Reflex sympathetic dystrophy syndrome (complex regional pain syndrome) is a condition involving chronic pain or elevated nerve impulses affecting a regional side on the body. Medical scientists believe that the condition is the result of a dysfunctional peripheral or central nervous system.
This rare disorder involves the autonomic nervous system regulating involuntary function occluding constricting blood vessels, heartbeat, and blood pressure. Any abnormal or excessive response to the sympathetic nervous system is thought to cause pain associated with the syndrome. The pain usually involves the foot, hand, leg or arm. However, excessive pain can cause significant changes in the body's temperature, skin color, or swelling.
- Who Is at Risk for Reflex Sympathetic Dystrophy?
- Common Symptoms
- Diagnosing Reflex Sympathetic Dystrophy
- Reflex Sympathetic Dystrophy Treatments
Who Is at Risk for Reflex Sympathetic Dystrophy?
Typically, regional sympathetic dystrophy syndrome affects individuals between 20 and 35 years of age. However, children can also be affected. Can also develop the condition five years and older and gender also seems to be a factor because women are affected much more often than men.
Scientists have not yet determined the cause of reflex sympathetic dystrophy. However, it is thought that the malfunctioning of the sympathetic nervous system could be the result of a fracture, sprain, damage to blood vessels, nerve damage, brain injuries, or surgical procedures.
Some research suggests that the syndrome is the result of genetics because family clusters of reflex sympathetic dystrophy syndrome have been reported in rare instances. Other scientists believe that the condition is the result of numerous causes that all lead to contributing factors to the development of the condition.
The most common reflex sympathetic dystrophy syndrome symptoms involve:
- Burning pain
- Stiff or swollen joints
- Changes in skin including the temperature, color (red, purple, pale, or blotchy), texture and a thin or shiny appearance
- Noticeable changes in hair and nail growth patterns that include no growth or rapid growth
- Changes in mobility where the affected body part lacks the ability to move that might lead to distant the (fixed abnormal posture)
- Jerking or tremoring in a limb
- Abnormal sweating at the affected site or surrounding area
Other symptoms commonly associated with reflex sympathetic dystrophy syndrome (complex regional pain syndrome) involve:
- Algodystrophy with characteristics including edema, erythema, vasomotor and sensory disturbance, and functional impairment.
- Algoneurodystrophy that involve functional impairment without demonstrable nerve lesions.
- Reflex Neurovascular Dystrophy that leads to severe pain of the muscles and joints, especially in children, producing and aching, burning, sharp sensation like the cut from a knife.
- Major Causalgia Syndrome that is characterized by severe pain that seems excessively out of proportion to the injury. It might involve changes in the skin including swelling and sensitivity.
- Sudeck's Atrophy characterized by the presence of regional pain that develops after a harmful event.
Many individuals who suffer from this syndrome have a heightened sense of emotional distress, likely caused by a disturbance in the body's central or peripheral nervous system messengers.
Diagnosing Reflex Sympathetic Dystrophy
Medical science has not yet developed one diagnostic tool to verify the presence of reflex sympathetic dystrophy syndrome. However, the diagnostician will obtain a comprehensive patient medical history, perform laboratory tests and completed a clinical physical examination. Early diagnosis and receiving proper treatment provides the highest probability of the condition going into remission.
The doctor will likely recommend a variety of tests that will rule out any other condition with similar symptoms like generalized muscle disease, Lyme disease, arthritis, small fiber polyneuropathy, or a clotted vein. These tests could include a bone scan that identifies bone changes in noticeable problems with blood circulation. In some cases, the doctor will perform a stimuli test to determine sensory perception that detects heat, cold, or touch. This helps locate pain in a specific region of the body.
Accurately diagnosing reflex sympathetic dystrophy syndrome is challenging, especially in the initial stages of its development. This is because many patients have fewer mild symptoms. Usually, the diagnosis is verified through an observation of known symptoms that include:
- Injury associated with an initial injury
- A significant and obvious change in appearance at the affected site
- A greater than normal amount of pain caused by a minor injury
- Ruling out all other causes of pain or the altered appearance of skin at the affected site
Reflex Sympathetic Dystrophy Treatments
The doctor has numerous options for treating reflex sympathetic dystrophy syndrome including therapies and medications. An accurate diagnosis of the severity of the condition can help determine the best level of treatment to ensure a successful outcome. These therapies include:
- Physical and Rehabilitation Therapy – The doctor may recommend an exercise program to ensure painful limbs in areas can continue to move. This therapy will ensure proper blood flow and lessen the symptoms involved with the circulatory system. In addition, increase mobility will strengthen function and flexibility of the limb or affected site. Rehabilitating a limb can assist in preventing secondary brain changes related to chronic pain.
- Occupational Therapy – The doctor might recommend this form of therapy to learn new ways of performing routine daily tasks.
- Psychotherapy – The level of debilitating pain can cause profound psychological symptoms that lead to anxiety, depression, or posttraumatic stress disorder. Each one of these problems can heighten pain perception making rehabilitation much more difficult.
- Drugs – The doctor may recommend various classes of medications especially in the early stage of the disease. While the Food and Drug Administration (FDA) has not yet approved any medication to treat reflex sympathetic dystrophy syndrome, there are medications that can help. However, many of these drugs or combination of drugs can produce unwanted side effects including increased heart rate, dizziness, drowsiness, and impaired vision. These include:
- Bisphosphonates including intravenous pamidronate or high-dose alendronate
- Corticosteroids for treating swelling, inflammation, and edema, including methylprednisolone and prednisone
- Medications for treating depression or seizures that have been proven to be highly effective for treating neuropathic pain
- Botulism toxin injections
- Topical local anesthetic patches and creams including lidocaine
- Opioids including Vicodin, fentanyl, hydrocodone, morphine, and OxyContin. However, because of their highly addictive properties, these medications are prescribed in highly monitored (supervised) by the prescribing doctor.
- NMDA (N-methyl-D-aspartate) receptor antagonist including ketamine and dextromethorphan.
- Sympathetic Nerve Block – The doctor can inject an anesthetic alongside the spine to improve blood flow and block sympathetic nerve activity. However, this procedure does not provide long-term benefits to all patients.
- Spinal Cord Stimulation – Using stimulating electrodes where a needle is inserted near the spinal cord can produce a tingling sensation that distracts the signal sent to the brain.
- Surgical Sympathectomy – This controversial procedure can destroy the nerves that are causing pain. The procedures usually worked well in individuals who have had their pain relieved temporarily by sympathetic nerve blocks.
The outcome (prognosis) of reflex sympathetic dystrophy syndrome varies greatly among patients. It appears as though children, teenagers, and young adults have better outcomes compared to older individuals. Some research shows that treatment can lessen severe pain and disability as can some rehabilitations and early treatment of the condition. However, once the syndrome has progressed, it is often more difficult to produce successful results.