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Reflex Sympathetic Dystrophy Syndrome
from: Dr. Jeffrey A. Oster, Medical Director Of Myfootshop.com.The description of complex regional pain syndromes (CRPS) dates back to the days of the civil war when Mitchell first described this condition in 1864. Mitchell coined the term causalgia, meaning burning pain. The most striking feature of this condition is pain that is disproportional to an injury. CRPS typically follows minor injuries such as sprains, fractures or surgery. Other names for this condition include;
reflex sympathetic dystrophy syndrome (RSD/RSDS)
Sudeck's atrophy
shoulder-hand syndrome
algodystrophy
peripheral trophone urosis
sympathetically maintained pain
post-traumatic pain syndrome
sympathalgia
sympathetic overdrive syndrome
Due to confusion arising from the many names for this set of symptoms, The International Association for the Study of Pain (IASP) developed nomenclature to more accurately describe CRPS.
CRPS I - Consists of pain, sensory abnormalities, abnormal sweating and blood flow, abnormal motor system function and trophic changes ( thickening of the skin and nails, coarse thin hair growth) and atrophy of the superficial and deep tissues (skin, muscle, bone). The most common form is RSD and may not present with an identifiable nerve injury.
CRPS II - Same as CRPS I but presents with an identifiable nerve injury. Symptoms include burning pain made worse by light touch, temperature changes or motion of the limb. These findings are most common in the foot or hand following partial injury to the nerve. The affected area appears cool, reddish, and clammy. The superficial and deep tissue structures may also begin trophic changes.
Treatment for complex regional pain syndromes
Treatment consists of many different measure, but there is general agreement that the success of treatment depends upon early implementation of treatment. Treatment may include;
Medications
Narcotics- for pain suppression
Anti-inflammatory- non-narcotic control of inflammatory pain
Antidepressants-maintenance of normal sleep cycles, anxiety control
Calcium channel blockers- increased blood flow to extremities
Anticonvulsant- regulation of normal sleep cycle, control of pain
Pain blocks
Peripheral nerve blocks of the affected area
IV regional blocks of the affected extremity
Lumbar sympathetic blocks- given by an anesthesiologist
Physical therapy
Range of motion, strengthening exercises, continuous passive motion
(CPM)
Whirlpool, ultrasound, heat treatment
TENS, nerve stimulation
Steroid injections
Lumbar sympathectomy
Dorsal column stimulation -
Morphine pump
Neurectomy - surgical excision of the nerve
The prognosis for patients with CRPS varies greatly and depends upon the degree of symptoms, when treatment is initiated and the type of treatment. Studies have shown that the overall success rate of the treatment of RSD has been 50%. In a study performed by Anderson and Fallat, they found that 3.5 years following the onset of traumatic injury resulting in CRPS, 12 of 13 patients still had pain considered to be moderate to considerable. (1)
Symptoms:
CRPS vary dramatically in their symptoms and intensity. One of the difficulties of CRPS is making an initial diagnosis due to the complex nature of this group of conditions. Once diagnosed, aggressive treatment is important to try to arrest the symptoms of each of the CRPS's.
Additional references include;
1. Anderson, D.J., Fallat, L.M. Complex Regional Pain Syndrome of the Lower Extremity: A Retrospective Study of 33 Patients. The Journal of Foot and Ankle Surgery 38(6):381-387, 1999
About the Author
Jeffrey A. Oster, DPM, C.Ped is a board certified foot and ankle surgeon. Dr. Oster is also board certified in pedorthics. Dr. Oster is medical director of Myfootshop.com and is in active practice in Granville, Ohio.
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