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What Causes Progression of Reflex Sympathetic Dystrophy?

written by: Victoria Trix • edited by: Leigh A. Zaykoski • updated: 12/31/2009

Causes of the progression of reflex sympathetic dystrophy or complex regional pain syndrome are not necessarily known at this time, as doctors are not sure what the causes are. Theories are that it is caused by the immune system responding to the body and attacking it.

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    Symptoms

    Complex regional pain syndrome, CRPS or reflex sympathetic dystrophy is all the same chronic pain condition. There is no known cure for reflex sympathetic dystrophy, nor is there any known reason for the progression. The symptoms of CRPS includes serious and intense pain that is majorly out of proportion to the type of injury incurred that tends to get worse and not better with time. Most often if affects one arm or leg, hand or foot. The pain is said to spread to the entire limb and not just a local area. Other features are the color and temperature of the skin becoming red, as well as burning sensations and sweating or swelling of the area. At this time there is no known cause of the disease, no known reason for the progression, and no known cure.

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    Treatment for Progression of Reflex Sympathetic Dystrophy

    Since there is no known cure for this disorder, the treatment is generally used to relieve pain only. There are many topical solutions that can be prescribed as well as corticosteroids, opioids, antidepressants and analgesics. At this time there is no one drug or treatment or even a combination of any of the above that gives a long lasting symptom relief for patients. Some patients will undergo physical therapy for this disorder as well as sympathetic nerve blocks, intrathecal drug pumps and spinal cord stimulation to help with the pain.

    Progression of the disease is split into three sections including acute stage 1 which constitutes hyperalgesia, continuing pain and allodynia where pain is very over exaggerated compared to the cause. The skin temperature is higher, swelling and redness are seen as well as hair or nail growth in the area being much accelerated. The second stage involves cold skin that is pale as well as brittle nails and hair loss being seen. The last stage is seen with muscles beginning to atrophy, reduced range of motion and joint contractures. Many people simply do not progress all the way through each stage before entering the next, so it is said that the clinical courses of this disease can vary.

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    Progression

    The progression of reflex sympathetic dystrophy can be very fast or slow, depending on the sympathetic nerve system and overall health. When the immune system is failing for any reason, the progression of the disease will also wane. This is due to the fact that when the body is ill, everything internally slows down, including the sympathetic nervous system. However, if illness continues, the progression will speed up because the body will get used to the weakened immune system and will then begin attacking the limb again.

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    Diagnosis

    To be diagnosed with CEPS, immobilization is required as well as continuing pain that is not normally felt with an event. For example, if a doctor hits your knee with a reflex hammer and you scream out in pain, this is not a normal pain felt with this event. Evidence of blood flow changes and an absence of any condition that would account for the pain or dysfunction is also required.

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    Resources

    National Institute of Neurological Disorders and Strokes from the article NINDS Complex Regional Pain Syndrome last updated December 18, 2009

    Reflex Sympathic Dystrophy Syndrome Association from the article An Unusual Presentation of Complex Regional Pain Syndrome Type I