What Are the Treatments for Late RSD?

Reflex Sympathetic Dystrophy (RSD), also known as Complex Regional Pain Syndrome (CRPS), is a chronic, often poorly understood, syndrome characterized by severe pain and changes in the tissues and bones. The late stage of RSD usually begins within 6-12 months of an injury and can last for years. This stage can be recognized by extreme pain, disturbances to the immune system, hypertension, chest pain and psychological trauma.

About RSD

• According to the National Institute of Neurological Disorders and Stroke, RSD generally develops as a response to acute trauma to a joint or limb, such as a sprain, fall, accident or medical procedure. Due to changes in motor systems, there is generally thought to be a malfunction in the central nervous system, whereby nerves send constant pain signals to the brain.

  RSD evolves through three stages--acute, dystrophic and atrophic. Each phase shows a discernible progression of pain and physical changes in the patient. Late RSD symptoms include irreversible changes to the skin and bones, prominent muscle atrophy, severely limited mobility, and twisted limbs from constant contractions of the muscles and tendons.

  RSD is classified among the 100+ types of arthritis and rheumatic diseases. It is estimated that between 500,000 and 750,000 people suffer from RSD.

Treatment

• Although there is no quick fix for the late stages of RSD, patients can be helped as long as they are willing to change their medication and eating habits and stay active.

  The single most important object in treating an RSD patient is education. The physician should define the potential benefits, risks and alternatives, and the patient can make educated decisions based on these evaluations.

  Treatment for the late stage of RSD generally focuses on pain management combined with physical therapy to restore function to the affected limb, psychological support, sympathetic nerve blocks, drug pumps and spinal cord stimulation.

  Medications include the calcium channel blocker Nifedipine or the alpha-sympathetic blocker Phenoxybenzamine, nonsteroidal anti-inflammatory agents, topical analgesics such as gels or creams, corticosteroids and opioids (for pain).

  Surgical procedures for the chronic phase of RSD include sympathectomy, a controversial surgical procedure whereby the surgeon severs the network of nerves near the spinal column and sympathetic nerve blocks to dull the pain signals.