FAMILY MEDICINE® COLUMN

By Martha A. Simpson, D.O., M.B.A.
Associate Professor of Family Medicine
Ohio University College of Osteopathic Medicine

REFLEX SYMPATHETIC DYSTROPHY -- CHRONIC, PROGRESSIVE PAIN

Question: My husband sprained his ankle a few months ago. It should have healed by now, but he continues to be bothered by it. His doctor says he may have something called “RSD” and wants to send him to another specialist. What is RSD? What does RSD stand for? What can be done for it?

Answer: The initials “RSD” stand for reflex sympathetic dystrophy. You’ll sometimes see the word “syndrome” added to the end of the name, making it “RSDS.” A newer -- and somewhat more descriptive -- term for this disorder is complex regional pain syndrome (CRPS) type I. By whatever name, it’s a relatively “new” medical condition. It was formally identified a little over 20 years ago.

This is an uncommon disorder of unknown cause that can follow an injury. A part of the nervous system malfunctions, and affected nerves start to misfire, sending constant pain signals to the brain. A telltale sign is that the pain is more severe than would be expected for the type of injury. RSD is not psychological, but it can lead to psychological problems when friends and doctors don’t take the complaints of pain seriously.

Sometimes the RSD is set off by a major trauma to a limb, for example, a broken leg. Often, however, as in your husband’s case, the injury can be quite mild. Other times no injury can be identified at all.

RSD is not only painful, but chronic and progressive. It can occur at any age but is most common between the ages of 40 and 60 years. Men and women suffer from it in equal numbers, and it has been reported in children as young as 3.

RSD is fairly uncommon in mild to moderate trauma -- affecting about 1 to 2 percent of bone fracture sufferers. However, with more severe trauma, the likelihood increases. For instance, in people who are paralyzed on one side, it has been reported to occur in about 21 percent of cases.

The symptoms usually progress through three stages -- acute, dystrophic and atrophic. The acute stage starts within a few months of the injury with burning pain associated with skin and nail changes, color changes of the limb, swelling, and sensitivity. In the dystrophic phase, the limb is swollen, cool to the touch, discolored and the muscles are beginning to wither. Osteoporosis can begin in the area. This stage occurs about three to six months after the injury. During the atrophic stage, the muscles get weak and stiff, the skin gets cool and shiny and RSD may progress to another limb.

RSD can be difficult to diagnose, but it can sometimes be treated successfully. Non-steroidal antiinflammatory drugs like aspirin and ibuprofen can be effective for some people in reducing the inflammation and pain. Muscle relaxants, topical balms and physical therapy can also be beneficial. In addition, antidepressants and anticonvulsants can be used to help with sleep difficulties caused by RSD. Some people are helped by transcutaneous electrical nerve stimulation, or TENS, units or nerve blocking injections.

The prognosis for RSD varies from person to person. Some sufferers undergo spontaneous remission of their symptoms. Others, unfortunately, in spite of treatment have unremitting pain and crippling, and experience irreversible changes. For such a complex disorder, it’s important that the treatment be individualized for each patient.

Family Medicine® is a weekly column. To submit questions, write to Martha A. Simpson, D.O., M.B.A., Ohio University College of Osteopathic Medicine, P.O. Box 110, Athens, Ohio 45701, or via e-mail to readerquestions@familymedicinenews.org. Medical information in this column is provided as an educational service only. It does not replace the judgment of your personal physician, who should be relied on to diagnose and recommend treatment for any medical conditions. Past columns are available online at www.familymedicinenews.org.