Reflex sympathetic dystrophy Dr Rob Hicks Reflex sympathetic dystrophy (RSD) involves a malfunction of the nervous system and has been known by many names. Now it's most commonly known as RSD or complex regional pain syndrome (CRPS).

In this article

What's the cause? Who's affected?

What are the symptoms? What's the treatment?

Advice and support

RSD occurs when the part of the sympathetic (unconscious) nervous system that controls blood flow and sweat glands in the hand and arm is disturbed and becomes overactive. Burning pain, swelling, stiffness and discolouration of the hand or other extremities develop.

Infection, pressure on a nerve, heart attack, stroke or surgery may trigger RSD, but it's usually brought on by injury. Even minor injuries can be responsible, but the pain tends to be greater than would be expected from the type of injury sustained.

Often, the exact reason for RSD remains unknown.

Women are more likely to develop rsd, but the condition affects people of any age, including children.

The process of RSD involves three stages.

The initial acute stage, which may last up to a few months, causes pain, often described as burning, and excess sweating in the affected part of the limb, which also becomes warm and red. During this stage, someone with RSD may notice their hair and nails grow faster than usual. The joints of the affected limb may become painful, too.

Stage two can last up to a year and is known as the dystrophic stage. During this, the affected limb may be constantly swollen, causing wrinkles in the skin to disappear. Fingernails become brittle, and the pain and stiffness spread up the limb and along the same side of the body, or may spread to the opposite limb.

After a year, RSD enters stage three - the atrophic stage. The muscles may waste away and the skin usually becomes stretched, shiny and pale. The pain may lessen but is constant, and the part of the body affected is stiff. The skin may also be hypersensitive to touch. Once this stage has been reached, the chance of recovering movement diminishes.

Because of the long-term nature of RSD and its symptoms, depression often develops.

If identified early, RSD is treatable.

Treatment is aimed at controlling pain, enabling the person to regain or improve the function of the affected limb, and providing emotional support.

Nerve blocks are most effective - these are injections of local anaesthetic into the affected nerve.

Medication may also be used to relieve symptoms, including painkillers and drugs such as amitriptyline, which is most commonly used to treat depression but can treat nerve pain too. Other drugs that may be prescribed include gabapentin and oral steroid medication.

Physiotherapy is important to help regain function and relieve symptoms. Occupational therapy can help someone learn how to overcome the difficulties they're facing with everyday activities.

If RSD has progressed significantly, surgery may be recommended.

RSD UK Alliance
Website: www.rsdalert.co.uk

This article was last medically reviewed by Dr Rob Hicks in July 2006.