Vivian Grisogono


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Reflex sympathetic dystrophy (RSD) is also known as causalgia, complex regional pain syndrome (CRPS) or Sudeck’s atrophy.

It causes a variety of symptoms, which are often inconsistent, and don't seem to have any obvious direct cause. The condition can arise following apparently minor injuries. It can also follow operations, illnesses, including heart disease and breast cancer, and neurological conditions like stroke or multiple sclerosis. It has been associated with taking barbiturates or drugs to treat tuberculosis.

RSD tends to happen mainly in the extremities - hands, wrists, feet and ankles - , but it can happen almost anywhere in the body. If it happens in the foot, it can spread up the leg to the knee and even beyond. From the hand it can affect the elbow and up to the shoulder. It can happen at any age, but is least common in very young children. It is more likely to happen in people who are anxious and tense, whether about their injury or generally.


What are the symptoms of RSD?

Generally, the affected area stops functioning normally. There are skin changes: the affected area may turn a deep red-purplish colour, especially when you change position, for instance putting your foot to the floor as you get out of bed, or putting your hand down after it has been supported in a sling for a while. The skin may be unusually pale and shiny. It may feel clammy and sweaty, either hot to the touch, or abnormally cool. The skin hairs can disappear, or in some cases grow at an unusual rate. 

Unusual, unexpected pain is characteristic. There is increased pain after or during even moderate exercise. The area becomes abnormally sensitive to the touch. Joints become tender and ever-stiffer, while the muscles weaken, waste and tighten. If the condition develops, the bones in the area become thinner and weaker, and the nails of your fingers or toes may stop growing normally.


How is RSD diagnosed?

The symptoms are usually sufficient to provide the diagnosis. In some cases medicalpractitioners may choose to do investigations such as blood tests, X-rays or scans, if there is a specific need.

Be warned that RSD is often missed, misdiagnosed or misunderstood by inexperienced practitioners.


How is RSD treated?

Treatment is sometimes directed at the affected area directly, but this may aggravate the symptoms.

The alternative is to activate the whole body, without over-emphasis on the painful part. For instance you can do exercises for the thigh and hip region when the foot is affected, or the shoulder and upper arm if the problem is the hand. Massage and acupuncture to the shoulder blade region can be helpful for many cases of RSD, whether it is the leg or arm which is affected. Many RSD patients benefit from psychotherapy to alleviate underlying tension.

Individuals differ in their responses to the various treatments which might be offered for RSD. Some treatments are drastic, others more subtle.

It takes time and patience to recover from RSD. Full or near-full recovery is always possible.


Self-help for reflex sympathetic dystrophy

Look after your circulation

* Drink plain water regularly throughout each day

* Reduce stress

* Practise relaxation techniques and deep breathing exercises

* Practise visualization techniques: picture the problem area(s) as healthy, and imagine yourself doing your normal activities again

* Keep your diet simple, and avoid irritants, especially caffeine and alcohol

* Watch out for symptoms of food intolerance

* Find the right practitioner or team

* If you are offered interventions like injections or surgery, make sure you are fully informed of the pros and cons

* When you are confident you have found the right treatment or combination of treatments, follow the instructions to the letter

* Always discuss any fears or problems relating to the treatment with your practitioner(s)

* Keep a diary of your activities, food and drink intake, stress levels and your symptoms - this will provide guidelines as to what you should or should not be doing.

© Vivian Grisogono 2016