FAQ’s on Reflex Sympathetic Dystrophy (RSD) and Complex Regional Pain Syndrome (CRPS)
What is RSD & CRPS?
RSD & CRPS (Complex Regional Pain Syndrome, AKA Reflex Sympathetic Dystrophy), is a chronic neurological disorder. There are two types of the disorder, type I and type II respectively (RSD/CRPS: the end of the beginning 2008).
CRPS Type I (RSD, or Reflex Sympathetic Dystrophy) is a form of the condition in which the nerve injury is not immediately identifiable and the cause is unknown (CRPS of the upper or lower extremity: surgical treatment outcomes 2009).
The second type, CRPS type II (Causalgia) is cases in which a distinctive, major injury to a nerve has been identified. The condition occurs when a soft tissue injury (usually a broken bone) does not heal normally and disrupts the normal functioning of the central nervous system associated with the area of injury.
Who may experience RSD & CRPS?
Persons most likely to be affected by the condition are females twenty to thirty five years of age, although it can affect children and males as well. The condition may occur due to injury, but there has not been any one identifiable cause of RSD & CRPS.
It is believed that in cases caused by injury that pain receptors in the area of injury become responsive to catecholamines, these are more commonly known as epinephrine (adrenaline), norepinephrine (noradrenaline), and dopamine. These are hormones released by the body in situations that may elicit the “fight or flight” response, such as an accident, injury, or fear. When pain receptors become responsive to these natural hormones, any such excitement that may elicit this natural response can become a source of pain (Complex regional pain syndrome (CRPS): survey of current practices 2009).
What are the symptoms of RSD & CRPS?
- Swelling and stiffness in the joints of the affected area
- Impaired mobility of the affected area
- Decreased or increased nail and hair growth patterns
- Changes in skin texture, color, (purple or red blotches may appear)
- Skin temperature (skin temperature of the affected area can be different than skin temperature in the surrounding area)
- Odd pain patterns; pain may increase rather than decrease over time after the injury or pain may be felt in an unusually large area surrounding the injury. Pain may even redistribute to the opposing affected area (ex: an injury to the right hand may cause pain in the left hand)
How is RSD & CRPS diagnosed?
There are no specific diagnosis procedures for RSD & CRPS but rather other conditions can be ruled out through various specific tests ([Complex regional pain syndrome type I (CRPS type I/”RSD“) — an overview 2009].Your physician may determine an increased likelihood of the condition if there is an obvious injury, there is an unusual amount of pain for the apparent severity of the injury, the injured area displays a noticeable unordinary change in appearance, no other cause of pain can be determined through other testing means.
What treatments are available for RSD & CRPS?
With no known cause of the condition, there is no cure for the condition, so treatment of the condition is limited to controlling the pain. This can be accomplished by various means. Physical therapy is often used to treat the condition as is psychotherapy. Prescription medications may be used to help reduce pain levels, some of these medications include: corticosteroids, anti-inflammatory drugs, topical analgesic, antidepressants, anti-seizure medications, and opioid analgesics.
Other treatments of the condition include sympathetic nerve block. This is a procedure that is performed by injecting a combination of medications into the spinal nerves associated with the affected area in order to numb the pain signals to the brain. Another treatment is surgical sympathectomy. This is a procedure in which the target nerves are cut, cauterized or removed. There is debate in the medical profession whether this is a beneficial treatment or if it exacerbates the condition.
Spinal cord stimulation can be used to treat the pain symptoms as well (Spinal cord stimulation for complex regional pain syndrome: an evidence-based medicine review of the literature 2004).. This is a procedure where electrical stimulation of the affected nerves is used to disrupt the pain signals to the brain. Intrathecal drug pumps are also used. These are permanent devices that utilize implants to deliver pain medication to the spinal fluid in the area of the spine where the affected nerves are located.
What can the patient expectation from these treatments?
Most people receiving one or more of these treatments find relief from their symptoms. However some persons respond better to some treatments than others and so no specific results can be anticipated for any one patient (Complex regional pain syndrome type I (CRPS I). Pathophysiology, diagnostics, and therapy (2003).
How long will the effects of the treatments last?
Some treatments such as oral medication will have limited and temporary results, however if taken regularly the relief will continue as long as you are taking the medication. Some treatments, such as the surgical procedures, may result in long lasting or even permanent results.
What side effects are possible with these treatments?
Side effects can vary from patient to patient, for most of these treatments the side effects are mild. Some medications may cause drowsiness or dizziness, and others may have no negative side effects at all. Side effects from the more invasive procedures such as sympathetic nerve block injections can include bruising or bleeding at the injection site, temporary increased pain, and swelling. In rare cases infection of the injection site may occur, but this is unusual if the site is kept bandaged and clean. The most serious side effects are those that may occur with the surgical procedures. These, although rare, could include infection, tissue, nerve, and vessel damage, scar tissue, and temporary increased pain. Consult your physician to determine which treatment is best for you and at that time ask questions about any potential negative side effects.