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WHAT IS REFLEX SYMPATHETIC DYSTROPHY SYNDROME (RSD)



Reflex Sympathetic Dystrophy is a chronic pain disorder involving the sympathetic nervous system.

It usually is the result of an injury or trauma, but can also be a complication of surgery, infection, casting or splinting and myocardial infarction (heart attack). The trauma sets off the body's mechanism for pain recognition, but then the "normal system of pain perception" begins to misfire in it neural response, and an abnormal cycle of intractable pain begins. As RSD progresses, the abnormal pain of the sympathetic nervous system has an effect on other areas of the body and can result in total disability as muscles, bones, skin and the autonomic immune system become involved.

The first indication of RSD is prolonged pain usually more severe than the injury. The symptoms are severe burning pain in a localized area, intense sensitivity to temperature and light touch, and a color change to the skin.

Most physicians agree that there are three stages to RSD, which progress at different rates in different people. Initially, there is swelling and redness in the affected area. Next, the area may become blue and cold, with increased pain and stiffness of ligaments and joints, and Osteoporosis may become evident. Finally, there may be a wasting of affected muscles, contraction of tendons, and a definite withering of the affected limb. In all of the stages, severe chronic pain continues to be a major complaint.

Although RSD can be a progressive disorder, it should not be assumed that all cases will advance and present all clinical symptoms and dysfunction. Early and effective treatment may lesson the effect of RSD in some individuals.

"Reflex Sympathetic Dystrophy is a system complex and patients do not have all the signs and symptoms or clinical features. A physician may consider RSD as a result of minor trauma, inflammation following surgery, infection, lacerations, degenerative joint disease, burns and any compression such as casting or swelling due to injury that may cause prolonged pressure on peripheral nerves. Peripheral neuropathies, nerve-entrapment, neuromas, thoracic outlet syndrome and carpal or tarsal tunnel can coexist. Many physicians have a difficult time in going to the next step when they diagnose a disease. It is hard for some to believe that you can have a dual disease process and not just focus on only one of the diseases. Many other chronic pain disorders may be mistakenly diagnosed as sympathetically maintained pain or RSD because of similarities in clinical presentations. Diagnosing RSD is very important so proper therapy can be applied. A wrong diagnosis is like having carburetor problems with the engine of your car and using a tire pump to try to fix it."



Nelson Hendler, MD; Honorary Chairman for the RSDSA of California.
Lecture Remarks at the 1998 RSD Medical Conference, San Diego, California
Chapter 7, 1998 RSD Conference Journal, RSDSA-CA





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