Reflex Sympathetic Dystrophy

Reflex Sympathetic Dystrophy (RSD) is a debilitating disorder involving the human skin, nerves, blood vessels, and bones. The sympathetic nervous system reacts to a stimulus for example, an injury. Blood flow may be affected in reaction to a burn, cut, or severe temperature changes. To prevent you from further using an injured limb, the limb swells. Sometimes inexplicably an abnormal or prolonged sympathetic reflex begins in a limb as reaction to a trauma.

The sympathetic nerves become overactive and can cause a variety of symptoms that may cause debilitating consequences. There can be many symptoms, but the most common one is burning pain. Some of the other symptoms include swelling, temperature change, skin color change, diminished motor function, and severe sweating. These symptoms usually happen in a limb but can occur in other body parts eg. face. Symptoms may vary with each individual who has CRPS type one (RSD). Read about other experience or share your own in our RSD Forum.
RSD is the common name used for Complex Regional Pain Syndrome (CRPS). The name of Reflex Sympathetic Dystrophy (RSD) was changed to Complex Regional Pain Syndrome (CRPS) in 1993 by the International Association for the Study of Pain. The are 2 forms of CRPS. The only difference between type 1 and type 2 is type two is easier to diagnose. CRPS type one is formerly known as RSD and CRPS type two was causalgia. Complex Regional Pain Syndrome and Reflex Sympathetic Dystrophy are used synonymously today. RSD should not be confused with rhabdomyosarcoma (rhabdo) which is another debilitating disease.

RSD Causes

- Trauma (often minor)
- Soft-tissue injuries
- fractures heart disease (caused by inadequate blood supply)
- Spinal cord disorders
- Cerebral lesions
- Infections
- Surgery
- Repetitive motion disorder (RMD)
- carpal tunnel syndrome

In many cases, a definite cause of CRPS Type 1(RSD) has never been found. It is not known why these factors cause CRPS but there are many hypotheses that are the subject of research around the world even today.

CRPS type two (causalgia) is defined by burning pain, allodynia, and onset usually occurs after nerve injury but it may be delayed. The most common nerves involved are the median, sciatic, ulnar, and tibial. The burning pain is constant and exacerbated by:

- light
- touch
- stress
- temperature
- movement of the limb
- emotional disturbance

Abnormalities in skin temperature and blood flow may occur as well as sudomotor dysfunction. Dystrophic changes may occur in the skin, hair or nails.

Symptoms  OF RSD

The main difference between CRPS type 1 (RSD) and CRPS type 2(Causalgia) is that Type 2 is caused by a proven nerve injury. Recent research (see Medical Updates) shows CRPS Type 1 is nerve injury and NOT a somatic disorder. The symptoms of both diseases are identical.

There are four cardinal signs that indicate CRPS Type 1 and 2:

PAIN is constant and characterized by burning. The non-relenting pain is enhanced with every movement.

SWELLING is sometimes localized, but often unrelenting, and progressive. Swelling intensifies the pain and promotes stiffness which can be the beginning of atrophy and deformity.

When tissue is injured or inflamed, excess fluid enters the tissues from damaged blood vessels within these injured tissues.  If the veins cannot remove all of this fluid, the part swells (edema).  However this swelling is usually only temporary, because the tissues heal and the blood vessels no longer leak excessively.
Swelling is one of the symptoms of RSD.  Early in the course of the disease, this inflammatory process causes edema.  The swelling in RSD may exist far longer than it would take normal tissue to heal because RSD:

- prevents healing
- causes constant inflammation
- may cause dilation of the arteries which will cause more fluid to leak, and may cause the veins to contract, which also prevent the normal removal of non-protein fluid from tissues.
- It is pretty easy to see that the edema of RSD may last for long periods of time.

STIFFNESS, like swelling, is progressive resulting in less motion of the joints, which again, results in increased swelling and pain This in turn, can produce further deformity and joint changes.

DISCOLORATION indicates circulatory changes that diminish the nutrition of the tissues of the skin, ligaments, bones and tendons. The result is thin, shiny skin, pencil-like fingers and changes in ligaments. This further contributes to stiffness and pain. CRPS in the upper extremities had been classified in the following five ways, based on the location and intensity of symptoms.

RSD & CRPS Frustration

RSD/CRPS is frequently dismissed by health professionals for many reasons including:
They don’t understand the diagnosis and/or they are not familiar with the disorder.
They understand the diagnosis but lack experience in how to treat it properly.
Many think that the client is pretending to be ill.
RSD/CRPS is thought to be hopeless and there is no cure. (There is hope!)
RSD/CRPS is purely psychological and that it is not a medical condition, i.e. “It’s all in your head”. (This is a myth.)

Many people who work within the health care system dread accepting a client with RSD because effective treatment requires an ongoing, almost daily assessment of the condition to develop the proper regimen. It is far too time consuming for most clinics to adequately care for RSD clients.

Due to the nature of RSD, the condition can quickly change for better or worse for reasons that are not fully understood. Therefore it is necessary to schedule evenly spaced treatment sessions in order to benefit the client.

The health care provider must address the plan of care very carefully once the diagnosis is made and must thoroughly customize therapy for each client. All individual characteristics (psychological, social, physiological) must be taken into account during therapy.

Communication between the family members, health professionals, and the client must be clear, ongoing and become well established. It is common for the client to have failed in a previous program if a positive, creative, caring relationship was not established. If either the client or the therapist senses a communication problem, it is far better to acknowledge that another clinician may be of greater benefit to the client’s progress.

RSD DIAGNOSIS

Diagnosis is determined through X-rays, three phase bone scan, skin tests, joint fluid analysis, and thermo graphic studies. Sometimes the phentolamine test is used. Thermography is more sensitive than any other diagnostic tool when diagnosing RSD according to Dr. H. Hooshmand. He states that diagnosing RSD without thermography is like diagnosing a heart attack without an EKG. It should be noted that the CT scan, EMG, and MRI studies may be normal during the first stage of RSD. Along with the tests, signs and symptoms of RSD are taken into account. All the pieces of the puzzle must fit to render a proper diagnosis.
NOTE: In some parts of Canada, thermography is available but other areas do not have this diagnostic tool. We are trying to get better diagnostic tools which will mean earlier diagnosis of RSD and faster, more efficient treatment.

WHAT CAN BE DONE?

The primary task is to eliminate or treat all possible causes. If there is no known cause, or if with the removal of the cause, the symptoms do not satisfactorily disappear, then there are only the symptoms of RSD/CRPS to be treated.  Before undertaking any skin treatment, whether it is a mole removal, birthmark removal, or expected case of RSD, it is important that you consult a trained medical professional.

SUCCESSFUL TREATMENT OF RSD/CRPS is dependent on:
Early diagnosis. If diagnosed early, the prognosis is very good.
Begin treatment of the underlying cause, if there is one. If not, then focus on the treatment of the CRPS process.

Effective sympathetic blocks by blocking nerve impulses with anaesthetic agents used in severe pain. Blocks may provide permanent or temporary relief. Sustained physical therapy to maintain flexibility, strength, and range of motion are recommended. No use of the limb can result in atrophy and eventually not being able to use the limb.

Progressive management techniques, if necessary for example, biofeedback to control pain and blood flow, pain management techniques, counseling, etc.

MAKING CIRCUMSTANCES FAVORABLE

It is the task of the practitioner to give advice concerning the limits of the client’s endurance. The outcome of the treatment is not only in the hands of the doctor or physiotherapist but also in the hands of the client himself. Listening and following advice regarding the stress applied, in relation to the current stress tolerance, (of the affected extremity) becomes a problem that reoccurs in treatment. The client and the doctor can work together towards the common goal.

Too much or too little exercise of the arm or leg is not good. It often requires an adjustment of lifestyle and sensible handling of the burden of the affected arm or leg. Rehabilitation is appropriate and must be ongoing. One must make the circumstances for recovery as favorable as possible.

Due to the mysteries surrounding CRPS, problems can arise concerning the client’s disabilities, social functioning, employment, relationships, and the environment. These problems also need to be addressed.

RSD REHABILITATION

As part of the treatment, if recovery fails to materialize, and if the client is limited by circumstances in everyday life i.e. getting around, then special steps may be necessary. A referral to a rehabilitation specialist is always sensible in this case.

We know that a minority of CRPS clients will be left with disabilities and that treatment may be insufficient for them. Client and doctor must keep an eye on the treatment, its progress and make changes if necessary. If recovery is complete, people can, in principle, function fully again. Even with incomplete recovery, work is often possible but one must take into account chronic pain, and the decreased ability to bear weight.

THE SECOND OPINION

For the client, there is always the possibility of asking for a second opinion. This should be done in consultation with the doctor, but permission is not necessary. A second opinion certainly does not mean that the doctor who gives it will then begin treating his client. However, a second opinion is reasonable in cases of RSD/CRPS.

Reflex Sympathetic Dystrophy – How Barby Survives RSD Symptoms

Learn how this survivor copes with the symptoms of Reflex Sympathetic Dystrophy (RSD) – she was diagnosed 10 years ago. Her tips for living with chronic illness can change your life!
You may be surprised to learn how many people are diagnosed with Reflex Sympathetic Dystrophy every year…

“More people have Reflex Sympathetic Dystrophy than Multiple Sclerosis, HIV, and breast cancer combined,” she says. “There is upward of 78,000 new cases of Reflex Sympathetic Dystrophy diagnosed each year in the US alone. RSD can affect anyone, regardless of age, race, gender, or financial status. Paula Abdul – a famous singer – has Reflex Sympathetic Dystrophy and struggles with the same physical battles that we as chronic care patients deal with every day.”

Does it help to know you’re not alone in your struggle to live with Reflex Sympathetic Dystrophy? Here, 39 year old Barby Ingle from San Tan Valley, Arizona, describes what it’s like to be a 10 year veteran of Reflex Sympathetic Dystrophy.

She is the author of RSD In Me! A Patient And Caretaker Guide To Reflex Sympathetic Dystrophy And Other Chronic Pain Conditions - as well as another book on Reflex Sympathetic Dystrophy called ReMission Possible!

How Barby Developed Reflex Sympathetic Dystrophy (RSD)

I developed symptoms of Reflex Sympathetic Dystrophy after an auto accident in 2002, and wasn’t properly diagnosed until 2005. I am currently in remission. Any time my body perceives a trauma, I can come out of remission. Therefore, I am unable to do a lot of physical activity. I have to be careful and stay away from activities that can injure me.

As I search for a cure for Reflex Sympathetic Dystrophy, I have become my own best advocate. After seeing over 100 healthcare professionals, having major surgeries I didn’t need, complications such as internal bleeding, medication interactions, kidney stones, tumors, and so much more – I did not give up or give in! I was tested to my limits and realized they are past the boundaries I placed on myself. If I can do it, anyone can.

I learned to take a proactive approach to my medical care, an empowering step that helped in my health journey.

What is Reflex Sympathetic Dystrophy?

Reflex Sympathetic Dystrophy is a progressive Autoimmune Neurological condition that affects multiple systems in the body, and needs to be treated early so that disability does not take over.
I know how hard it is to continue looking for relief, perfect answers, and then coming up against healthcare professionals who blow you off or do not believe what you’re saying about your symptoms of Reflex Sympathetic Dystrophy.

What Barby Wishes She Knew When She Was Diagnosed With RSD

I wish I would have known that the healthcare system is not always what we are led to believe. People look up to their doctors and put total faith in them. I have learned though my own health experiences and through volunteering with the Power of Pain Foundation that I am responsible for me, just as you are for you.
It is important to remember that doctors study a particular practice of medicine. Just because they are a Neurologist doesn’t mean they can treat Diabetic Neuropathy, Multiple Sclerosis, Lyme, and Reflex Sympathetic Dystrophy. Each doctor gets a small variety of a medical field and then finds a part of a specialty that they love and work on with great ease, research and education.

Therefore, it is important to find a doctor that specializes in your specific condition. Become the Chief of Staff of your own medical team!

Tips for Living With Reflex Sympathetic Dystrophy

Prepare yourself for changes will keep your life with Reflex Sympathetic Dystrophy on a positive track. Use your community resources such as food banks, church supports, and non-profit support to get the help you need. Help is there; you just have to be willing to take it and put in as much as you can to keep your life on track.
Be prepared to face the pain that the symptoms of Reflex Sympathetic Dystrophy can bring, and have a plan. In order to remain as independent as possible and to minimize the disruption of daily life, consider changes to you daily routine and surroundings. If you have Reflex Sympathetic Dystrophy, you want to stay independent.
Unfortunately, pain still poses a problem for patients who are under-diagnosed, over-diagnosed or misdiagnosed with Reflex Sympathetic Dystrophy or other chronic illnesses. Controlling the pain you are in is essential to quality of life. Knowing the characteristics of pain and why it is happening will give you an advantage in coping with it.
Taking control of your life and being responsible for yourself will help you cope with the symptoms and treatments of Reflex Sympathetic Dystrophy.
If your RSD symptoms include fatigue or exhaustion, read Too Tired to Work? How to Survive Chronic Fatigue.

Tips for Family and Friends

Take care of yourself first! You cannot care for someone with Reflex Sympathetic Dystrophy if you’re not keeping yourself together. And, try not to feel guilty when you need a break to do something for yourself. No one can be there for someone else around the clock.
You might also consider joining a support group for people affected by Reflex Sympathetic Dystrophy.

Sympathetic Nervous System

Sympathetic Nervous System & All About It

 

The sympathetic nervous system belongs to autonomic nervous system along with parasympathetic nervous system. The sympathetic nerves starts from the spinal column running towards the middle part of spinal cord in the lateral horn. It originates at the spinal cord’s first thoracic segment and extends to third lumbar segment. This nervous system is considered to have thoracolumbar outflow since the cells of these nerves originates in the lumbar and thoracic regions. The primary function of this nervous system is mobilization of the body’s nervous system due to fight or flight response. 

This is done by mediating hormonal and neuronal stress response. This nervous system is continuously active to maintain stability, temperature, and pH of the body. Primarily, this nervous system counteracts parasympathetic nervous system. This system also helps in controlling the internal organs of the body such as eyes, heart, lungs, blood vessels, sweat glands, digestive system, kidney, and penis. Dilation of pupils, rate and force of contraction, dilation of bronchioles, constriction of blood vessels, activation of sweat secretion, inhibition of peristalsis, promotion of renin secretion, and promotion of ejaculation in men are all aided by this nervous system. Since the messages through this system travels in a bidirectional flow, both afferent and efferent messages help in various functions of the body such as acceleration of heart rate, widening of bronchial passages to give increased oxygen, decreased movement of large intestine, piloerection, and perspiration.

It also helps in feeling sensations like cold, heat, and pain. The stress response of this system is also known as sympathoadrenal response since the preganglionic fibers of this nervous system activates secretion of adrenaline and noradrenaline which are commonly called epinephrine and norepinephrine. Since these fibers end in the medullar part of the adrenal gland, it secretes acetylcholine which also helps in activation. Sometimes this nervous system is affected by various causes. Some of the causes are diseases such as parkinson’s disease and alzheimer’s disease due to the damage caused to the transmission system with degeneration of sympathetic nerves, autoimmune disorders, excessive alcohol consumption, traumatic brain injury, brain infection in addition to spinal cord infection such as meningitis and encephalitis, structural defects such as birth defects, problems of the immune system, benign or malignant tumors of the brain, and stroke due to the interruption in supply of blood to the brain. The common symptoms of SNS disorders are slurred speech, loss of muscle strength, hypertension, headache, loss of memory, seizures, tremors, cardiovascular diseases, erectile dysfunction, breathing problems, and trouble with swallowing. 

The major disorders of the sympathetic nervous system are sympathicotonia, fibromyalgia, complex regional pain syndrome or reflex sympathetic dystrophy syndrome, diabetic neuropathy, and Parkinson’s disease. Sympathicotonia is a condition where the nervous system is stimulated leading to hypertension, goose bumps, and vascular spasm. Fibromyalgia is a painful condition which is also caused due to hyperactivity of this nervous system. Reflex sympathetic dystrophy syndrome is caused by immune response of SNS which causes pain, swelling, and redness. Diabetic neuropathy is a condition where the blood vessels are damaged due to diabetic injury. Parkinson’s disease occurs due to widespread damage to this nervous system leading to trembling, akinesia, and postural instability. This major part of the autonomic nervous system helps the body in performing various functions.

sympathetic nervous system definition

The nervous systems in humans and indeed in all mammals have so many subdivisions. It is, therefore, important that individuals should get a clear sympathetic nervous system definition in order to make individuals understand the role that each division of the nervous system works. The CNS is the most commonly known by all and it controls the entire nervous system in the body. However, the autonomous nervous system is also very essential in the body. It is important also to keep in mind that one cannot offer a clear sympathetic nervous system definition if the person does not understand the mechanics of the autonomous nervous system.

The functions of sympathetic nervous system definition must include accelerating heart rate, constriction of blood vessels, increasing blood pressure and so many other involuntary functions in the body. It should be noted that these are merely the functions of sympathetic nervous system and they should not be mistaken, or even be considered to offer sympathetic nervous system definition. In fact, the closest that these functions can be used in the definition of the system is stating that sympathetic nervous system is the part of the nervous system that performs and controls involuntary actions.

The autonomous nervous system was considered a part of the nervous system that is functionally independent of the brain although this has been discredited since all impulses rely on the brain for execution and transmission. It is worth mentioning that sympathetic nervous system is only one part of the autonomic nervous system besides the parasympathetic nervous system. The two systems work by generation of electric impulses that are conducted to the muscles of the heart, which in turn trigger action. Sympathetic nervous system definition cannot be complete if the definition does not offer an insight into the mechanisms by which sympathetic nervous system works to control the involuntary nervous functions. One thing that cannot be left behind during the definition is that the system works in conjunction of other networks such as the sinoatrial nodde and atrioventricular nodes that together form what is referred to as the cardiac conduction system. Additionally, it would be unjust to fail in mentioning that the sinoatrial node is the natural pacemaker of the human heart which is quite essential to the organism. It is thus easy to deduce from the functions of the system that sympathetic nervous system definition relies on the functions and modes of actions of the nervous system.

The nervous system is what determines the reactions of the body to any changes in the environment. Sympathetic nervous system is more responsible for the reactions that come from unexpected changes in the body and the environment. These changes are usually the fight and flight responses and includes those involuntary activities mentioned above. Sympathetic nervous system definition must therefore reflect these activities if it has to be complete and true to the letter. Most people do not know the human anatomy and physiology and may not realize how important sympathetic nervous system is in life. However, this should not be misconstrued to indicate the superiority of the system in the entire nervous system.

The Parasympathetic Nervous System

The sympathetic and parasympathetic nervous system is a division of the human autonomic nervous system (ANS). Autonomic nervous system innervates the smooth muscle and glands and cardiac muscle and regulates the automatic reflexes and autonomic activities. The function of the ANS is to prepare the body for stress and recover the body from stress. This is where the sympathetic nervous system (SNS) and parasympathetic nervous system (PNS) stems from. SNS and PSNS are anatomically separate and different from one another. These 2 divisions antagonize one another by working against one another. The sympathetic nervous system acts as our fight or flight and parasympathetic nervous system function while on rest or digest action. The sympathetic nervous system connects the internal organs to the brain via the spinal nerve. When stimulated, these nerves provides essential control of many tissues by increasing heart rate, dilating the pupil, inhibiting digestion, nasal secretions and production of saliva. It inhibits liver, kidneys and gall bladder and dilates the bronchioles.

 

It also stimulates sweating. The parasympathetic nervous system is composed of 4 cranial nerves that originate from the brainstem. The PNS activity begins in the head to the sacral region this reason why this is called activity that is called cranio-sacral in nature while the SNS is thoraco-lumbar in nature. The most involved nerve in a PNS activity is the vagus nerve. It works by transmitting information between the posterior hypothalamus, the brainstem of the central nervous system and vital organs as well as the glands. Sympathetic nervous system does the fight and flight functions, while the parasympathetic nervous system performs the rest and digests response. PNS works by antagonizing the action of SNS by lowering heart rate, decreasing blood pressure, constricting pupils and increasing intestinal motility. It increases the release of endorphins a hormone that is called “feel good” so we can recover from the actions from sympathetic nervous system stimulation. 

While both of these 2 ANS divisions work in an opposite manner. Take note that both activities take place in the same organs. This is called dual innervations wherein they work by complementing each other through innervating the exact same organs. An example of this action is presented in cases of exposure to stress. When you are stressed, your heart rate increases, the pupils get dilated and so on. The SNS gets activated and as you recover from stress, the PNS will take control as it slows down the heart rate, contracts the pupil, and stimulates the liver, bladder and kidneys and so on. 

Knowing what happens in our sympathetic and parasympathetic nervous system during an activity gives us a clear idea how our reaction to things is being manifested and acted upon by our own physiologic functions. In a way, somehow, we would understand what is happening inside our body. The moment we reacted to situations and the moment we recover from that event are clearly explained in this occurrence. The body is so designed to respond to different stimulus as well as cope up so it can recover from any danger that could possibly happen should the situation become worse.

 

 

Sympathetic nervous system

The sympathetic nervous system (SNS) is part of the autonomic nervous system (ANS), which also includes the parasympathetic nervous system (PNS).

The sympathetic nervous system activates what is often termed the fight or flight response. Like other parts of the nervous system, the sympathetic nervous system operates through a series of interconnected neurons.
Sympathetic neurons are frequently considered part of the peripheral nervous system (PNS), although there are many that lie within the central nervous system (CNS).

Sympathetic neurons of the spinal cord (which is part of the CNS) communicate with peripheral sympathetic neurons via a series of sympathetic ganglia.

Within the ganglia, spinal cord sympathetic neurons join peripheral sympathetic neurons through chemical synapses.

Spinal cord sympathetic neurons are therefore called presynaptic (or preganglionic) neurons, while peripheral sympathetic neurons are called postsynaptic (or postganglionic) neurons. At synapses within the sympathetic ganglia, preganglionic sympathetic neurons release acetylcholine, a chemical messenger that binds and activates nicotinic acetylcholine receptors on postganglionic neurons.

In response to this stimulus, post ganglionic neurons principally release noradrenaline (norepinephrine).
Prolonged activation can elicit the release of adrenaline from the adrenal medulla. Once released, noradrenaline and adrenaline bind adrenergic receptors on peripheral tissues.

Binding to adrenergic receptors causes the effects seen during the fight-or-flight response.
These include pupil dilation, increased sweating, increased heart rate, and increased blood pressure. Sympathetic nerves originate inside the vertebral column, toward the middle of the spinal cord in the intermediolateral cell column (or lateral horn), beginning at the first thoracic segment of the spinal cord and are thought to extend to the second or third lumbar segments.

Because its cells begin in the thoracic and lumbar regions of the spinal cord, the CNS is said to have a thoracolumbar outflow.

Axons of these nerves leave the spinal cord in the ventral branches (rami) of the spinal nerves, and then separate out as 'white rami' (so called from the shiny white sheaths of myelin around each axon) which connect to two chain ganglia extending alongside the vertebral column on the left and right.
These elongated ganglia are also known as paravertebral ganglia or sympathetic trunks.
In these hubs, connections (synapses) are made which then distribute the nerves to major organs, glands, and other parts of the body.

 

Sympathy is one of the most powerful emotions anyone can give or feel.

Steps:

1. Try to put yourself in 'their' shoes. If you see someone having a hard time, like a lost relative or mother, ask yourself how you would like other people to treat you if you were in that situation.
   • Would you want people to be sympathetic or not?
2. Offer a shoulder or an ear. Everyone wants sympathy and comfort during a hard time, and if you can comfort or deliver advice to someone who needs it, they appreciate it more than you know.
3. Understand that being 'hard' doesn't help anyone. Being hard or having the attitude like you really don't care, can hurt the person deeper than they are hurting right now.
   • If you can, talk to the person. Offer words of comfort and treat them as good as you would want to be treated.
4. Consider a person's religion when offering comfort. Tell the person that God puts hard times in our life to strengthen us, not to hurt us, and whatever hard times there are they are for the good, even if they don't seem like it.
   
   

Tips:

• If you don't really do this often, do your best.
• A hug always makes someone day brighter!