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What is Reflex Sympathetic Dystrophy Syndrome (RSD)?

Reflex Sympathetic Dystrophy Syndrome (RSD) is also known as Complex Regional Pain Syndrome (CRPS) is a chronic neurological syndrome. There are two types of this disease – Type I and Type II and they are characterized by:

  • Severe burning pain
  • Pathological changes in bone and skin
  • Excessive sweating
  • Tissue swelling
  • Extreme sensitivity to touch

Complex Regional Pain Syndrome Type I (RSD)

  • Usually follows a noxious event, or a cause of immobilization
  • Continuing pain, allodynia, or hyperalgesia with which the pain is disproportionate to any inciting event
  • Pain is continuous and may be heightened by emotional stress
  • One visible sign of RSD near the site of injury is warm, shiny red skin that later becomes cool and bluish
  • Evidence at some time of edema, changes in skin blood flow (skin color changes, skin temperature changes more than 1.1°C difference from the homologous body part), or abnormal sudomotor activity in the region of the pain
  • This diagnosis is excluded by the existence of conditions that would otherwise account for the degree of pain and dysfunction

Complex Regional Pain Syndrome Type II (Causalgia)

  • The presence of continuing pain, allodynia, or hyperalgesia after a nerve injury, not necessarily limited to the distribution of the injured nerve
  • Evidence at some time of edema, changes in skin blood flow (skin color changes, skin temperature changes more than 1.1°C difference from the homologous body part), or abnormal sudomotor activity in the region of pain
  • This diagnosis is excluded by the existence of conditions that would otherwise account for the degree of pain and dysfunction.

What is the prognosis?
Good progress can be made in treating RSDS if treatment is begun early, ideally within 3 months of the first symptoms. Early treatment often results in remission. If treatment is delayed, however, the disorder can quickly spread to the entire limb and changes in bone and muscle may become irreversible.

To date, the only chance for a cure is with immediate and aggressive treatment by RSD experts. Otherwise, as the disease progresses, the effectiveness of treatment sharply drops off.

Those with RSD often suffer devastating personal, financial and social hardships. If the disease is left untreated, the sufferer can expect a lifetime of pain and disability, abandonment by family and friends, financial ruin, social isolation and depression which very often leads to the ultimate pain killer—suicide. All this makes life with RSD a supreme challenge.

 

About Reflex Sympathetic Syndrome (RSD/CRPS)

Reflex Sympathetic Dystrophy Syndrome (RSD) is also known as Complex Regional Pain Syndrome (CRPS). RSD/CRPS is a multi-symptom, multi-system, syndrome usually affecting one or more extremities, but may affect virtually any part of the body. Although it was clearly described 125 years ago by Drs. Mitchell, Moorehouse and Keen, RSD/CRPS remains poorly understood and is often unrecognized.

The best way to describe RSD/CRPS is in terms of an injury to a nerve or soft tissue (e.g. broken bone) that does not follow the normal healing path. The development of RSD/CRPS does not appear to depend on the magnitude of the injury (e.g. a sliver in the finger can trigger the disease). For reasons we do not understand, the sympathetic nervous system seems to assume an abnormal function after an injury.

If undiagnosed and untreated, RSD/CRPS can spread to all extremities, making the rehabilitation process a much more difficult one. If diagnosed early, physicians can use mobilization of the affected extremity (physical therapy) and sympathetic nerve blocks to cure or mitigate the disease. If untreated, RSD/CRPS can become extremely expensive due to permanent deformities and chronic pain. At an advanced state of the illness, patients may have
significant psychosocial and psychiatric problems, they may have dependency on narcotics and may be completely incapacitated by the disease. The treatment of patients with advanced RSD is a challenging and time-consuming task.

 

RSD/CRPS may present itself in four stages:

The staging of RSD/CRPS is a concept that is dying. The course of the disease seems to be so unpredictable between various patients that staging is not helpful in the treatment of RSD/CRPS. Not all of the clinical features listed below for the various stages of RSD/CRPS may be present. The speed of progression varies greatly in different individuals. Stage I and II symptoms begin to appear within a year. Some patients do not progress to Stage III. Furthermore, some of the early symptoms (Stage I and II) may fade as the disease progresses to Stage III.


STAGE I

Average duration of Stage 1 is 3 months



STAGE II

Stage 2 may last from 3 to 6 months in many patients



STAGE III

 

STAGE IV

Stage IV is almost the flip side of earlier stages, and points to the exhaustion of autonomic and immune systems. Ganglion blocks in this stage are useless and treatment should instead be aimed at improving the edema and the failing immune system.

 

Any comments can be emailed to me at
MichiganInjuredWorker@yahoo.com

 

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