What is Reflex Sympathetic Dystrophy? 

Reflex sympathetic dystrophy explained by Denver, Golden, Aurora, Boulder, Broomfield, Jefferson, and Littleton Colorado’s top pain doctors

Reflex Sympathetic DystrophyCharacterized by severe and chronic pain, reflex sympathetic dystrophy is a relatively uncommon pain condition that affects the sympathetic nervous system. In general, the pain associated with this condition occurs within the extremities. This condition can also be known as complex regional pain syndrome. Individuals with reflex sympathetic dystrophy generally complain of severe and persistent pain accompanied by difficulties with motor deficits and sensory problems. In general, most patients experience these symptoms occurring in a circumscribed area; however, there are some instances in which symptoms can spread to other parts of the body. Below is a list of other common symptoms reported to occur in conjunction with reflex sympathetic dystrophy.

  • Skin color changes
  • Persistent burning or throbbing pain, typically arising from the peripheral nervous system
  • Touch or cold sensitivities
  • Swelling
  • Changes in skin temperature (skin temperature can switch between feeling cold to feeling sweaty)
  • Joint stiffness
  • Muscles spasms
  • Changes in hair or nail growth
  • Muscle weakness or loss of muscle tone (atrophy)
  • Loss of ability to move affected body parts

At the onset of the condition, patients generally report symptoms of pain, swelling, and redness. Other symptoms that can occur at the onset include touch or cold sensitivities. As with many other chronic pain conditions, emotional stress is known to cause exacerbations in symptomatology. Should patients experience ongoing symptoms of pain associated with reflex sympathetic dystrophy, they are at an increased risk for irreversible damage. Symptoms that are believed to indicate that the patient has sustained irreversible damage can include changes in skin color (particularly loss of color or pale skin), skin feeling cool to the touch, muscle tightening, and muscle spasms.

Causes of Reflex Sympathetic Dystrophy 

Reflex Sympathetic Dystrophy FeetNerve damage is believed to be at the root of the symptoms of reflex sympathetic dystrophy. This nerve damage is thought to arise from stroke, heart attack, surgery, or other serious injury, such as a spinal injury. Thus, nerve inflammation and damage resulting from these causes is thought to lead to severe and persistent pain associated with reflex sympathetic dystrophy.

Thus, reflex sympathetic dystrophy is a neurologic pain condition that is primarily associated with the sympathetic nervous system. For instance, tiny nerve fibers that transmit pain information can become irritated, inflamed, and damaged, causing them to send exaggerated signals of pain to the brain. Further, when the nerve becomes inflamed, this can lead to damage to the blood vessels (e.g., constriction, dilation, or even fluid leakage). Changes in the blood vessels are believed to explain symptoms of discomfort and pain within the extremities. Further, the muscles within this area can become deprived of oxygen, which then leads to muscle damage and additional pain.

Many patients with reflex sympathetic dystrophy describe that their pain occurred suddenly following a discrete injury. In other cases, the precise cause of the pain may not be known, though this is generally quite rare. Below is a list of common injuries that can be linked to reflex sympathetic dystrophy.

  • Sprain or strain
  • Fracture
  • Immobilization of a limb
  • Surgery
  • Injury to soft tissue (such as bruises or cuts)

In cases where there is no known injury that is believed to be the source of the pain, a blood vessel problem, infection, or even nerve entrapment may be the actual cause for the patient’s symptoms. Very limited data exists that suggests there is a genetic component to reflex sympathetic dystrophy.

Treatments for Reflex Sympathetic Dystrophy

Patients are strongly encouraged to speak with their physician regarding their symptoms of pain associated with reflex sympathetic dystrophy. Patients who are in the early stages of the condition may benefit significantly from physical therapy. These patients may experience a significant reduction in the pain and discomfort, along with reductions in poor circulation, muscle stiffness, inflexibility, and loss of muscle tone that is associated with reflex sympathetic dystrophy. By undergoing a course in physical therapy at the onset of the condition, patients may actually significantly reduce the risk for developing long-term difficulties associated with the condition.

Over-the-counter pain relievers with anti-inflammatory qualities (such as non-steroidal anti-inflammatory drugs) can be very beneficial for patients with reflex sympathetic dystrophy. These medications are believed to be effective because of their anti-inflammatory characteristics. Other medications, such as oral corticosteroids like prednisone and cortisone, may be recommended in instances where the patient’s pain was not significantly reduced using an over-the-counter pain reliever.

Spinal Cord Stimulator - XRAYIn terms of patients who report that their pain has not been responsive to over-the-counter pain medications, it may be recommended that they try more aggressive pain management techniques. For instance, opioid medications, such as codeine, may be prescribed for patients needing short-term relief from the pain of reflex sympathetic dystrophy. These medications act by binding to the opioid receptors within the brain and have received extensive support for their effectiveness in reducing pain. There are significant risks, however, associated with the use of opioids, particularly long-term. These risks include the potential for addiction; in other words, patients may become psychologically or physically dependent on them.

Given that this condition is also associated with significant and chronic pain, many cases may not be alleviated with these methods. Thus, other options such as spinal cord stimulation or intrathecal pump implants are available for more long-term pain management. Spinal cord stimulation involves delivering an electrical impulse near the spinal column, which then acts to block the pain signal from traveling to the brain. Similarly, the intrathecal pump implant delivers pain-relieving medication into the area surrounding the spinal cord. In much the same way, this method blocks the transmission of pain signals to provide patients with significant pain relief.

Alternative and complementary pain management techniques are also available. These can include biofeedback training, relaxation training, and acupuncture. These methods have received some support in terms of their effectiveness in helping patients manage chronic pain, particularly when used in conjunction with other therapies.

Conclusion 

Generally a relatively rare condition, reflex sympathetic dystrophy is a condition affecting the sympathetic nervous system. This condition is associated with severe and persistent pain, particularly within the patient’s extremities. There are a number of treatment options available. It may be recommended that patients first attempt more conservative methods. Should these methods be ineffective in providing the patient with relief from the pain, then more aggressive pain management options are available. Many treatment options available are non-surgical and can be done on an outpatient basis. These methods allow the patient to have more control over their pain. Patients should speak with their doctor about their specific condition and to learn about the treatment options available for managing their pain.

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References

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  4. Hauser J, Hsu B, Nader ND. Inflammatory processes in reflex sympathetic dystrophy. Immunol Invest. 2013;42(4):263-72.
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  6. Stanton TR, Wand BM, Carr DB, Birklein F, Wasner GL, O’Connell NE. Local anaesthetic sympathetic blockade for reflex sympathetic dystrophy. Cochrane Database Syst. Rev. 2013;19(8):[Epub ahead of print].