What is Reflex Sympathetic Dystrophy (RSD) Syndrome?
RSD is an older term to describe one form of Complex Regional Pain Syndrome (CRPS). Both RSD and CRPS are neurological (nerve) disorders characterized by chronic and severe burning pain, pathological changes in bone and skin, excessive sweating, tissue swelling, and extreme sensitivity to touch. RSD is sometimes called Type I CRPS, which is triggered by tissue injury where there is no underlying nerve injury, while Type II CRPS refers to cases where a high-velocity impact (such as a bullet wound) occurred at the site and is clearly associated with nerve injury. Type II used to be called "causalgia" and was first documented over 100 years ago by doctors concerned about the pain that Civil War veterans suffered even after their wounds had healed. RSD is unique in that it affects the nerves, skin, muscles, organs, blood vessels and bones at the same time.
What are symptoms of RSD or CRPS?
Continuous, intense pain that is out of proportion to the severity of the injury (if an injury occurred) and which gets worse rather than better over time. It most often affects the arms, legs, hands or feet and is accompanied by:
What causes RSD/CRPS?
The syndrome usually develops in an injured limb, such as a broken leg. However, many cases of RSD/CRPS involve only a minor, seemingly inconsequential injury, such as a sprain. And in some cases, no precipitating event can be identified.
Conditions associated with the onset of RSD/CRPS include:
In 10% to 20% of cases, no direct cause can be found. Injury that precedes the onset of RSD/CRPS may or may not be significant.
How is RSD/CRPS diagnosed?
RSD/CRPS can be difficult to diagnose and often requires ruling out other conditions that produce similar symptoms. A thorough history and neurological examination is of utmost importance. During the exam, the clinician may notice that the response to mild sensory stimuli produces severe pain.
Physical examination involves observing: the skin’s color and temperature, swelling, and vascular reactivity; overgrown and grooved nails; swollen and stiff joints; muscle weakness and atrophy (wasting).
Other conditions are ruled out with appropriate testing that may include: MRI studies, a full laboratory panel, EMG/NCV (electrophysiological studies of the nerves and muscles), and a thermogram, a test which uses an infrared video camera to measure the emission of heat from the affected limb.
How is RSD/CRPS treated?
Physical therapy is a primary component of initial treatment. There are also several types of medications that can be used. Sometimes elevating the affected limb may be helpful. There are also surgical procedures that are used in some cases. Treatment needs to be individualized and treatment plans often incorporate several of these measures. Treatment, if begun early, ideally within the first three months after symptoms begin, can result in remission. Early diagnosis is the key.
What treatment options are available for RSD/CRPS?
The goal of treatment is pain control and as much mobilization of the affected limb as possible. An individualized treatment plan is designed, which often combines physical therapy, medications, nerve blocks, and psychosocial support.
Is there a cure for RSD/CRPS?
Not at this time, but research continues. Advances have resulted in some new and effective treatments.
Incidence and Prevalence
Prevalence. Millions of people in the United States may suffer from this chronic pain syndrome. Estimates of the number of people in the U.S. who suffer from RSD/CRPS range from 200,000 to six million. According to RSDHope, the prevalence of RSD/CRPS is in the range of 1.5 to three million sufferers in the U.S. Approximately 1% to 2% of the U.S. population has RSD/CRPS. RSD/CRPS affects both men and women, but is more common in women. It can occur at any age, but usually affects people between 40 and 60 years old.
According to a 2006 survey by the American Pain Foundation, 54% of returning war veterans who experienced chronic pain were eventually diagnosed with polytrauma or causalgia.
Incidence. RSD/CRPS is generally under-diagnosed. A 2003 study estimated the number of new cases of Type I CRPS to be about 5.5 new cases per 100,000 person-years at risk and the prevalence to be 21 cases per 100,000 people. Type II CRPS has an incidence rate of 0.8 new cases per 100,000 and a prevalence rate of 4 cases per 100,000 (Sandroni et al., 2003). A larger, more recent study by de Mos et al. (2007) estimated the incidence to be four times greater, at 16.8 new cases per 100,000 population.
The National Institute of Neurological Disorders and Strokes (NINDS) reports that 2% to 5% of peripheral nerve injury patients and 12% to 21% of patients with hemiplegia (paralysis on one side of the body) develop RSD as a complication. The Reflex Sympathetic Dystrophy Syndrome Association of America (RSDSA) reports that the condition appears after 1% to 2% of bone fractures.
For more information on RSD/CRPS contact the following organizations:
Power of Pain Foundation
Tel: 804-657-PAIN (7246)
National Institute of Neurological Disorders & Stroke
National Institute of Health
Reflex Sympathetic Dystrophy Syndrome Assn.
American RSDHope Group
American Chronic Pain Assn. (ACPA)
National Chronic Pain Outreach Assn. ((NCPOA)
Mayday Fund (For Pain Research)
Chronic Disease Prevention and Control Programs
109 Governor St, Richmond, VA 23219
804.864.7877, FAX: 804.864.7880