Jane (* not real name) was a patient I got to know really well during my residency training. For many years she would complain of intense sharp pains that first started at her left wrist, gradually made its way to shoulders and back. Over the counter pain pills didn't seem to help, and despite numerous X-rays and CT scans, nothing was found. It got so bad, it seemed even clothing would exacerbate her pain. She ended up having to wear a tube top wherever she went, which certainly caused a ruckus at home and at the workplace. She received lecherous advances from strangers who interpreted her less than discrete apparel as an easy come-on for sex. This once vibrant woman, once a receptionist for a telecommunications company, now was asked to transfer to a much less public position as a telemarketer. Only through numerous visits with her doctor, was the diagnosis of reflex sympathetic dystrophy (RSD) given. Jane is now learning to cope with her disease, with a combination of treatments, yet every day is a struggle.

Reflex sympathetic dystrophy is a controversial, often misunderstood disease among the medical establishment. Also known as Complex Regional Pain Syndrome (CRPS), its causes are unknown. Reflex sympathetic dystrophy affects the sympathetic nervous system, which controls various bodily functions, among which is our body's temperature regulation through blood vessel constriction. Although anyone may be affected, it is commonly seen in middle-aged women. It often is in relation to recent trauma, although 25-30 percent report never having had a previous injury. A similar percentage has also been seen following a stroke or heart attack.

Usual symptoms are severe burning pain usually affecting an arm, leg, hand, or shoulder. There is often a change in temperature and intense sweating of the limb. The extremity may also be swollen, and there is an intense overprotection and avoidance of the limb by the person affected with RSD.

There have been various therapies postulating how RSD works. Many think RSD is a result of misfiring or overactive sympathetic nerve fibers. An abnormal response to the normal pain cycle ensues, resulting in intractable pain. If this pain persists, it may result in permanent disability as different components of the body become affected. It seems to improve with nerve blocks.

There are three stages of RSD that are commonly categorized. Each stage can vary in time with different individuals, but they are approximately six months in duration and all involve chronic pain. The first stage, also known as the acute stage, the affected extremity has redness or swelling. The second stage may have a bit lessened intensity of pain, but changes in the skin, hair, and nail are seen. Stage three is severe function restriction, osteoporosis, and muscle atrophy. At this last stage, it is often thought to be irreversible.

Diagnosing treatment is often one of exclusion. Past history and physical examination are very important components in diagnosing RSD. Other testing may involve nerve studies, X-rays, bone and CAT scans. A trial of a sympathetic nerve block may also aid in elucidating the diagnosis.

Treatment has been multifocal. Although nerve blocks were commonly used, most successful therapies employ begin with vigorous physical therapy. To encourage more limb movement, have been found to decrease the progression of the disease. A key component of treatment is early recognition.

An anti-inflammatory medication such as ibuprofen has been employed. Narcotics have proven to be of short-term benefit and not as useful. A TENS (Transcutaneous Electrial Nerve Stimulator) is a battery-operated device that has been tried to help block nerve impulses. Last resort may include surgery, involving sympathetectomy.

Living with RSD is a constant struggle. Significant changes can affect family and the workplace. Avoidance of stressful situations is sometimes the most helpful course of action.