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Reflex sympathetic dystrophy

N Gordon

    Brain & Development
    |July 1, 1996
    PubMed
    Summary
    This summary is machine-generated.

    Reflex sympathetic dystrophy (RSD) causes severe pain and functional loss due to autonomic nervous system dysfunction. Early diagnosis and management, including pain control and physiotherapy, are key for satisfactory outcomes.

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    Area of Science:

    • Pediatric neurology
    • Autonomic nervous system disorders
    • Pain management

    Background:

    • Reflex sympathetic dystrophy (RSD), now often termed Complex Regional Pain Syndrome (CRPS), is characterized by disproportionate pain, functional loss, and autonomic dysfunction.
    • Psychological disturbances frequently accompany RSD/CRPS and can significantly impact the patient's condition.
    • Pediatric cases exhibit distinct features, including higher prevalence in girls, more frequent leg involvement, and potential absence of trauma history or trophic changes.

    Purpose of the Study:

    • To review the clinical presentation, etiology, diagnostic methods, and treatment strategies for reflex sympathetic dystrophy, with a focus on pediatric presentations.
    • To explore the underlying pathophysiology, including sympathetic nervous system involvement and neurotransmitter sensitivity.
    • To outline effective management approaches, emphasizing pain control, early mobilization, and physiotherapy.

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    Main Methods:

    • Clinical diagnosis based on characteristic symptoms and signs.
    • Diagnostic support from imaging techniques such as X-ray, bone scans (Technetium 99m labelled diphosphonates), and scintigraphy.
    • Utilizing Laser Doppler flowmetry for objective physiological measurements.

    Main Results:

    • The etiology is multifactorial, with theories including sympathetic nervous system hyperactivity, neurotransmitter super-sensitivity, pain substance release, altered opioid metabolism, and exaggerated inflammation.
    • Diagnosis is primarily clinical, supported by specific imaging findings.
    • Treatment response is variable, with a range of pharmacological and non-pharmacological interventions showing potential efficacy.

    Conclusions:

    • Reflex sympathetic dystrophy in children presents unique characteristics and requires a comprehensive management approach.
    • Effective management hinges on early diagnosis, aggressive pain control, and multidisciplinary interventions, including physiotherapy.
    • While various treatments exist, including medications, nerve blocks, and surgical options, physiotherapy and early mobilization remain paramount for optimal outcomes.