Reflex Sympathetic Dystrophy syndrome, also known as Complex regional pain syndrome (CRPS) is a chronic pain condition that is believed to be the result of dysfunction in the central or peripheral nervous systems.
Reflex Sympathetic Dystrophy syndrome, which is also known as Complex regional pain syndrome (CRPS) is a chronic pain condition that is believed to be the result of dysfunction in the central or peripheral nervous systems. Patients often describe CRPS as a burning pain, and it can occur in your arms, hands, feet, and legs.
However, not too many people have actually heard about this rare and complex syndrome. Reflex Sympathetic Dystrophy syndrome may develop after a stroke, heart attack, or other type of injury and it can cause lasting affects to those who suffer with it.
Typical symptoms of Reflex Sympathetic Dystrophy may include:
Typical symptoms of Reflex Sympathetic Dystrophy may include:
- dramatic changes in the color and temperature of the skin over the affected limb or body part
- changes accompanied by an intense burning pain
- skin sensitivity
- excessive sweating
- swelling
Incidence and Prevalence
Although, not too many people believe- the fact is that already millions of people in the United States suffer from this chronic pain syndrome. This syndrome affects both men and women, and also occurs in children. Although, it can occur at any age, but usually affects people between the ages of 40 and 60 years. Experts are saying that 2% to 5% of peripheral nerve injury patients and 12% to 21% of patients with paralysis on one side of the body develop reflex sympathetic dystrophy as a complication.
Types of Reflex Sympathetic Dystrophy syndrome
In generally, it is considered that there are two different types of RSD:
- RSDS I
This type is frequently triggered by tissue injury and, what's important- it includes almost all classical symptoms but with no underlying nerve injury.
- RSDS II
Patients with this type of syndrome experience the same symptoms but their cases are clearly associated with a nerve injury.
Symptoms of Reflex Sympathetic Dystrophy
Most important thing to know is that the key symptom of RSD is continuous, intense pain in affected limb. It is also important that the pain is out of proportion to the severity of the injury and it gets worse rather than better over time. CRPS most often affects one of the extremities and is often accompanied by:
- burning sensations and pain
- increased skin sensitivity
- changes in skin temperature: warmer or cooler compared to the opposite extremity
- changes in skin color: often blotchy, purple, pale, or red
- changes in skin texture: shiny and thin, and sometimes excessively sweaty
- changes in nail and hair growth patterns
- swelling and stiffness in affected joints
- motor disability, with decreased ability to move the affected body part
The pain usually starts in one part of the limb but with time- the pain spreads to include the entire arm or leg. Pain can sometimes even travel to the opposite extremity.
Possible causes of Reflex Sympathetic Dystrophy
Although some experts are claiming different- the fact is that doctors still don’t know what causes RSDS.
Catecholamines theory
The most recent theory suggests that pain receptors in the affected limb become responsive to a family of nervous system messengers known as catecholamines. Several researches done in the past have proven that norepinephrine- catecholamine released from sympathetic nerves, is responsible for activating pain pathways after tissue or nerve injury.
Immune theory
Another theory is that syndrome is caused by a triggering of the immune response, which leads to the characteristic inflammatory symptoms of redness, warmth, and swelling in the affected area.
Other conditions
Causes associated with the onset of RSD/CRPS include the following:
- Cerebral lesions
- Heart disease, heart attack
- Infection
- Paralysis on one side of the body
- Radiation therapy
- Repetitive motion disorder
- Spinal cord disorders
- Surgery
- Trauma
- Diabetes
- Thyroid disorders
- Lung disease
Stages of the disease
Experts are saying that this disease has three stadiums in which the symptoms are changing and in which different tissue changes are happening.
- Stage one, also called- an acute stadium, is thought to last from 1 to 3 months. In most cases this stadium is characterized by:
- severe, burning pain
- muscle spasm
- joint stiffness
- rapid hair growth
- alterations in the blood vessels
- changes in skin color and temperature
- Stage two, also called- the dystrophic stadium- lasts from 3 to 6 months and is characterized by:
- intensifying pain
- swelling
- decreased hair growth
- cracked, brittle, grooved, or spotty nails
- softened bones
- stiff joints
- weak muscle tone
In stage three, atrophic stadium occurs from one year on. The syndrome progresses to the point where changes in the skin and bone are no longer reversible. This stadium is characterized by:also called- the
- unyielding pain which involves the entire limb or affected area
- muscle loss
- severely limited mobility
- involuntary contractions of the muscles and tendons
- skin of the affected area is now pale, dry, tightly stretched
Diagnosis of Reflex Sympathetic Dystrophy
Since there is no specific diagnostic test for CRPS, the most important role for testing is to help rule out other conditions.
- Review of your medical history
Well, logically, the first diagnostic method should be simple medical history because the onset of disease symptoms can often be traced back to an accident, illness or injury.
- Physical examination
There is no doubt- a simple examination of skin, muscles and joints may reveal many useful information about the source of tenderness and pain because there may be changes in the normal texture and color of skin.
- Bone scan
We are talking about simple X-ray technology scans but done a bit differently! Some radioactive substance is being injected into veins and this permits viewing of bones with a special camera.
- Sympathetic nervous system tests
These tests are probably the best diagnostic tool because they seek for disturbances in sympathetic nervous system- the main cause of all problems
- X-rays
Some researches have proven that simple loss of minerals from bones may show up on an X-ray in later stages of the disease.
Treatment of Reflex Sympathetic Syndrome
Because there is no cure for CRPS, treatment is aimed at relieving painful symptoms. Early diagnosis and treatment are important. Three forms of treatment may be combined:
- Medication
- physical therapy
- surgery
- psychological support
Medications
There is no doubt- there are lots of different medication that can help decrease the symptoms and which can be taken by mouth. To reduce symptoms and provide long-term relief, local anesthetics may be injected into a nerve bundle at the base of the neck. This procedure is called -stellate ganglion block. Doctors may prescribe topical analgesics, antidepressants, corticosteroids, and opioids to relieve pain. However, it is important to remember that no single drug or combination of drugs has produced consistent long-lasting improvement in symptoms. Over-the-counter nonsteroidal anti-inflammatory drugs (NSAIDs) such as Aspirin, ibuprofen (Advil, Motrin, others) and naproxen sodium (Aleve) may ease pain and inflammation. Other treatments may include sympathetic nerve block, spinal cord stimulation, and intrathecal drug pumps to deliver opioids and local anesthetic in order to relieve the pain!
Physical therapy
It is proven that gradually increasing exercise program to keep the painful limb or body part moving could be extremely helpful and may help restore some range of motion and function. Therapy is important to regain function and reduce discomfort caused by RSD. Gentle, guided exercising of the affected limbs may improve range of motion and strength. Important thing to know is the fact that the earlier the disease is diagnosed, the more effective exercises may be. Chronic pain is sometimes eased by applying electrical impulses to nerve endings. Sometimes doctor inserts tiny electrodes along your spinal cord and a small electrical current delivered to the spinal cord results in pain relief.
Surgery
Occasionally, surgery is performed in the later stages, but every patient should be aware of the fact that the results can be disappointing. The use of surgical sympathectomy, a technique that destroys the nerves involved in CRPS, is controversial and some experts approve it, while some- don’t! Some experts think it is unwarranted and makes CRPS worse; others report a favorable outcome. The bottom line is that sympathectomy should be used only in patients whose pain is dramatically relieved by selective sympathetic blocks.
Prognosis of Reflex Sympathetic Syndrome
The fact is that the prognosis for CRPS varies from person to person. Extremely rarely- spontaneous remission from symptoms occurs in certain individuals. Others can have unremitting pain and crippling, irreversible changes in spite of treatment. It is proven that, when treated early, many individuals with RSD have relief of symptoms within 18 months. Others individuals, unfortunately, develop chronic pain and disability. Future research will no doubt discover how and why RSD begins, how it develops, and identify those individuals at risk for chronic disease.