TO
RSD --- WHAT IS IT?
FACTS AND FICTION

RSD?  These letters stand for something terrifing:
REFLEX SYPATHETIC DYSTROPHY.

Our human make up provides us with a nervous system.  This system completes many tasks throughout our lives.  One of these tasks is PAIN.  Pain alerts us to injury, without pain you could touch something hot and burn yourself beyond repair, without pain to alert us we would surely die from any number of injuries, or illnesses.  Pain stays for the time it is needed to tell us something is wrong, as we heal pain subsides.

RSD is a terrifing disease.  RSD is a type of chronic pain syndrome when your nervous system forgets to shut pain off.  Imagine some off the pain that you get on a day to day basis, now imagine some of the most terrible pain you have ever had, such as that of a broken bone.  You have the pain for a short time then it lessens and eventually goes away.  Now imagine what it would be like if that pain NEVER lessened and NEVER goes away only gets worse and even spreads to more of your body --- THIS IS RSD -REFLEX SYMPATHETIC DYSTROPHY.   This disease is unrelenting and dibilitating and there is NO KNOWN CURE. RSD can strike anyone at anytime, the young and old alike.  There are treatments for the symtoms of RSD, such as that of strong pain killers like morphine, nerve blocks and stimulators, but no cure at this time for the disease itself.

WHAT IS RSD - REFLEX SYMPATHETIC DYSTROPHY?

In 1993, the name of Reflex Sympathetic Dystrophy was changed to COMPLEX REGIONAL PAIN SYNDROME (CRPS) mainly for research purposes and to avoid confusion with the many lables that have been attached to RSD in the past. CRPS type one is formerly known as RSD and CRPS type two was causalgia.

CRPS type one or RSD is a dibilating disease which involves the skin, nerves, blood vessels and bone.  The sympathetic nervous system reacts to a stimulous for example, an injury.  Blood flow may be affected in reaction to a burn, cut, or severe temperature changes.  To prevent you from further injury or using an injured limb, the limb swells.  Sometimes, and for no apparent reason, and know one knows why, an abnormal or prolonged sympathetic reflex begins in a limb as a reaction to a trauma.

The sympathetic nerves become overactive and can cause a variety of symptoms that may cause debilitating consequences.  There can be many symptoms, but the most common one is burning pain. some other symptoms include:  swelling   temperature changes   color changes   diminished motor function   severe sweating.  These symptoms usually happen in a limb but can occur in other body parts.  Symptoms may vary with each individual who has CRPS type one (RSD).

COMMON CAUSES OF CRPS Type 1

Trauma (often minor) example: soft-tissue injuries, fractures, heart disease (caused by inadequate blood supply).
Spinal Cord Disorders
Cerebral lesions
Infections
Surgery
Repetive motion disorder (RSI) or cumulative conditions conditions such as carpal tunnel syndrome.

In many cases, a definate cause of CPRS Type 1 (RSD) has never been found.  It is not known why these factors cause CRPS/RSD but there are many hypotheses that are the subject of research around the world even today.

COMMON CAUSES OF CRPS Type 2

CRPS Type 2 (formerly causalgia
CRPS Type 2 is defined by burning pain, allodynia, and onset usually occurs after nerve injury but may be delayed.  The most common nerves involved are the median, sciatic, ulnar, and tibial.  The burning pain is constant and is exacerbated by: Abnormalities in skin temperature and blood flow may occur as well as submotor dysfunction.  Dystrophic changes may occur in the skin, hair or nails.

Many thanks to Dr. Hooshmand for helping with these medical sections.  He has written a book on RSD and well over a hundred RSD "puzzels", or answers to some questions.  To order a FREE disk of all of Dr. Hooshmands RSD "puzzels" please visit http://www.rsdinfo.com and fill out the form, making sure you include your entire postal mailing address.  They are provided free by Eric Phillips, another man who has done a lot for RSD patients for years.

RSD is a disease that is poorly understood by patients, their families and health professionals. In some, the disease is mild, in some moderate, and in others it is a severe condition.  The following facts and fictions were compiled by RSDSA OF AMERICA HADDONFIELD, NEW JERSEY.

1. FICTION ---  RSD Reflex Sympathetic Dystrophy is rare.
  FACT --- It is not a rare disorder, and may affect millions of people in this country.  The syndrome may follow 5% of all injuries.  Diagnosis is often not made in the early stage of RSD, and some of the very mild cases resolve with no treatment.  Other cases may progress through the stages and become chronic and dibilitating.

2. FICTION --- RSD is a recently discovered disease.
    FACT --- RSD was described during the CIVIL WAR, and has been in literature under a variety of names ever since.

3. FICTION --- RSD does not spread.
   FACT --- RSD does spread in 70% of patients.  The usual pattern of spread is up the same extremity and then may continue to spread on the same side of the body, or to the opposite extremity

4. FICTION --- RSD will burn itself out in 6 months.
    FACT --- Many patients who are not treated early will experience spread of RSD, and this may become a lifelong problem.  Even with early treatment, RSD may become a chronic condition.

5. FICTION --- Minor injuries can not cause RSD.
    FACT --- Minor injuries such as a sprain or fall, are frequent causes of RSD. It can start immediately after the injury, or up to several days later.  One characteristic of RSD is that the pain is more severe than expected for the type of injury that occurred.

6. FICTION --- A painful limb should be casted.
    FACT --- Casting and immobilization can cause a worsening of RSD symptoms.  In some cases, it may be necessary, but great care should be taken.

7. FICTION --- Vigorous and aggressive physical therapy is best.
    FACT --- Physical theropy should be carried out only under a physician's supervision. Osteoporosis occurs with RSD, and as a result of bone loss, pathological fractures can be caused by overly aggressive therapy.  Additionally, nerve entrapment and other disorders are sometimes mistakenly diagnosed as RSD.  Proper diagnosis should be obtained by a competent physician.
Physical therapy should be a part of the pain control program.  The goal is to keep the limb moving and have the patient be able to perform the normal activities of daily living.

8. FICTION --- The treatment for all RSD patients should be the same.
    FACT --- Each patient needs an individual treatment plan.  What helps one patient may not help another.

9. FICTION --- The pain is not as bad as the payient says it is.
   FACT --- The pain is often as bad as claimed, and may even be worse.  Very often a chronic pain patient underrates his or her pain.

10. FICTION --- RSD occurs only in psychologically unbalanced people.
     FACT --- Persons who get RSD are not any different than the rest of the population psychologically.  Once they get RSD, and they are in constant pain, they may become depressed and suffer other psychological changes.  When the symptoms of RSD are relieved these changes will disappear.

11. FICTION --- If a patient has no visible signs or positive tests, they do not have RSD
     FACT --- RSD is a clinical diagnosis.  This means that the physician makes a diagnosis based on a thorough history and physical examination.  A number of diagnostic tests may be ordered to rule out other disorders, such as Carpal Tunnel Syndrome, disk disease, etc.  There may or may not be changes compatable with RSD on x-ray, bone scan, thermography, MRI's and other scans.

12. FICTION --- RSD following surgery means the doctor did something wrong.
    FACT --- Just as RSD can follow mild trauma, it can follow surgery which causes the same type of response in the body as an injury.

13. FICTION --- There is no hope for a person who has had RSD for a long time.
     FACT --- The future of RSD is very hopeful. There is research going on in a number of institutions in this country and around the world.  Research involving the basic processes that cause RSD, as well as finding effective treatment and cure is being studied.  Groups of physicians and scientist are meeting in conferences and seminars to reach an understanding of what RSD is and what causes it.

This is called the acute stage and can last one to three months.  Some characteristics are warmth, coolness, burning pain, edema, increased sensitivity to touch, increased pain, accelerated hair/nail growth, tenderness or stiffness in the joint, spasms, limited mobility, some bony changes may be visible on x-ray, abnormal amoount of pain for the injury.  In this stage there is decreased sympathetic activity.

This is called the dystrophic stage and can last three to six months.  Pain is constant, as in stage one, and throbbing, burning, aching, crushing in nature and is exacerbated by any stimuli.  The affected limb may still be edematous, cool, cynotic (discolored) or mottled (different shades).  Nails are brittle and ridged.  Pain and stiffness persists.  Muscle wasting may begin.  Patient may start experiencing short-term memory problems as well as increased pain from noises and/or other vibrations.  X-rays may reveal signs of osteoporosis.  Patients may start to repeat themselves.  In this stage there is increased sympathetic activity.

This is called the atrophic stage and can last an unlimited amount of time.  Pain can increase or decrease, depending on the person, and the RSDS may spread to other parts of the body.  At this stage irreversible tissue damage may occur.  Skin becomes cool, thin, and shiny.  Contractions of the extremity may occur as well as atrophy of the limb(decreased joint movement).  Skin atrophies [wasting away] and loss of movement or mobility may occur. X-Rays may show marked demineralization and increased osteoporosis.

Not all agree on the existance of a FOURTH Stage. Basically, it is two years or more post-onset.  At this stage the RSD is not likely to be effectively treated with blocks as the percentage of (SIP) Sympathetically Independent Pain is now much greater than the percentage of (SMP) Sympathetically Medicated Pain, meaning the majority of the pain signals are now originating in the brain and not at the  original RSD site where a local block would help.  In this Fourth Stage, RSD is resistant to many forms of treatment and many physicians would now recommend a pump or a DCS/SCS.

to pain links

to suggestions

For  visiting my web page. Hope you gained the knowledge of your quest. Knowledge is power and power will conquer this disease.

CLICK ON THE MAIL BOX TO E-MAIL ME.

to tips

to news

to med adv

LINKS TO GREAT RSD SITES

to inspiration

to relaxation

TO MY HOME PAGE

JOIN MY CHRONIC PAIN SUPPORT CLUB: Chat room, bulletin board and great friends who understand and care