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 �
