Minor trauma can lead to unbearable pain
Reflex Sympathetic Dystrophy (RSD) is a common disorder, with two million to six million people suffering from it at any time, say the few experts on the disorder. The wide range is due to varying definitions of RSD among clinicians and the difficulty in accurately diagnosing the disorder.
About 200,000 people are diagnosed with RSD each year, more than better-known disorders such as Lou Gehrig’s Disease and retinitis pigmentosa, says Nelson Hendler, MD, MS, clinical director of the Mensana Clinic in Stevenson, MD. He also is president and director of clinical research for the RSD Syndrome Association of America, a nonprofit organization based in Haddonfield, NJ.
Educating health care providers about the disease is made more difficult by the fact that it is known by several names. RSD also is known as Sudeck’s atrophy, sympathetically maintained pain, and chronic regional pain syndrome types one and two.
Extraordinary pain can be a warning sign
An early symptom of RSD is burning pain in the limb. A tipoff to RSD is that the pain is wildly out of proportion to the injury. Later, the limb may become cold because of reduced blood flow. The patient also may experience weakness, tremors, spasms, and involuntary movements.
The pain of RSD can be intense, especially if the condition goes undiagnosed and untreated. Some RSD sufferers have compared the pain to having a bad burn on your arm that never stops hurting. Pain medications may not be very effective with neuropathic pain such as that caused by RSD.
RSD can result in total disability
Difficulty in diagnosing the problem, along with the intensity of physical symptoms, can lead patients to suffer serious mental depression. Over the years, some physicians have considered RSD to be the result of malingering or emotional instability, but that may only indicate how poorly the disorder is understood. Total disability is possible, and if the patient is accused of malingering, suicide is not uncommon, Hendler says.
Another confounding fact about RSD is that traditional treatments indicated by common RSD symptoms actually worsen the condition. Splints, bed rest, ice, and massage can contribute to immobility, Hendler says. Proper treatment involves aggressive physical therapy aimed at keeping the limb flexible. Psychotherapy also may be necessary to help the patient deal with the chronic pain and lifestyle limitations from the disorder.
Look for pain, color changes, swelling
To diagnose RSD, experts recommend watching for unexplained, diffuse pain in the affected limb, difference in skin color and swelling of the limb, higher or lower skin temperature than other limbs, and limited range of motion. Hypersensitivity to light touch on the skin can be an important indicator. Some patients even feel pain from a light breeze on the affected limb. Also suspect RSD if the pain affects the entire limb and not just a definable nerve distribution within the limb.
Other telltale signs are excessive swelling after a cast is applied and an intense burning pain after a seemingly routine break or sprain. t
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