What is Reflex Sympathetic Dystrophy (RSD)?- Symptoms, Causes and Treatment

Reflex Sympathetic Dystrophy (RSD), also known as Algodystrophy, is a type of complex regional pain syndrome (CRPS), characterized by edema, erythema, functional impairment, vasomotor and sensory disturbance. 
RSD causes chronic pain, usually in an arm or leg, and it appears after an injury, stroke, or even a heart attack. 
Reflex sympathetic dystrophy syndrome (RSDS) is a combination of symptoms: severe and specific pain, localized swelling, limitation of movement of the organ, etc.

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Reflex Sympathetic Dystrophy (RSD) is a type of complex regional pain syndrome (CRPS)

What is Reflex Sympathetic Dystrophy (RSD)? - Symptoms, Causes and Treatment

What is Reflex Sympathetic Dystrophy (RSD)?

Reflex Sympathetic Dystrophy (RSD), also known as painful dystrophy (Algodystrophy) or CRPS type 1, is a combination of various and varied symptoms, which is severe and specific pain, the appearance of local swelling, limited range of motion in arm or legs and disorders of enteric nervous system function with vascular congestion and the occurrence of hyperhidrosis and cyanosis.

RSD syndrome is characterized by osteopenia. This phenomenon can be seen by bone imaging, which shows the rate of Rapid Turnover of bone tissue, as the rate of bone decomposition exceeds the frequency of construction.

RSDS takes many forms, depending on its location in the body, and the circumstances of this syndrome. This disease appears, especially in post-traumatic cases, for example, 7% -35% of patients with a fractured wrist named Colles, as well as 5% -20% of patients after a heart attack and 5% -20% of patients with cerebral palsy, in the paralyzed part of the body. 
The syndrome is not only present in a single joint, nor the innervation area of a particular nerve, but by location in the body, such as the end of the body.

It is unclear how and why this syndrome develops. With a reciprocal relationship between the nervous system and connective tissue, only in a few cases in which patients suffer from severe disease.

Also read: What is Complex Regional Pain Syndrome (CRPS)?

Stages of Reflex Sympathetic Dystrophy

Reflex sympathetic dystrophy usually develops in three stages:

Stage I: severe pain, sometimes overnight, with allergies and local swelling, just like inflammation. Disturbances in the function of the independent nervous system appear in the affected area to varying degrees from case to case.  However, there are usually difficult functional disorders in the patient at an early stage due to paralysis of the affected area and acute pain.

Stage II: Lasts for about 3 - 6 months. The disease subsides, but tissue atrophy - the skin and muscles - is obvious, and the skin becomes thicker and softer (as in Scleroderma). Early curvature in the affected joints also appears. At this stage, osteoporosis can be clearly seen by means of bone imaging.

Stage III: This stage can take a very long time, or even become a permanent phenomenon. It is about the personality and psychological nature of the patient. There are soft tissue shrinkage and atrophy with severe curvature contraction, accompanied by a sense of psychological instability.

Symptoms of Reflex Sympathetic Dystrophy

The symptoms of RSD syndrome are: 

• Changes to the skin in the affected area.
• Sweating around the affected area.
• Pain or burning sensation.
• Feeling warm to the touch.
• Skin paleness with a blue tone.
• Sensitivity to heat or cold.
• Nail and hair changes
• Joint pain and stiffness
• Muscle atrophy
• Muscle weakness.
• Muscle spasms
• Swelling.
• Skin redness.
• Tenderness.
• Discomfort.




Causes of Reflex Sympathetic Dystrophy

The exact cause and mechanism of how RSD develops are not well understood. Some theories such as abnormal excitation of nerve tissue and irritation lead to abnormal impulses along the nerves that affect blood vessels and skin. Several underlying conditions and factors can trigger  and lead to RSD, including:
• Soft tissue injuries such as burns and bruises.
• Trauma, such as broken bones, fractures, or amputation.
• Paralysis of one side of the body.
• Emotional stress.
• Radiation therapy.
• Nerve pressure.
• Heart attack.
• Stroke.
• Surgery.
• Infection.
• Sprains.
• Cancer.

Treatment of Reflex Sympathetic Dystrophy

Treatment goals include pain relief, reduction of tissue congestion, prevention of tissue contraction and treatment of anxiety and depression in these patients.
Strong analgesics and long-term physiotherapy are usually needed to activate the affected area. 

The fixation of the painful organ should be avoided; hydrotherapy has been shown to be particularly effective.
In the acute phase, a moderate to high steroid dose is given to reduce the high metabolic frequency.


Calcitonin and other drugs that reduce osteoporosis, where it is found effective, especially in the first or second stage, not only by affecting the bones, but also in relieving pain.


Local blocking of the autonomic nervous system by local anesthetics, as well as drugs that block receptors in the autonomic nervous system, contribute to the reduction of pathological circulatory interactions between connective tissues and this nervous system.


Intensive rehabilitation treatment, in the second and third stage, is important in order to restore the proper functioning of the patient.




Medication

A variety of medications are available for RSD, ranging from over-the-counter pain relievers and topical creams to prescription drugs from your doctor. These medications include:
• Nonsteroidal anti-inflammatory drugs.
• Tricyclic antidepressants (TCAs).
• Anticonvulsants.Benzodiazepines.
• Topical anesthetics.
• Beta-blockers.
• Systemic steroids.
• Membrane stabilizers.
• Bisphosphonates.
• Muscle relaxers.
• Vasodilators.
• Guanethidine.
• Opioids.

Medical procedures



• Interventions for reflex sympathetic dystrophy syndrome (RSDS) include:
• Spinal cord stimulation
• Deep brain stimulation
• Transcutaneous electrical nerve stimulation
• Intrathecal (in the spine) drug pumps
• Electroacupuncture
• Biofeedback
• Pump implantation
• Peripheral nerve blocks
• Sympathectomy, either surgical or chemical, which damages some of the sympathetic nerves
Read more: Complex Regional Pain Syndrome (CRPS) - Symptoms, Causes and Treatment