RSD/CRPS Summary Description
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.
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
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.
must have perseverance and above all confidence
Life is not easy for any of us. But what of that? We
in ourselves. We must believe that we are gifted
for something and that this thing must be attained.  
--Marie Curie Polish-French chemist
RSD Advisor (CRPS Advisory Mirror)
Reflex Sympathetic Dystrophy Syndrome
Complex Regional Pain Syndrome

RSD(S)-CRPS Advisory