CRPS Advisory
RSD(S)/CRPS Summary Description
Reflex Sympathetic Dystrophy (RSD), also known as Complex Regional Pain Syndrome
(CRPS) Type I (here called RSD/CRPS), is a chronic condition characterized by burning
pain and abnormalities in the sensory, motor and autonomic nervous systems. The
syndrome typically appears after an acute injury to a joint or limb, though it may occur with
no obvious precipitating event. In most cases, regardless of the site of injury the symptoms
begin and remain most intense in the distal most extremity. In the initial stages of
RSD/CRPS, pain and swelling from the injury do not subside but actually intensify,
spreading from the site of the injury to other parts of the limb, to the contralateral limb
or to remote regions of the body. The skin in affected areas and particularly deep somatic
tissues are painfully sensitive to touch, often red and abnormally warm due to alterations in
regional blood flow. Changes in sweating patterns, hair growth, subcutaneous tissues,
muscles, joints or bones and difficulty moving the joint or limb are other hallmarks of the
disorder. In addition to the evidence of inflammation and abnormal autonomic nervous
system function, there are changes in motor systems including tremor, weakness and
dystonia, which strongly suggest a central nervous 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 and
physical 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 skin, rapid nail and hair growth Stiffness. The second stage occurs after weeks or
months, and includes the following symptoms: Burning pain, cool skin, brittle 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
medications treatment 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.
Reflex Sympathetic Dystrophy (RSD), also known as Complex Regional Pain Syndrome
(CRPS) Type I (here called RSD/CRPS), is a chronic condition characterized by burning
pain and abnormalities in the sensory, motor and autonomic nervous systems. The
syndrome typically appears after an acute injury to a joint or limb, though it may occur with
no obvious precipitating event. In most cases, regardless of the site of injury the symptoms
begin and remain most intense in the distal most extremity. In the initial stages of
RSD/CRPS, pain and swelling from the injury do not subside but actually intensify,
spreading from the site of the injury to other parts of the limb, to the contralateral limb
or to remote regions of the body. The skin in affected areas and particularly deep somatic
tissues are painfully sensitive to touch, often red and abnormally warm due to alterations in
regional blood flow. Changes in sweating patterns, hair growth, subcutaneous tissues,
muscles, joints or bones and difficulty moving the joint or limb are other hallmarks of the
disorder. In addition to the evidence of inflammation and abnormal autonomic nervous
system function, there are changes in motor systems including tremor, weakness and
dystonia, which strongly suggest a central nervous 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 and
physical 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 skin, rapid nail and hair growth Stiffness. The second stage occurs after weeks or
months, and includes the following symptoms: Burning pain, cool skin, brittle 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
medications treatment 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.
Life is not easy for any of us. But what of that? We must have
perseverance and above all confidence in ourselves. We must
believe that we are gifted for something and that this thing
must be attained. --Marie Curie Polish-French chemist
perseverance and above all confidence in ourselves. We must
believe that we are gifted for something and that this thing
must be attained. --Marie Curie Polish-French chemist
