From the Guidelines
RSD, or Reflex Sympathetic Dystrophy, now more commonly known as Complex Regional Pain Syndrome (CRPS), should be managed with a multidisciplinary approach, including physical therapy and medications such as NSAIDs, anticonvulsants, and antidepressants, as early intervention is crucial to prevent progression and improve quality of life. The condition typically affects a limb after an injury or trauma, involving abnormal and excessive pain, changes in skin color and temperature, swelling, and limited mobility 1. Treatment should focus on maintaining function and preventing disability, with physical therapy playing a crucial role. Medications such as nonsteroidal anti-inflammatory drugs (NSAIDs), anticonvulsants (such as gabapentin), and antidepressants (like amitriptyline) can help manage pain, as suggested by the 2017 HIVMA of IDSA clinical practice guideline for the management of chronic pain in patients living with HIV 1. Some key points to consider in the management of CRPS include:
- Early intervention to prevent progression
- Multidisciplinary approach, including physical therapy and medications
- Psychological support to address potential depression and anxiety
- Consideration of nerve blocks, spinal cord stimulation, or intrathecal drug delivery for more severe cases. It is essential to note that CRPS can be associated with hair loss, tissue changes, and skin discoloration at the site of the pain, and sympathetic dysregulation is proposed to play a role in its development 1.
From the Research
Definition and Classification of RSD
- Reflex Sympathetic Dystrophy (RSD) is also known as Complex Regional Pain Syndrome type 1 (CRPS I) 2, 3, 4
- It is a chronic pain condition characterized by hyperalgesia and allodynia of the extremities 5
- CRPS is divided into two types: Type I (without confirmed nerve injury) and Type II (with known associated nerve injury) 5
Symptoms and Pathogenesis
- RSD is characterized by pain and altered sensation, motor disturbance and soft tissue change, vasomotor and autonomic changes, and psychosocial disturbance 4
- The pathogenesis of CRPS is not yet clarified, but potential pathways include neuropathic inflammation, activation of peripheral nociceptors, and involvement of the autonomic nervous system 5
- Risk factors for developing CRPS include female gender, fibromyalgia, and rheumatoid arthritis 5
Treatment Options
- Treatment modalities for RSD include physical therapy, pharmacotherapy, and interventional techniques 5
- Gabapentin has been shown to be effective in reducing pain and sensory deficits in RSD patients 2, 6
- Other pharmacotherapies that have shown promise include short-course steroids, bisphosphonates, ketamine, and antioxidant treatment 5
- Sympathetic blocks and active physiotherapy are also considered cornerstones of efficient management 3