RSD - What Is Reflex Sympathetic Dystrophy Syndrome?

Reflex Sympathetic Dystrophy (RSD) is referred to by several other names:

• Reflex Sympathetic Dystrophy Syndrome - RSDS
• Complex Regional Pain Syndrome
• Shoulder-Hand Syndrome
• Causalgia
• Sudeck's Atrophy

The syndrome is as complicated as its nomenclature.

What Causes RSD?

According to the National Institute of Neurological Disorders and Stroke (NINDS), RSD is "a chronic pain condition that is believed to be the result of dysfunction in the central or peripheral nervous systems."

According to MedicineNet, RSD involves "irritation and abnormal excitation of nervous tissue, leading to abnormal impulses along nerves that affect blood vessels and skin."

Animal studies indicate that norepinephrine, a catecholamine released from sympathetic nerves, acquires the capacity to activate pain pathways after tissue or nerve injury, resulting in RSD.

Another theory suggests RSD which follows an injury is caused by triggering an immune response and symptoms associated with inflammation (redness, warmth, swelling).

RSD is not thought to have a single cause, but rather multiple causes producing similar symptoms.

What Are The Symptoms Of RSD?

RSD usually affects one of the extremities (arms, legs, hands, or feet). The primary symptom of RSD is intense, continuous pain. According to NINDS, the list of symptoms includes:

• burning pain
• increased skin sensitivity
• skin temperature changes (warmer or cooler than opposing extremity)
• skin color changes (blotchy, purple, pale, red)
• skin texture changes (shiny, thin, sweaty)
• changes in nail and hair growth patterns
• stiffness and swelling in affected joints
• decreased ability to move affected extremity

Pain can spread to a wider area (i.e. from finger to entire arm) and can spread to the opposite extremity (i.e. from left arm to right arm). Emotional stress can cause symptoms to worsen.

Some experts suggest there are three stages of RSD, during which progressive changes occur in the skin, muscles, joints, ligaments, and bones of the affected area. The progression has not been confirmed by clinical studies though.

Stages Of RSD

Stage 1

lasts 1 to 3 months

severe, burning pain

muscle spasm

joint stiffness

rapid hair growth

skin color and temperature changes

Stage 2

lasts from 3 to 6 months

pain which becomes more intense

swelling

decreased hair growth

nails which are cracked, brittle, grooved, spotty

softened bones

stiff joints

weak muscle tone

Stage 3

irreversible changes to skin and bone

pain is continuous

muscle atrophy

severe limited mobility

contractions of muscles and tendons (limbs may be twisted)

What Triggers RSD?

There can be numerous triggers for RSD including:

• injury or trauma
• surgery
• degenerative arthritis of the neck
• shoulder problems
• heart disease
• stroke
• diabetes
• cancer
• infection
• brain diseases
• thyroid disorders
• carpal tunnel
• shingles
• certain medications

In an estimated one-third of patients with RSD, there is no associated trigger.

How Is RSD Diagnosed?

A patient's clinical history (signs and symptoms) are the major factor in diagnosing RSD. The diagnosis is made difficult because many of the symptoms overlap with other conditions.

There is no specific blood test or other diagnostic test for RSD. X-rays can show thinning of bones (osteoporosis). Nuclear bone scans can show characteristic uptake patterns which help diagnose RSD.

How Is RSD Treated?

Treatment focuses on relieving painful symptoms associated with RSD. Treatment can include:

• physical therapy and exercise
• psychotherapy to relieve stress, anxiety, and depression
• sympathetic nerve blocks
• surgery including sympathectomy (considered controversial)
• spinal cord stimulation
• intrathecal drug pumps
• medications including:
  • topical analgesics
  • anti-seizure drugs
  • antidepressants
  • corticosteroids
  • opioids

Celebrity Announces Battle With RSD

American Idol judge and celebrity Paula Abdul announced that following a 25 year battle with chronic pain, precipitated by a cheerleading accident when she was 17 years old, a new diagnosis (RSD) and new course of treatment (Enbrel) has produced amazing results.

The media attention given to Abdul's medical struggle has placed RSD on front pages and magazine covers. RSD is among the 100 types of arthritis and rheumatic diseases. It is estimated that between 500,000 and 750,000 people have RSD.

Is Enbrel Commonly Used To Treat RSD?

Enbrel is among the TNF blockers used to treat rheumatoid arthritis. When asked if it is used to also treat RSD, rheumatologist Scott Zashin M.D. commented, "Enbrel is not FDA approved to treat RSD. Studies have shown some benefit in treating nerve inflammation. Since RSD is felt to have a neurological component, it might be beneficial and worth a try. This condition may sometimes be difficult to treat with standard therapies."

Related Resources

RSD / CRPS

Guide To RSD / CRPS

Nerve Pain

Inflammation

Pain Relief

_{Sources: NIH Publication No. 04-4173; Reflex Sympathetic Dystrophy Syndrome, MedicineNet; My Secret Battle (Paula Abdul), PEOPLE}