Diagnosing Reflex Sympathetic Dystrophy



Reflex Sympathetic Dystrophy (RSD) is considered to be the Type I form of Complex Regional Pain Syndrome (CRPS). Diagnosing Reflex Sympathetic Dystrophy can be challenging for doctors not familiar with the disease. RSD symptoms are the first indicators that a patient may have RSD disease; Reflex Sympathetic Dystrophy has no known etiology (set of causal factors) nor any implied pathophysiology (body functional changes associated with onset of RSD disease). When this form of Complex Regional Pain Syndrome shows up, the RSD symptoms that a patient may suffer from include:

  • Burning pain in a general area of the body
  • Pain with a light touch to the affected area
  • Increased sweating
  • Temperature change of the skin in affected area
  • Redness or mottled skin in the affected area

Reflex sympathetic dystrophy has been diagnosed in adults, teenagers and younger children.

Diagnosis for RSD Disease

Reflex Sympathetic Dystrophy, or Type I Complex Regional Pain Syndrome, has no known causes. It is thought that RSD disease tends to develop in limbs that have experienced a minor injury. RSD is somewhat troubling to patients suffering from its symptoms because RSD disease can be:

  • Temporary, affecting a patient for a short time before symptoms and the effects disappear;
  • Periodic, affecting a patient for short periods of time, but not continuously;
  • Migratory, affecting one part of the body then moving on to others; or,
  • Localized, affecting a specific area, though it may affect more than one area of the body.

Due to the uncertainty related to Reflex Sympathetic Dystrophy and the lack of awareness of RSD in the medical community, the International Association for the Study of Pain developed a set of four criteria to use in diagnosing RSD. For a patient to be diagnosed with RSD disease, all four criteria must be met.

Injury

A patient must have suffered an injury of some sort that caused tissue damage (hard and soft tissue, i.e. bone, muscle, etc) and/or must have had something cause a part of their body to be immobilized. The injury in question typically will not have had a known direct effect on the nervous system; any diagnosis that involves a previous nerve injury is usually defined as Type II Complex Regional Pain Syndrome, or Neuralgia.

Pain Symptoms

A patient must be experience ongoing pain symptoms. This chronic pain can occur in the following three ways:

  • Continuous Pain / Chronic Pain – pain that continues well after the pain from the injury would have gone away;
  • Abnormal Pain – pain from something that does not normally cause pain, called allodynia (e.g. a light touch to the problem area causes pain; light touch should not cause pain);
  • Intense Pain – pain in excess of what the patient would expect for a given event, called hyperalgesia (e.g. a bump to the problem area causes pain much more intense than you think it would).


Confirmation of RSD Symptoms

In addition to an injury with pain symptoms, the body needs to have shown an abnormal response. These abnormal responses are an indication of the fact that the bodies pain messages and responses are not working correctly. These symptoms are as follows:

  • Excess Fluid in Problem Area – the body moves fluid throughout its various systems trying to make sure that the amount of water leaving the body equals the amount that has entered the body. When there is an injury, not moving the injured body part or the heat caused by the injury can cause the body to retain fluid, leading to a buildup of fluid in an area. This is called edema. In the case of RSD disease, the problem area may be inflamed, causing the body to retain water in the problem area.
  • Abnormal Bodily Function – the body has certain things that it does automatically based on how it responds to the things around it that are affecting it every day. In the case of RSD disease, there is a malfunction in response. As a result, a patient may experience change in the overall skin temperature, changes in the color and texture of the skin, or excess sweating. These symptoms indicate that the body is being confused by the pain signal and is trying to “fix” itself.


No Other Explanation

If a patient has passed all the other criteria, the final one is a requirement that there be no other explanation for the chronic pain and other RSD symptoms that would suggest the patient was suffering from RSD disease.

If the above four criteria are met, a doctor may diagnose a patient with Reflex Sympathetic Dystrophy. Insurance companies are still developing the set of tests and treatments allowable in the cases where a patient has RSD disease. Fortunately, this set of diagnostic criteria provided a standard for the medical profession and meant insurance companies had to recognize RSD/CRPS as diseases.

Do You Think You Have Reflex Sympathetic Dystrophy?

To put it in simple terms, RSD disease can occur when the body experiences an injury and begins to respond to its treatment of the injury site as indicators of pain. In a nutshell, the body feels pain, the body responds to pain. In responding to the pain, the body confuses its own response as more pain so it responds to higher levels of pain. As this continues, the body’s response can be permanently affected. If you think you have RSD, consult a medical professional.



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