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Reflex sympathetic dystrophy.

Robert J Schwartzman1, Anca Popescu

  • 1Department of Neurology, MCP Hahnemann University School of Medicine, Broad and Vine Streets, MS 423, Philadelphia, PA 19102-1192, USA. robert.schwartzman@drexel.edu

Current Rheumatology Reports
|March 14, 2002
PubMed
Summary

Reflex sympathetic dystrophy (RSD) is a progressive nerve condition characterized by pain, swelling, and autonomic issues. Treatments aim to reduce pain and sympathetic activity, with new therapies targeting central sensitization.

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Area of Science:

  • Neurology
  • Pain Medicine
  • Autonomic Neuroscience

Background:

  • Reflex sympathetic dystrophy (RSD), now often termed Complex Regional Pain Syndrome (CRPS), is a debilitating condition with five key features: pain, swelling, autonomic dysregulation, movement disorders, and tissue atrophy.
  • It originates from nerve injury, particularly involving C- and A-delta fibers, leading to a progressive illness that can spread throughout the body.
  • While not psychologically caused, patients experience severe depression due to chronic pain, sleep deprivation, and lifestyle disruption.

Purpose of the Study:

  • To elucidate the multifaceted nature of Reflex Sympathetic Dystrophy (RSD).
  • To describe the underlying pathophysiological mechanisms contributing to RSD symptoms.
  • To outline current and emerging treatment strategies for managing RSD.

Main Methods:

  • The abstract describes the clinical features and proposed pathophysiology of RSD.
  • It reviews the known causes, including nerve injury and central sensitization.
  • It discusses established and novel therapeutic approaches.

Main Results:

  • RSD presents with pain, swelling, autonomic dysfunction, movement disorders, and atrophy.
  • Chronic pain is often linked to central sensitization, and autonomic dysregulation involves the central nervous system.
  • Tissue atrophy results partly from impaired blood supply, and movement disorders may involve GABAergic mechanisms.

Conclusions:

  • Effective treatment requires reducing afferent pain, managing the underlying defect, and blocking sympathetic activity.
  • Emerging treatments focus on neurotrophic factors to reverse dorsal horn changes.
  • Pharmacological agents blocking NMDA channels are being investigated to manage central sensitization in RSD.

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