By Foead Geula, M.D.
Chronic Pain Management And Reflex Sympathetic Dystrophy
Reflex Sympathetic Dystrophy (RSD) is also known as complex regional pain syndrome (CRPS) or “causalgia.” It is a debilitating condition caused by a derangement in the sympathetic nervous system, which is responsible for the body’s “fight or flight” reaction. In reflex sympathetic dystrophy, this system becomes maladaptive. Even slight injuries to the arms, legs, or a nerve can precipitate a vicious cycle in which damaged nerves can no longer properly control sensation, temperature, or blood flow to the affected area.
The symptoms of reflex sympathetic dystrophy include severe pain, usually of burning quality, disproportionate to the initiating injury. If untreated, the symptoms may progress to involve the entire affected limb. In addition to the intense pain, there are many other associated symptoms that occur with reflex sympathetic dystrophy. These may include changes to the nails, hair growth, and skin, which may become blotchy and progress to become shiny and sclerotic. Changes to the underlying bone may occur. If the disease is allowed to progress without treatment, irreversible changes may occur to muscles and tendons, with significant limitations in movement because of contractures. Unfortunately, there is no specific test available to diagnose complex regional pain syndrome. The chronic pain management physician obtains a thorough history and assesses the constellation of clinical signs and symptoms to arrive at a tentative diagnosis. For suspected RSD, we may perform a sympathetic block, which may sometimes be done under ultrasound guidance. Sympathetic blocks have both diagnostic and therapeutic value in suspected cases of CRPS. If sympathetic blocks fail to provide long-lasting pain relief, we may suggest spinal cord stimulation. Physical therapy is also an important component of treatment to maintain mobility and flexibility.