Reflex Sympathetic Dystrophy
Fact Sheet

WHAT:	RSD is a complex multi-symptom pain syndrome affecting a limb or limbs that can affect any one of any age It usually occurs following tissue damage to the limb, but it can also be triggered by visceral diseases, central nervous system lesions or from unknown causes. It goes under a variety of names, including Complex Regional Pain Syndrome I (CRPS I).
HOW MANY:	It is hard to pinpoint the number of people who have RSD, though some estimates put the number of people afflicted with this syndrome at 6 million and other estimates claim between 5% and 10% of the population. A 1993 study of 829 RSD patients reports that the incidence of RSD may occur in 5% of fractures, myocardial infarctions, peripheral nerve injuries and Colles fracture. [Signs and Symptoms of Reflex Sympathetic Dystrophy Prospective Study of 829 Patients, Veldman, Peter HJM, Reynen, Han M, Arntz, Ivo E and Goris, R Jan A, The Lancet. Oct. 23, 1993, 342:1012-1016.]
DISABILITY:	RSD is a major cause of disability because only 20% of patients are able to fully resume prior activities.
SYMPTOMS:	All RSD patients suffer from pain, usually burning in nature. Other possible symptoms include:
	Abnormally acute sensitivity to stimulus (hot, cold, touch, pressure) Diminished sensitivity to stimulus (both can occur in the same patient) Sweating Edema Pain from mechanical stimulation or movement Muscle weakness Joint stiffness Anxiety Depression	Muscle atrophy Tremors Changes in hair and nail growth Discoloration of the limb Changes in limb temperature Arthropathy Osteoporosis Intolerance to noise Intolerance to stress Increased pain and symptoms at night Reactions to weather changes
DIAGNOSIS:	When diagnosed and treated within the first three to 6 months, there is the highest possibility of cure and treatment of RSD is most effective. Unfortunately RSD is not well known within much of the medical community so diagnosis is often overlooked. Further, many uninformed medical personnel have categorized the symptoms as psychosomatic or malingering delaying treatment for years. There is no single test for diagnosing RSD. Instead diagnosis is made through observation of the patient's signs and symptoms followed by lab tests, which include thermography, three-phase bone scans (scintigraphy), X-rays, quantitative sweat tests and diagnostic nerve blocks.
TREATMENT:	This is no cure for RSD. Treatment in the first three to six months after onset with nerve blocks, medications and physical therapy has been reasonably effective. After six months treatment becomes harder and the success rate diminishes the longer one has RSD. Early treatments include sympathetic nerve blocks, medication (such as tricyclic antidepressives, anticonvulsives, beta blockers, and NSAIDs), physical therapy, psychotherapy, and electrical stimulation. More invasive treatments are often used in the later stages of RSD, including chemical sympathectomies, spinal cord stimulators, dorsal column stimulators, and possibly morephine pumps. Though still used by some doctors, surgical sympathectomies and amputation of the affected limb are not effective and cause serious side effects.
PROGNOSIS:	Treatment and success rate will improve as more practitioners are made aware of the symptoms and effective treatments. More research is needed to determine the systems through which RSD operates. Double blind studies are needed to determine the effectiveness of most common treatments of RSD.
REFERENCES:	Janig, Wilfred and Stanton-Hicks, Michael (eds.), Reflex Sympathetic Dystrophy: A Reappraisal, Progress in Pain Research and Management, Vol. 6. IASP Press, Seattle, 1996. Portenoy, Russell K. and Kanner, Ronald M. (eds.), Pain Management: Theory and Practice, Contemporary Neurology Series, F.A. Davis Company, Philadelphia, 1996. Raj, P. Prithvi (ed.), Pain Medicine: A Comprehensive Review, Mosby, St. Louis, 1996. Warfield, Carol A. (ed.), Principles and Practice of Pain Management, McGraw-Hill, Inc., New York, 1993.
FOR MORE INFORMATION CONTACT:	The Reflex Sympathetic Dystrophy Network Karen Strauss, Executive Director 280 Riverside Drive New York, NY 10025 Fax: 212-666-6722 Email:Info@rsdnet.org Web: http://www.rsdnet.org