RSD—A Puzzling, Painful Disorder

By Awake! correspondent in Canada

REFLEX SYMPATHETIC DYSTROPHY (RSD) is “one of the most puzzling syndromes in medicine and one of the most painful and potentially debilitating,” wrote Allison Bray in the Winnipeg Free Press newspaper. RSD “often goes unrecognised clinically simply because it is poorly understood,” said patient Anna Alexander in the British Medical Journal. The same journal stated that RSD is probably underdiagnosed in children. For many years doctors even thought that the pain was psychological, self-induced.

Those who suffer from this mysterious disorder experience unrelenting pain and in some cases barely remember having done anything to cause the agony. Sarah Arnold writes in Accent on Living: “The disease is caused by an injury or trauma to an area of the body rich in nerve endings, such as the hand or foot. The injury could be as simple as a pinprick or as complex as surgery. The first indication of the disease is prolonged pain more severe than the injury. The symptoms are severe, burning pain in a localized area, intense sensitivity to temperature and light, hair and nail changes and a color change in the skin.”

The disease goes through several stages. Initially, there is swelling and redness in the affected area and hair growth where there was no visible growth before. This can last from one to three months. Next, the area becomes blue and cold, with increased pain and stiffness of ligaments and joints. Osteoporosis can set in. Finally, there is a wasting of affected muscles, contraction of tendons, and withering of the affected limb.

Irreversible damage can be prevented, according to Dr. Howard Intrater, director of the pain clinic at the Health Sciences Centre in Winnipeg. The sympathetic nerves need to be blocked from sending pain signals.a The Winnipeg newspaper reports that “treatments range from electrical stimulation to beta blockers, epidural stimulators (where an electrode is implanted in the spinal cord to stimulate the affected area) to blocking the sympathetic nerves with injections.” Physiotherapy is used along with acupuncture to decrease pain and improve mobility. The British Medical Journal says that “effective treatment includes some combination of electrical nerve stimulation, chemical blocking of sympathetic nerves, psychological therapy, and intense physical therapy.”

Early diagnosis is obviously advantageous. However, doctors writing in The American Journal of Sports Medicine say that their results with patients diagnosed with symptoms for less than 6 months, or from 6 to 12 months, or for more than 12 months “were almost identical. This finding contradicts the current opinion that duration of symptoms greater than 1 year before treatment is a poor prognostic sign.”

It is hoped that as medical knowledge increases, RSD will become less mysterious and open to even more effective treatment.

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