Reflex Sympathetic Dystrophy Syndrome

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Introduction

What is reflex sympathetic dystrophy syndrome?

Reflex sympathetic dystrophy syndrome, also known as complex regional pain syndrome, is a chronic pain disorder. Reflex sympathetic dystrophy syndrome can occur in any part of the body, but it most commonly occurs in an arm or leg. Generally, the pain is intense and continuous. The pain gets worse over time, rather than better, and may spread.

The cause of reflex sympathetic dystrophy syndrome is not known, but it is often related to an injury or infection, which may inflame a nerve. In rare cases, an illness, such as a stroke or heart attack, may be the cause. The pain of reflex sympathetic dystrophy syndrome is generally greater than the severity of the injury that caused it.

In addition to pain, symptoms of reflex sympathetic dystrophy syndrome include changes in skin temperature, changes in hair growth, muscle spasms, discoloration of the skin, stiff joints, and the potential for muscle wasting. These symptoms can be very severe and disruptive.

Currently, there is no cure for reflex sympathetic dystrophy syndrome, but it can be treated. Treatments for reflex sympathetic dystrophy syndrome include physical therapy, pain medications, and behavioral therapy. In severe cases, treatment may involve cutting or blocking the nerve.

Seek immediate medical care (call 911) for severe, constant burning pain that is interfering with your ability to function.

Seek prompt medical care for chronic pain, as early diagnosis and treatment of reflex sympathetic dystrophy syndrome improves your chances of alleviating symptoms.

Symptoms

What are the symptoms of reflex sympathetic dystrophy syndrome?

Symptoms of reflex sympathetic dystrophy syndrome include pain related to problems with a nerve. Pain may be related to a mild injury or infection, but is often disproportionate to the severity of the injury. Usually the symptoms of reflex sympathetic dystrophy syndrome progress through three phases, however, symptoms can occur at any time.

First stage symptoms of reflex sympathetic dystrophy syndrome

The first stage of reflex sympathetic dystrophy syndrome usually lasts a few months, with symptoms such as:

  • Changes in hair or nail growth
  • Changes in skin temperature
  • Joint pain
  • Muscle spasms
  • Severe aching pain
  • Severe burning pain
  • Skin discoloration, such as bruising or pallor

Second stage symptoms of reflex sympathetic dystrophy syndrome

The second stage of reflex sympathetic dystrophy syndrome also lasts a few months, with symptoms such as:

  • Changes in hair or nail growth
  • Changes in skin temperature
  • Slowed hair growth
  • Stiff joints
  • Weak or brittle nails
  • Weakness (loss of strength)
  • Worsening, severe aching pain
  • Worsening, severe burning pain

Third stage symptoms of reflex sympathetic dystrophy syndrome

In the third stage of reflex sympathetic dystrophy syndrome, your symptoms can become permanent. The symptoms of third stage reflex sympathetic dystrophy syndrome include:

  • Contracture of the limb (limited movement)
  • Increased area and severity of pain
  • Muscle wasting

Symptoms that might indicate a serious condition

In some cases, reflex sympathetic dystrophy syndrome can be a serious condition that should be evaluated immediately in an emergency setting. Seek immediate medical care (call 911) if you, or someone you are with, have any of these serious symptoms including:

  • Difficulty moving a painful limb
  • Muscle wasting
  • Severe, intractable pain
Causes

What causes reflex sympathetic dystrophy syndrome?

The exact cause of reflex sympathetic dystrophy syndrome is not known. It is possible that a trigger event, such as an injury or an infection, causes damage to a nerve. This nerve then loses control of its normal functions, including sensation (feeling), sweating, temperature sensitivity, and even blood flow. Over time, this loss of function leads to worsening pain and muscle dysfunction. Because of this, preventative measures include early mobilization after fracture, myocardial infarction, or stroke. Vitamin C use after fracture also lowers rates of reflex sympathetic dystrophy syndrome.

The word “sympathetic” in reflex sympathetic dystrophy syndrome refers to the sympathetic nervous system, which controls functions like blood flow and sweating. A problem with the sympathetic nervous system can lead to damage of blood vessels, muscle, sweat glands, and hair follicles that are served by the damaged nerve. Problems with the sympathetic nervous system lead to many of the symptoms of reflex sympathetic dystrophy syndrome.

What are the risk factors for reflex sympathetic dystrophy syndrome?

A number of factors increase the risk of developing reflex sympathetic dystrophy syndrome. Not all people with risk factors will get reflex sympathetic dystrophy syndrome. Risk factors for reflex sympathetic dystrophy syndrome include:

  • Age between 40 and 60 years
  • Infection, especially of a limb
  • Injury, especially of a limb
Treatments

How is reflex sympathetic dystrophy syndrome treated?

Currently, there is no cure for reflex sympathetic dystrophy syndrome, although research is being done to find one. However, reflex sympathetic dystrophy syndrome can be treated and may go into remission if prompt treatment is obtained. Treatments for reflex sympathetic dystrophy syndrome are intended to treat the pain and loss of function that can result from the condition.

Behavioral and physical therapy for reflex sympathetic dystrophy syndrome

In order to improve limb function, prevent muscle wasting, and help you cope with chronic pain, certain therapies may be helpful including:

  • Cognitive or behavioral therapy to help you deal with chronic pain
  • Occupational therapy to help you perform activities of daily living
  • Physical therapy to improve joint and muscle flexibility

Medication for reflex sympathetic dystrophy syndrome

Medications for reflex sympathetic dystrophy syndrome include painkillers, drugs to improve muscle strength, drugs to improve blood flow, and drugs to treat loss of bone strength including:

  • Blood pressure medications
  • Osteoporosis medication, specifically bisphosphonates, such as risedronate (Actonel) and alendronate (Fosamax)
  • Pain medications (analgesics or opioids)
  • Antidepressants that have been effective in relieving neuropathic pain
  • Steroids

Other treatments for reflex sympathetic dystrophy syndrome

In severe cases of reflex sympathetic dystrophy syndrome, it may be necessary to prevent the damaged nerve from sending inappropriate signals. Treatments to stop the nerve from sending pain signals or to interfere with pain signaling include:

  • Electrical stimulator implant to send interfering signals through the spinal cord that will help block painful signals from the damaged nerve

  • Implanted pain medication pump (delivers pain medicine directly to the spinal cord)

  • Nerve block (injections that chemically block the nerve)

  • Nerve transaction (cutting the damaged nerve)

What you can do to improve your reflex sympathetic dystrophy syndrome

In order to improve reflex sympathetic dystrophy syndrome, it may be helpful to learn techniques to cope with the pain and to seek support, such as from a support group or counselor.

Complementary treatments

Some complementary treatments may help some people in their efforts to deal with reflex sympathetic dystrophy syndrome. These treatments, sometimes referred to as alternative therapies, are used in conjunction with traditional medical treatments. Complementary treatments are not meant to substitute for traditional medical care. Be sure to notify your doctor if you are consuming nutritional supplements or homeopathic (nonprescription) remedies as they may interact with the prescribed medical therapy.

Complementary treatments may include:

  • Acupuncture

  • Massage therapy

  • Nutritional dietary supplements, herbal remedies, tea beverages, and similar products

  • Yoga

What are the potential complications of reflex sympathetic dystrophy syndrome?

Reflex sympathetic dystrophy syndrome is a severe, painful condition that can interfere with daily life. Complications of untreated or poorly controlled reflex sympathetic dystrophy syndrome can be serious. You can help minimize your risk of serious complications by following the treatment plan you and your health care professional design specifically for you. Complications of reflex sympathetic dystrophy syndrome include:

  • Depression
  • Inability to participate normally in activities
  • Loss of the use of a limb
  • Severe pain
  • Sleep disturbance
  • Social isolation
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Medical Reviewer: William C. Lloyd III, MD, FACS
Last Review Date: 2019 Jan 5
    1. Complex Regional Pain Syndrome. National Organization of Rare Disorders. https://rarediseases.org/rare-diseases/reflex-sympathetic-dystrophy-syndrome/
    2. Telltale Signs and Symptoms of CRPS/RSD. Reflex Sympathetic Dystrophy Syndrome Association. https://rsds.org/telltale-signs-and-symptoms-of-crpsrsd/
    3. Complex regional pain syndrome. Mayo Clinic. https://www.mayoclinic.org/diseases-conditions/complex-regional-pain-syndrome/symptoms-causes/syc-20... 
    4. Domino FJ (Ed.) Five Minute Clinical Consult. Philadelphia: Lippincott Williams & Wilkins, 2013.

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