Neuro Disorders: Reflex Sympathetic Dystrophy

Introduction

Reflex Sympathetic Dystrophy (RSD) is a somewhat controversial neurological disorder and it is type of chronic pain syndrome.

Now a days the preferred term is CRPS (complex regional pain syndrome) and CRPS is divided into;

Type 1 & Type 2. Type 1 is our previous RSD & Type 2 is our previous causalgia.

In this article RSD and CRPS terms are used interchangeably.

Type 1 & 2 are similar conditions and the difference is, with causalgia there is a nerve damage that be demonstrated and no such nerve damage can be demonstrated with RSD.

What causes RSD?

RSD is generally preceded by some injuries, usually trivial in nature. Similar conditions can also occur after a heart attack or stroke.

What triggers RSD is not entirely clear. First it was thought be a psychiatric kind of condition, or faking by the patients, because the pain is generally out of proportion to the prior injury and examination findings. But more and more physicians have been leaning towards a diagnosis of genuine neurological pain syndrome now.

Activation of the sympathetic autonomic nervous system somehow takes place and contributes to several clinical manifestation of the RSD condition. Also it seems that the pain receptors, and pathways that take the peripheral pain signals to the awareness centers in the brain become hyperactive.

How do these patients present?

The follwing are some usual presentation (may vary from case to case);

• Severe pain (out of proportion, as mentioned above)
• Swelling
• Trophic changes (certain skin changes like hair loss etc)
• Discoloration of the skin
• Symptoms spreading to areas out side the initial injury zone
• Thinning of the bone in or around the injury area
• Loss of fat (in or around the injury area) etc

Diagnosis

Unfortunately there is no diagnostic test to confirm this diagnosis. Diagnosis has to be made by the characteristic clinical features. Relevant investigations are done to rule any mimicking conditions that produce similar symptoms. X rays, CT, MRI, EMG, varieties of blood tests are not uncommonly done when dealing with this condition.

Treatment

Treatment is not always easy as many patients do not adequately respond to the pain controlling measures. Patients are tried with various pain killers like NSAIDs, nerve pain pills, opioids etc. Anti sympathetic nervous system drugs like beta blockers (e.g. propranolol) are also tried.

Many patients require some kind of surgical interventions like sympathetic blocks, sympathectomy, epidural pain pump, spinal cord stimulators etc.

A neurologist,pain specialist and psychiatrist are generally involved in the care of patients with Reflex Sympathetic Dystrophy.



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