I have a young woman friend who has been going to doctors for three years with the complaint of a severe limp. She has been told that she has Reflex Sympathetic Dystrophy (RSD) and that she’ll have to learn to live with this condition. Could you please explain this condition and what can be done about it?
A: Reflex Sympathetic Dystrophy (RSD) is a pain syndrome following an injury in which one’s nerves have been damaged or traumatized in the context of a sometimes more significant injury. The mechanism by which the injury causes pain is unclear. In the spectrum of kinds of pain, the pain that results from RSD is chronic, often burning, and constant. Even minimal contact with one’s skin often sets off an intense wave of pain disproportionate to the degree of contact. It does not respond to the usual kinds of medications used to treat pain. Individuals with RSD often have a great deal of difficulty being properly diagnosed and are sometimes wrongly labeled as malingerers or accused of drug-seeking behavior.
Treatment is usually on an outpatient basis and varies but can include:
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local anesthesia directed at the source of the pain
- physical therapy
- electrical stimulation of the nerve root
- acupuncture
- hypnosis
- relaxation training and biofeedback
- occasional surgical intervention
- maintenance of a daily regimen of physical activity
There are also a variety of medications that are available. Often, different combinations need to be tried to determine the best mix for pain relief and tolerable side effects.
The most important aspect of treatment is the development of a relationship with a physician you trust. This may be an anesthesiologist with special expertise in pain, a specialist in rehabilitative medicine, a neurologist, or a group of providers in a pain clinic. One has to be careful of unscrupulous practitioners who use unorthodox techniques and ineffective (and often expensive) medications that prey upon those in search of relief.
Extinguishing pain and maintaining function may not always be possible. Instead, one may need to look for a balance that allows for maximum productivity and function. I know several patients who daily cope with pain who to me are to be greatly admired for their perseverance and courage.
