FAQs on Reflex Sympathetic Dystrophy (RSD)


Reflex sympathetic dystrophy (RSD) is characterized by a cluster of symptoms, which includes burning pain, tenderness, skin discoloration, and swelling of an extremity. The symptoms occur in three stages: acute, dystrophic, and atrophic. This condition is often referred to as complex regional pain syndrome (CRPS).

What causes RSD?

The exact mechanism of RSD is poorly understood at present. However, experts believe the condition involves irritation and abnormal excitation of nervous tissue, which results in abnormal nerve impulses that affect the skin and blood vessels.

What triggers the onset of reflex sympathetic dystrophy?

While there is no identified inciting event in around 33% of people with RSD, a variety of events are associated with the onset of RSD. These include:

  • Surgery
  • Injury
  • Degenerative arthritis
  • Heart disease
  • Brain diseases
  • Shoulder problems
  • Shingles
  • Carpal tunnel syndrome
  • Certain medications

How common is reflex sympathetic dystrophy?

Incidence rates were investigated in one U.S. study, which reported a rate of 5.5 per 100,000 persons. In a European study, the rate was much higher at 26 per 100,000. CPS was found to affect women more than men, and most cases occur during ages 50 to 70 years. RSD also occurs mainly in Caucasian and Japanese races.

What are the stages of RSD?

There are three stages of RSD with specific symptoms. These are:

  • Acute – Lasts 3-6 months and involves burning, blanching, flushing, swelling, sweating, pain, and tenderness.
  • Dystrophic – Lasts 3-6 months and involves skin changes of thick, shiny skin and persistent pain, but the flushing and swelling is less.
  • Atrophic – Can be long-term and involves loss of function, mobility, contracture development, and skin thinning.

What treatment options are available for patients with RSD?

The goal of symptom control with RSD is early treatment. Because what works for one patient may not work for others, treatment has to be individualized and varies from person to person. Options include:

  • Medications – Depending on the severity of pain, options include high doses of corticosteroids for the first few weeks. Other medications used include Lyrica, clonidine, and amitriptyline.
  • Physical therapy – To avoid muscle atrophy, spasms, and weakness, the doctor may order physical therapy. The therapist teaches the patient on various exercises and stretching techniques.
  • Lumbar sympathetic block – With this procedure, the doctor injects an anesthetic agent near the sympathetic nerve chain of the low back, which is done under x-ray guidance. In several research reports, the efficacy rate of this block was found to be 75%, with many patients reporting significant relief of pain.
  • Stellate ganglion block – This treatment involves the injection of an anesthetic agent near the certain nerves of the cervical spine. Done with x-ray guidance, this block improves blood flow to the arm and/or hand in many cases. In a recent clinical study, almost 80% of patients had pain relief, with 40% reporting complete symptom relief.
  • Surgical sympathectomy – Done to destroy nerves that supply the affected extremity, this procedure uses coagulation or a destructive agent (alcohol or phenol. It is reserved for patients who do not respond to nerve blocks. In a review of studies involving patients who had sympathectomy, pain reduction was reported in 50% of participants.