Reflex Sympathetic Dystrophy

RSD (reflex sympathetic dystrophy) is an older term but still commonly used. It is also called CRPS (complex regional syndrome) Type 1, and is known to be one of the most painful syndromes that exists today. RSD is characterized by the following symptoms which typically occur in an arm or leg after some sort of trauma:

• Constant chronic burning pain that is disproportionate to the original injury
• Inflammation of the affected area
• Spasms of the blood vessels and muscles in the affected area
• Emotional problems, cognitive dysfunction, and insomnia

These symptoms often develop slowly over the course of months, and continue to evolve and change over time. Without early and aggressive treatment, RSD can not only become incurable, but can also spread to other extremities and may eventually affect the whole body.

The hallmark of RSD is that it is caused by an initial injury. That injury is often severe but can also be quite minor, and usually falls into one of two categories:

• External trauma: joint sprain or strain, blunt injury such as a fall, fracture of a bone, penetrating injury such as a gun shot wound or surgery
• Physiologic trauma: infection such as cellulitis, compromised blood flow as seen in heart disease or blood clots, nerve injury as with carpal tunnel syndrome

It’s important to understand that the initial trauma may not be apparent at the time of injury, and it may be an event that’s not classically defined as trauma. As a result of such trauma, the body increases a certain kind of signal to the affected area called sympathetic outflow. This is a good healthy response that’s part of the normal healing process. This sympathetic outflow usually turns off in time as the body heals. In RSD, however, this sympathetic outflow continues well beyond the normal time frame and may continue indefinitely, causing the symptoms associated with this painful syndrome. Treatment of RSD is focused on blocking the sympathetic outflow and this is usually accomplished through a series of sympathetic nerve blocks. The appropriate block is determined based on the location of the pain: stellate ganglion block for arm/shoulder pain, lumbar sympathetic block for leg/hip pain, hypogastric plexus block for abdominal/pelvic pain. If these blocks are unsuccessful, then your doctor may advise ketamine infusions or a spinal cord stimulator