Reflex Sympathetic Dystrophy
What is it?
Reflex sympathetic dystrophy is a type of
neuropathic pain. Neuropathic pain is caused by an
abnormality somewhere along a nerve pathway. With
reflex sympathetic dystrophy, swelling and
sweating, changes in blood flow in a localized
area, or tissue changes occur along with the pain.
This syndrome is related to a condition called
causalgia, first diagnosed in Civil War veterans
who continued to feel pain after their wounds had
healed. Reflex sympathetic dystrophy is also known
as complex regional pain syndrome.
Who gets it?
Reflex sympathetic dystrophy can occur in
anyone, at any age. However, it is more common
between the ages of 40 and 60, and occurs more
often in women. It may occur in people with a
peripheral nerve injury , or paralysis of one side
of the body, called hemiplegia. It is also more
likely to occur in those who have suffered a
traumatic injury, such as one involving bullets or
shrapnel.
What causes it?
The cause of reflex sympathetic dystrophy has
not been determined. It is thought to be related
to damage to the nerves in the part of the nervous
system responsible for controlling the diameter of
blood vessels. This is called the sympathetic
nervous system. When these nerves are damaged, the
signals they send to the brain cause a disturbance
in the way the brain processes information about
temperature, sensations, and blood flow. Reflex
sympathetic dystrophy can occur after any trauma
to the arms or legs, including sprains or
fractures; after surgery; after any injury that
damages blood vessels or nerves; or after brain
injury. However, it can also occur without any
obvious injury.
What are the symptoms?
Reflex sympathetic dystrophy is a chronic
condition, which means it can last a lifetime. If
the pain occurs after an injury, the pain is
always more severe than would be expected for the
type of injury the patient has suffered. This pain
does not improve in the normal amount of time for
the injury to heal. In fact, the pain gets worse.
The pain is often described as "burning," and is
usually concentrated around the area of an injury
or an area covered by an injured nerve. Other
symptoms usually occur in stages. During stage
one, which usually lasts from one to three months,
there is increased sweating around the painful
area, swelling, sensitivity to touch, joint
tenderness or stiffness, muscle spasms, and
changes in the nails and skin. In some patients,
the skin around the painful area may be warm and
red, in others the skin is cool and looks blue. In
the next three to six months, stage two, the pain
gets worse. There is more swelling, hair begins to
stop growing in the area, and the nails look
pitted and brittle. At this point, the condition
causes a loss of bone density, usually associated
with a condition called osteoporosis. The muscles
begin to lose their tone from disuse, called
atrophy. By stage three, the patient may be unable
to move the injured area at all. The joints become
so stiff that they are unable to bend or
straighten completely, called contractures. At
this point, the changes in the skin and bones
cannot be reversed. The pain may spread up the arm
or leg on the same side of the body, or may spread
to the opposite side. The pain is constant, so it
causes emotional as well as physical distress.
How is it diagnosed?
Reflex sympathetic dystrophy is diagnosed
through a combination of medical history and
physical examination. Because the symptoms vary,
and often follow an injury, the condition may not
be diagnosed immediately. Your doctor may use a
technique called thermography to measure the blood
flow to the painful area. Thermography detects
changes in body temperature and produces a
color-coded map, called a thermogram. This map
will show your doctor any areas where the blood
supply is lower than normal. He or she may also
order x-rays to look for any changes in bone
density.
What is the treatment?
The outlook for recovery is best when the
condition is diagnosed early. For immediate pain
relief, your doctor may inject the painful area
with a local anesthetic, such as lidocaine. Other
drugs used to treat reflex sympathetic dystrophy
include corticosteroids; vasodilators, which
dilate the blood vessels; and alpha- or
beta-adrenergic-blocking compounds, which help
reduce muscle spasms. Your doctor will also
recommend immobilizing and elevating the painful
area. In some cases, physical therapy may help to
keep the joints stiffening and the muscles from
losing their tone. A procedure called
transcutaneous electrical stimulation (TENS), used
to treat chronic pain, may also offer some relief.
With TENS, brief pulses of electricity are applied
to nerve endings under the skin. In very severe
cases, pain is relieved by actually cutting the
nerves that are causing the pain. This procedure,
called surgical sympathectomy, completely relieves
the pain, but may also destroy other sensations.
Self-care tips
Because the symptoms of reflex sympathetic
dystrophy seem out of proportion to the injury
that caused the initial pain, it is easy for
others to dismiss the pain as an "overreaction."
Most cases of reflex sympathetic dystrophy can be
treated successfully if diagnosed within the first
three months of symptoms, so it is extremely
important to be persistent in your search for a
diagnosis. Once the symptoms have spread, they may
be irreversible.
This information has been designed as a comprehensive and quick reference
guide written by our health care reviewers. The health information written
by our authors is intended to be a supplement to the care provided by your
physician. It is not intended nor implied to be a substitute for
professional medical advice.
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