Reflex Sympathetic Dystrophy (RSD) or Complex Regional Pain Syndrome (CRPS)
Reflex sympathetic dystrophy syndrome (RSD) is a condition that triggers lasting pain in an arm or leg, typically after a stroke, heart attack, or injury. The severity of the pain may exceed the actual injury. Experts aren’t sure what causes RSD, but the disorder can be treated in numerous cases.
The term “reflex sympathetic dystrophy” is now considered an older one, with doctors now referring to it as Complex Regional Pain Syndrome (CRPS), also called Type I CRPS. The pain is usually caused by tissue injury. CRPS refers to a condition that causes pain and often changes in skin color in a specific part of the body, particularly the arm, leg, hand, or foot. CRPS Type II occurs after known nerve damage.
Symptoms
Many patients with RSD have symptoms that appear slowly. The pain doesn’t always feel severe right away, but over time, it will worsen. Various injuries that cause RSD include burns, cuts, fractures, amputation, minor surgery, radiation therapy, sprains, and bruises. It usually happens in the arm, leg, shoulder, or hip, and the pain can spread to other parts of the body.
RSD can cause redness, a warm feeling on the skin, and swelling, mainly because it affects the immune system. The pain itself can be hard to manage, and one may feel different sensations, such as aching, burning, cold, or deep throbbing. The skin of the affected limb may also feel more sensitive when performing everyday activities, such as putting on clothes and taking a shower.
Other symptoms include growth changes in hair/nails, skin texture, excessive sweating, muscle weakness, and spasms.
Causes
Experts believe the pain triggered by RSD is related to the sympathetic nervous system, which controls blood flow and regulates heart rate and blood pressure. After an injury, the sympathetic nervous system signals blood vessels to constrict to reduce blood loss at the injury site and later signals them to dilate to restore blood flow.
If someone has RSD, the sympathetic nervous system sends mixed signals, leading to pain and swelling. Although not common, some people can get RSD even when they haven’t had an injury.
Diagnosis and Medical Assessment
Diagnosing RSD isn’t always straightforward. Doctors don’t always know the patient has RSD until they have had it for a while. If the pain doesn’t go away or worsens with time, your healthcare provider may suspect the condition. There is no one test to determine if a patient has RSD. Typically, your doctor will rely on a physical exam and review your medical history to see if the condition is likely.
Your Diagnostic Options
The diagnosis may require all tests or a few, depending on your symptoms. Some tests that can be recommended include:
Bone Scan
To check whether there is damage to any bones or issues with blood flow.
Magnetic Resonance Imaging (MRI)
Your doctor may recommend an MRI to evaluate tissues and other structures inside the body.
Sweat Test
This test helps determine whether you sweat more on one side of your body.
Thermography Test
This test assesses the sympathetic nervous system by comparing blood flow or temperature at the injury site with that in other parts of the body.
X-Rays
They are usually ordered to check for mineral loss.
RSD or CRPS Treatment Options
Early detection is always helpful for RSD treatment. If the diagnosis happens sooner, the treatment is likely to be more effective. Some patients with RSD don’t respond to treatment. The condition itself doesn’t have a cure, but early intervention can relieve symptoms. Medications include:
Anesthetic Creams
Antidepressants
NSAIDs
Anti-Seizure Medications
Nerve Blocking Injections
OTC Options Like Aspirin, Ibuprofen, or Naproxen
Nasal Sprays for Bone Loss
Additional Treatment Options
In many cases, doctors also prescribe corticosteroids like methylprednisolone or prednisolone, or opioids, such as fentanyl, hydrocodone, and morphine. Although not as common, healthcare providers may recommend electrodes on the spinal cord to deliver small electric shocks to relieve pain. Physical therapy can help with movements, while psychotherapy can help relax.
If the patient doesn’t feel better with medications and trying other treatments, a surgery called sympathectomy can be suggested. The procedure involves removing specific nerves around blood vessels, which will help improve blood flow to the affected site. Usually, all other options, such as medications and physical therapy, will be considered to see if a patient gets relief from the pain.
When to Reach Out
If you have unexplained pain in an arm or foot after an injury or stroke that doesn’t seem to get better and is located in Westchester or NYC, connect with us at Chester Neurology. We have advanced testing facilities and experts to offer comprehensive care for Complex regional pain syndrome (CRPS) and Reflex Sympathetic Dystrophy (RSD).
Call us today at (914) 816-1941 or email info@chesterneurology.com to schedule an appointment.
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