Reflex Sympathetic Dystrophy

Reflex sympathetic dystrophy, a term historically used for a condition now generally associated with complex regional pain syndrome (CRPS), can involve persistent pain and changes in sensation, skin temperature, color, or swelling. At Advanced Pain & Spine Management, patients in Arlington Heights and Bloomingdale, IL, can receive an individualized evaluation for persistent pain and discuss appropriate management options. Call us or book an appointment online to discuss your symptoms and explore available pain management options.

Complex regional pain syndrome is another name for reflex sympathetic dystrophy (RSD). These two names are used interchangeably to describe the same condition. Reflex sympathetic dystrophy more commonly affects the upper or lower extremities. Reflex sympathetic dystrophy has two types:

CRPS 1:
Pain is due to an initial unpleasant incident that does not result in direct nerve damage to the affected limb.

CRPS 2:
Pain is due to an identifiable trauma or nerve injury.

What Causes Reflex Sympathetic Dystrophy?

Doctors believe RSD pain is due to abnormalities in your sympathetic nervous system. Your sympathetic nervous system regulates blood flow movements, which aid in the regulation of your heart rate and blood pressure.

When you are injured, your sympathetic nervous system instructs your blood vessels to constrict so that you do not lose too much blood at the damaged site. Later, it instructs them to reopen the wound so that blood may reach the injured tissue and mend it.

When you have RSD, your sympathetic nervous system receives contradictory signals. It activates after an injury but does not switch off. It causes significant pain and swelling at the site of your injury. RSD can occur even if you haven’t been injured. However, this is uncommon.

Symptoms Of Reflex Sympathetic Dystrophy

High levels of pain are the primary symptom of both CRPS 1 and CRPS 2. The pain is constant and excruciating, and it is frequently out of proportion to the severity of the damage. Other symptoms of RSD include:

• Drastic variations in the temperature and color of the skin across the affected limb or body part
• Severe burning pain
• Skin sensitivity
• Sweating
• Swelling
• Changes in skin color, texture, temperature
• Stiffness
• Swelling, and damage in the joints
• Limited mobility in the painful area

People with CRPS may be hypersensitive to pain, a condition that is known as hyperalgesia. They may also experience pain sensations in response to non-painful stimuli (allodynia). These symptoms may appear and disappear with time.

How Is Reflex Sympathetic Dystrophy Diagnosed?

Often, doctors don’t realize your pain is due to RSD until you’ve been suffering from it for a while. When pain does not go away or is more intense than it should be for your type of injury, this can be the first indication that you have RSD.

There is no single test that can determine whether you have RSD. Instead, they’ll rely on a physical exam and information from your medical history. There are a few tests that can help determine if you have certain symptoms of the illness. These are

Bone Scans:

This test can determine whether any of your bones are wearing away at the ends or if there are any problems with regular blood flow.

MRI:

Your doctor may request an MRI to examine the inside of your body, mainly your tissues, for any apparent changes.

The Sweat Test:

If you sweat more on one side of your body than the other, this test can be helpful for your doctor.

Thermography Examination:

This sympathetic nervous system test determines whether the temperature or blood flow at your injury site differs from that in other sections of your body.

X-Rays:

These are often ordered in the later stages of your disease to screen for mineral loss in your bones.

Treatment Options For Reflex Sympathetic Dystrophy

It is a complicated pain illness that can be extremely difficult to manage. It is common to start in the hand or foot before spreading to the affected arm or leg. The infection can then spread to the contralateral arm or leg.

Although the illness is treatable in the early stages, some symptoms may become permanent. This problem may be irreversible if the skin begins to change or the nails change in terms of growth. Early intervention is crucial.

In general, the following therapies for reflex sympathetic dystrophy may alleviate symptoms:

Medicines:

These include:

• Antidepressants, anti-inflammatory drugs (NSAIDs), and anti-seizure medications may alleviate pain.
• Pain relievers such as aspirin, ibuprofen, or naproxen are available over-the-counter.
• To relieve edema, corticosteroids such as methylprednisolone (Medrol) or prednisolone (AsmalPred Plus) are helpful.
• Fentanyl (Duragesic), hydrocodone (Hysingla ER, Zohydro ER), morphine (Arymo ER, Kadian, Morphabond, MS Contin), and oxycodone are opioids used for this condition.

Others Treatments:

Other alternatives include:

• Physical therapist-assisted desensitization treatments
• Blocks of stellate ganglion

• Cervical epidural space steroid injections
• Interscalene blocks
• Sympathetic nerve blocks in the lumbar region

• Lumbar epidural space steroid injections

Dorsal Root Ganglion and spinal cord stimulation are options to consider if conservative or minimally invasive treatments do not cure pain. These therapies require inserting small leads with electrodes into the spine’s epidural region. These small electrodes give a minor electrical current to the spinal region, disrupting pain signal transmission. These currents are so subtle that the patient doesn’t notice them, yet has relief. These treatments can be tested with a simple outpatient procedure, where the patient tries (trials) the treatment for up to one week. If the patient has a significant improvement in their pain during the trial, then they may qualify to have an implant for long-term pain control.