FAQs on Reflex Sympathetic Dystrophy (RSD)

Reflex Sympathetic Dystrophy (RSD)

Reflex sympathetic dystrophy (RSD) is a characterized by many symptoms, which include burning, skin discoloration, swelling, and tenderness of the affected extremity. Also called complex regional pain syndrome (CRPS), the symptoms of RSD occur in three stages, which are acute, dystrophic, and atropic.

What are the symptoms of reflex sympathetic dystrophy?

The symptoms vary according to each stage of RSD. In the acute stage (first 3-6 months), the patient experiences burning pain, flushing of the skin, extremity swelling and tenderness, as well as blanching and sweating of the skin. During the second stage (dystrophic – lasts 3-6 months), the patient’s skin becomes thick and shiny, and there is flushing and persistent pain. With the final stage (atrophic), which occurs 6-12 months from the onset of initial symptoms, the patient experiences loss of function, contracture development, mobility problems, and skin thinning.

What are the causes of RSD?

The exact mechanism of RSD is not well understood at present. However, doctors believe the condition involves abnormal excitation of nervous tissue and dysfunctional nerve impulses, which affect blood vessels and skin.

What are the triggers for the onset of reflex sympathetic dystrophy?

Several events and circumstances tend to trigger the onset of RSD. These include:

  • Injury
  • Surgery
  • Heart disease
  • Degenerative arthritis
  • Shoulder problems
  • Brain disease
  • Carpal tunnel syndrome
  • Shingles

How common is RSD?

In one U.S. study that investigated RSD incidence, the rate was found to be 5.5 per 100,000 persons. However, a European study reported the rate much higher, at 26 per 100,000. RSD affects women more than men, and most cases occur during the ages of 50 to 70 years. Additionally, Caucasian and Japanese people are affected more often.

How is RSD treated?

Several treatment options are used to control the symptoms of RSD. While one treatment may work for one person, it may not work for all, so treatment must be individualized. Therapies include:

  • Medications – The cornerstone of pain management is medications. Depending on pain severity, options include high doses of corticosteroids (used short-term), Lyrica, clonidine, and amitriptyline.
  • Physical therapy – To avoid muscle wasting, atrophy, spasms, and weakness, the patient will need to undergo physical therapy for several months. The therapist teaches exercises and strengthening techniques to the patient, as well as uses pain management therapies involving electrical stimulation and ultrasound.
  • Stellate ganglion block – The stellate ganglion are nerves that supply the upper extremities. The doctor will insert a small needle near the nerves and inject a long-acting anesthetic onto the nerves under x-ray guidance. This block will improve blood flow to the arm and/or hand. According to a clinical study, the success rate is 80% with around 40% of patients reporting complete symptom relief.
  • Lumbar sympathetic block – Found to be 75% effective in several research reports, this procedure involves blockage of the sympathetic nerve chain of the lower back. Done under x-ray guidance, the doctor injects an anesthetic onto the nerves.
  • Sympathectomy – To destroy nerves that supply the affected extremity of RSD, the doctor uses either a destructive agent or coagulation in sympathectomy. This procedure is reserved for patients who do not respond to nerve blocks and other treatment options. In a review of studies, the success rate for sympathectomy was reported at 50%.
  • Spinal Cord Stimulator – As a last resort, pain management doctors in Nashville will perform a spinal cord stimulator implant to mask and reduce the pain with RSD. Studies have shown the implants work well over 75% of the time for RSD and are an excellent option when all others have failed.

Resources

Ackermann, WE & Zhang, JM (2004). Efficacy of stellate ganglion blockade for the management of type 1 complex regional pain syndrome. Southern Medical Journal, 1084-1088.

Cepeda MS, Carr DB, & Lau J (2005). Local anesthetic sympathetic blockade for complex regional pain syndrome. Cochrane Database Syst Rev 19:CD004598.

de Mos M, de Bruijn AG, Huygen FJ, Dieleman JP, Stricker BH, & Sturkenboom MC (2007). The incidence of complex regional pain syndrome: a population-based study. Pain,129, 12-20.

Sandroni P, Benrud-Larson LM, McClelland RL, & Low PA (2003). Complex regional pain syndrome type I: incidence and prevalence in Olmsted county, a population-based study. Pain, 103, 199-207.

 

Sandroni P, Benrud-Larson LM, McClelland RL, & Low PA (2003). Complex regional pain syndrome type I: incidence and prevalence in Olmsted county, a population-based study. Pain, 103, 199-207.