Reflex Sympathetic Systrophy (RSD) Or Complex Regional Pain Syndrome (CPRS)

Reflex Sympathetic Dystrophy (RSD) is a chronic neurological syndrome that is also known as Complex Regional Pain Syndrome (CRPS). RSD/CPRS occurs when the nervous system functions abnormally after an injury. Symptoms involve severe burning pain, pathological changes in the bone and skin, excessive sweating, tissue swelling and extreme sensitivity to touch.

RSD/CRPS can be diagnosed when an injury, no matter how slight, fails to heal normally. There is no laboratory test that can diagnose RSD/CPRS, but a doctor can make the diagnosis based on past medical history, and the results of a physical examination. Usually when a patient has a history of trauma to an affected area, and an injury that involves an unusual amount of pain, doctors can diagnose RSD/CRPS if the injury is accompanied by one of the following:

1. Swelling
2. Movement disorders
3. Abnormal function of the sympathetic nervous system
4. Changes in tissue growth.

There are two types of complex regional pain. Type I is known as RSD, and Type II is known as Causalgia.

Type I involves a nerve injury that is not immediately identifiable. It starts with an immobilizing event that involves a disproportionate amount of pain. The event is followed by edema and changes in the skin coloration or skin temperatures, which is caused by skin blood flow. The injured area can also be affected by abnormal sudo-motor activity.

Type II involves a distinct major nerve injury that causes continuing pain long after the event of an injury. Like Type I, this is also followed by abnormal suto-motor activity at the point of injury, as well as edema and changes in skin blood flow.

Treatment
Currently, there is no cure for RSD/CPRS. However, there are methods of treatment that can reduce pain and prevent the problem from getting worse.

1. Medications
Doctors weigh a number of factors while deciding what kind of medication to use. It is common for doctors to use multiple medications to control pain. Oftentimes patients are given a sequence of medications in order to determine what works best.

The following factors are taken into consideration while determining what kind of medications to use:

1. Constant pain
2. Inflammatory pain
3. Muscle cramps
4. Spontaneous pain
5. Pain that interferes with sleep
6. Sympathetically maintained pain (SMP)
7. Pain due to recent injury

2. Physical Therapy
Physical therapy, hydrotherapy, massage therapy and even pool therapy can help relieve pain for CRPS patients. Pain can also be reduced by techniques such as applying pressure. Physical therapists can also educate patients about different ways that they can use the injured part of their body.

3. Sympathetic nerve blocks
Sympathetic nerve blocks can reduce pain and provide important diagnostic information. Chronic pain is often caused by sympathetic nerves that regulate blood flow, sweating and glandular function. When the nerves are blocked, pain is sometimes relieved. For example, pain in the legs and feet can be relieved when the lumbar sympathetic nerves on the spine in the lower back are blocked. Furthermore, pain in the face, arms and hands can be relieved when nerves along the spine in the lower neck are blocked.

4. Surgical Sympathectomy
A significant reduction in pain from a sympathetic block occurs when a patient has Sympathetically Maintained Pain (SMP). On the other hand, when sympathetic blocks do not relieve pain, a patient has Sympathetically Independent Pain (SIP). Surgical Sympathectomy can be performed on patients with SMP, to insert a permanent nerve block. Sympathectomy is an invasive surgery, so it is usually an option of last resort. Before a having a symapthectomy, patients should consult with their doctors about the possible complications.