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Reflex Sympathetic Dystrophy
Find relief from debilitating pain
Reflex sympathetic dystrophy (RSD) syndrome, also called Complex regional pain syndrome (CRPS), is a chronic pain condition that often occurs in the arms or legs after an injury.
It causes the body to react abnormally to even a minor injury, leading to worsened pain over time.
The specialists at NSOC provide treatment for a full range of neurological disorders, including complex regional pain syndrome.
Our mission is to provide the highest quality care and treatment for patients with neurological disorders, while advancing new therapies and uncovering the causes and cures of neurological diseases. Our physicians specialize in neurological treatment and care.
Signs and symptoms of complex regional pain syndrome
The symptoms of complex regional pain syndrome (CRPS) vary in their severity and duration. People who have CRPS often describe continuous, intense pain that gets worse rather than better over time. It may even spread to other areas of the body. For instance, if the injury only originally involved a finger or toe, pain can spread to include the entire arm or leg. In some cases, pain can even travel to the opposite extremity.
Other symptoms of complex regional pain syndrome include:
Burning pain
Swelling and stiffness in affected joints
Decreased ability to move the affected body part
- Skin changes and changes in nail and hair growth
Causes of reflex sympathetic dystrophy
Complex regional pain syndrome (CRPS) often develops after an injury to the arm or leg.
The condition may occur after what seemed like a minor injury, such as a sprain. However, in CRPS, the pain persists long after the injury has healed.
In some cases, the sympathetic nervous system plays an important role in the pain.
CRPS is also caused by a triggering of the immune response, which leads to the inflammatory symptoms of redness, warmth, and swelling in the affected area.
How is CRPS diagnosed?
There is no specific diagnostic test for complex regional pain syndrome. Making a firm diagnosis may be difficult early in the course of the disorder when symptoms are few or mild. The diagnosis is made after obtaining a complete medical history, performing a thorough physical examination and through observation of the symptoms such as presence of an initial injury, higher than expected amount of pain from an injury, change in appearance of the affected area.
A diagnosis can often be made if the patient has a history of a predisposing condition with typical symptoms and physical change in the painful region of the body. However, additional tests may be ordered to rule out other conditions.
Other tests may include:
- Magnetic resonance imaging (MRI)
- Triple phase bone scan
- Nerve block
Reflex sympathetic dystrophy treatments
Treatments for complex regional pain syndrome (CRPS) include medication, non-drug treatment and surgery, psychotherapy, physical therapy and drug treatment.
Medication
Narcotics such as morphine, codeine, hydrocodone and oxycodone often are not effective for this type of pain. More often, medications that modulate the neurotransmitters in the brain are used to help control CRPS. Most of them were originally developed for other purposes such as:
- Antidepressants: Duloxetine, amitriptyline and nortriptyline
- Anticonvulsants: Gabapentin, carbamazepine, phenytoin, pregabalin, topiramate and levetiracetam
Non-medication options
- Psychotherapy: This helps patients develop coping skills and manage the stress that accompanies living with pain
- Physical therapy: In conjunction with nerve blocks, helps to break the pain cycle and has been shown to lessen the duration of pain and loss of function when started early in the course of the pain condition
Improve Mobility
Surgical Treatment Options
- Sympathetic nerve blocks: These provide significant pain relief for some people. Types of nerve blocks include anesthetic placed next to the spine to directly block the sympathetic nerves and steroids to reduce inflammation
- Intrathecal drug pumps: Pumps and implanted catheters are used to continuously send pain-relieving medication into the spinal fluid.
- Spinal cord stimulation: In this minimally invasive technique, electrodes are placed in the spinal canal outside the sac containing the spinal cord, providing relief for many people with CRPS without medication-related side effects while allowing people significant control over their pain management.
- Motor cortex stimulation: Using computer-guided surgical techniques, stimulating electrodes are placed on the covering of the brain over the region controlling movement of the painful body area. An implanted pulse generator (battery) sends constant electric pulses to the area to relieve pain.
- Deep brain stimulation: One or two small wires are placed deep in the areas of the brain that relay pain signals. Microelectrode recording (brain mapping) techniques are used to precisely localize the area to place the electrode. An implanted pulse generator (battery) sends constant electric pulses to the area to relieve pain.
Recovery from surgery
The amount of time it takes to recover from CRPS varies from person to person.
Spontaneous relief of symptoms occurs in some individuals; however, others can have chronic pain and irreversible changes in their skin and hair patterns in spite of treatment.
The affected area should be pain-free with daily activities before returning to sports.