Reflex Sympathetic Dystrophy Syndrome (RSD) sometimes referred to as Complex Regional Pain Syndrome (CRPS), is a painful disorder affecting the nerves, blood vessels, muscles, tendons and bones, and the immune system. It is chronic, progressive and incurable.
CAUSES: Surgery is the number one cause of Reflex Sympathetic Dystrophy. Trauma (broken bones, sprains, bruises), electric shock, surgery, arthritis, infection, improper injections or nerve damage from compression (carpal tunnel syndrome) can also cause the sympathetic nervous system to go "crazy" causing a variety of chronic, painful, and sometimes unusual symptoms.
There is no known explanation of why this disorder occurs in some people and not others. Some believe that sympathetic maintained pain is caused by nerves and tissues that have healed with changed DNA. The bodies immune system then sees the nerves and tissues as "enemies" and attacks them causing inflammation and pain.
Others believe that a person is genetically predisposed to this condition by an over active sympathetic nervous system. Some think that susceptibility factors may include genetic predisposition (HLA typing) and in some patients a tendency towards increased sympathetic activity. This includes cold hands, hyperhidrosis (excessive sweating), or a history of fainting.
Many think RSD is a result of misfiring or overactive sympathetic nerve fibers. An abnormal response to the normal pain cycle ensues, resulting in sympathetic maintained pain.
SYMPTOMS: Not all patients have exactly the same symptoms but the most common are: severe sensitivity to touch and temperatures, swelling, muscle spasms, myoclonic jerks, sweating, muscle ticks, inflammation, anxiety, depression, trouble concentrating, irritability, bone loss, skin lesions (rare), immune system problems, with the most prominent symptom being chronic pain.
The picture on the left is my right hand, the initial site of my RSD.
Over time symptoms can change, become worse or better and many people develop spreads of RSD to other areas apart from the original injury. Spreads are more common than people think. Classifications when used are Stage 1, Stage 2 or Stage 3. There is a Stage 4, but that is usually fatal with system wide internal organ failure at that point in the illness.
Other symptoms of RSD/CRPS, not always mentioned, caused by the malfunction of the sympathetic nervous system: allergies/asthma, absence or abnormal system are; menstrual cycle, chest pain, cardiac complications, chronic fatigue, autoimmune disorders such as arthritis and Crohn's disease, IBS ( digestive problems-acid reflux, constipation ), fibromyalgia/myofacial syndrome, hypertension, Raynauds disease, increased sensitivity to external stimuli ( sight, sound, smell ), insomnia, memory loss, migraine headaches, mood swings/anxiety, tremors, visual disturbances.
Who Can Get RSD?
Anyone can get RSD and women seem to be especially prone. There are no age boundaries in RSD: it strikes the young and the old. Because the Sympathetic Nervous System effects so many different systems of the body, RSD/CRPS is a complex and little understood disorder.
Any treatment that works for one RSD/CRPS patient may not work for another. It is necessary to try different combinations until the pain and other symptoms are controlled.
There are a variety of prescription drugs available to treat the many symptoms of RSD/CRPS. Seratonin in chronic pain patients is depleted very quickly so some form of Seratonin reuptake inhibitor is needed e.g. tricyclic antidepressants.
Drug Therapy: Local or systemic corticosteroids, muscle relaxants, alpha-adrenergic and beta blockers, analgesics, anti-inflammatories, anticonvulsants, tricyclics and related compounds, Calcium channel blockers ( chronic pain causes the cells to become flooded with calcium and are stuck in the open position, which stops communication between nerve cells ).
Blocks: Nerve blocks, Sympathetic blockade (Stellate Ganglion Block) is one type, Intravenous regional blocks.
Alternative treatments that might be effective are: biofeedback, pain management specialists, physical therapists, (HBO) hyperbaric enhanced oxygen chambers, acupuncture, botox, massage, visualization therapy, herbal supplements, nutritional therapy, hypnosis, T.E.N.S. and hydrotherapy.
"When diagnosed in the first three months nerve blocks may be effective. It is important to get physical therapy (with a therapist who has knowledge of RSD/CRPS). If nerve blocks or other treatments are not working or making you worse, stop them and try something else. You are responsible for your own health care. Do not let anyone cast, perform surgery with out getting a second opinion from a RSD/CRPS specialist.".What is the prognosis?
There is currently no cure for Reflex Sympathetic Dystrophy (RSD). The patient with RSD/CRPS can learn to adapt and take control of their life again. Education is key; understand your condition. Be your own health advocate!
What research is being done? Investigators are studying new approaches to treat RSD and intervene more aggressively after traumatic injury to lower the patient's chances of developing the disorder. Scientists are studying how signals of the sympathetic nervous system cause pain in RSD patients. Using a technique called microneurography, these investigators are able to record and measure neural activity in single nerve fibers of affected patients. Ketamine treatments, coma and outpatient, have also shown promising results.