Explaining reflex sympathetic dystrophy

Managing Chronic-Pain Patients in the New Millennium: Clinical Basis and Regulatory Viewpoint from Texas, U.S.A

Chronic pain is a very significant health care problem. It is estimated that 9% of the US adult population suffers from moderate to severe noncancer-related pain. It is very difficult to objectively and quantitatively measure a patient's pain and response to treatment. This routinely results in under or overtreatment of pain in these patients. The authors' goal is to provide physicians with practical recommendations and guidelines for the treatment of the chronic-pain patient. This article also summarizes the neurobiology of pain and contrasts acute vs. chronic pain, and it explores the complex interplay between the physical manifestations of chronic pain and its emotional ramifications. In addition, this article offers clinician guidelines for the evaluation and treatment of chronic pain; treatment recommendations based on the current neurobiological understanding of pain; and numerous guidelines and position statements published by various physician associations, physician licensing boards, and local, state, and federal laws. A "Patient Pain Management Contract" and "Pain Treatment Functional Outcome Scale" are exhibited.

Reflex sympathetic dystrophy

Reflex sympathetic dystrophy (RSD) is composed of five major features: pain, swelling, autonomic dysregulation, movement disorders, and atrophy and dystrophy. RSD is caused by an injury to a specific nerve or the C- and A-delta fibers that innervate the involved tissue. It is a progressive illness that spreads with time and may encompass the entire body. There is no psychological disposition to the problem, but all patients are severely depressed because of the constant pain, lack of sleep, and complete disruption of their lifestyle. The continuing pain is usually secondary to the process of central sensitization. The autonomic dysregulation has a major central nervous system component. Atrophy and dystrophy are partly due to loss of nutritive blood supply to the affected tissues. The movement disorder is partly due to deficiency of GABAergic mechanisms; the tremor is an exaggeration of the normal physiologic tremor. Treatment consists of decreasing the afferent pain, maintaining barrage from the underlying defect, and blocking the sympathetic component of the process. New developments include the use of neurotrophic factors to reverse the phenotypic changes that occur in the dorsal horn and the use of pharmacologic agents to block the activity-dependent NMDA channels that appear to be instrumental in maintaining central sensitization.

Vascular diseases are the most common cutaneous manifestations of reflex sympathetic dystrophy

Reflex sympathetic dystrophy (RSD) is a chronic pain syndrome with prominent cutaneous findings. Atrophy has been considered to be the most common manifestation of the disease. We catalogued the abnormal skin conditions in RSD by means of chart review. Vascular problems were most common, followed by inflammatory diseases, infections, and atrophic diseases. Atrophic disease accounts for a minority of the skin problems seen in RSD. Most cutaneous complaints were related to vascular disease, particularly edema.