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What Is Reflex Sympathetic Dystrophy?

Reflex sympathetic dystrophy (RSD) is a type of complex regional pain syndrome (CRPS). This condition occurs due to malfunctions in the sympathetic nervous system and immune system. RSD causes severe pain in one or more limbs that lasts for months or even longer. In general, the condition develops after an injury or other medical condition. RSD can lead to many physical and emotional symptoms. A variety of treatments are available for RSD, and it’s important to get treated on time in order to prevent worsening of your symptoms. Here is what you need to know.

What Causes RSD?

Doctors think the pain caused by RSD comes from problems in the sympathetic nervous system. Your sympathetic nervous system controls blood flow movements that help regulate heart rate and blood pressure. When you get hurt, your sympathetic nervous system tells blood vessels to get smaller so you don’t lose too much blood. Later on, it tells them to open back up so blood can get to damaged tissue and repair it. When you have RSD, your sympathetic nervous system gets mixed signals. It turns on after an injury, but doesn’t turn back off. This causes a lot of pain and swelling at your injury site. Sometimes, you can get RSD even if you haven’t had an injury, although it’s not as common. RSD is a little more typical in women than in men.


The onset of RSD symptoms may be rapid or sometimes gradual. The condition may not display all features. It is bilateral in up to half of people with RSD. There are several stages of RSD with symptoms that include:

  • Acute (three to six months): burning, flushing, blanching, sweating, swelling, pain, and tenderness.
  • Dystrophic (three to six months): early skin changes of shiny, thickened skin and contracture with persistent pain, but diminished swelling and flushing.
  • Atrophic (may be long-standing): loss of motion and function of the involved hand or foot with contracture and thinning of the fatty layers under the skin. X-ray can show significant osteoporosis.


The diagnosis of RSDS may be confirmed by a thorough clinical evaluation that includes a complete history of symptoms and a comprehensive physical examination. Other specialized tests (e.g., skin temperature readings, x-rays, bone scans) may also suggest the diagnosis. A positive response to sympathetic blockade confirms the diagnosis of reflex sympathetic dystrophy syndrome.


Early treatment is imperative to stop RSD from worsening or spreading further. However, early treatment can be difficult if it takes time to diagnose the condition.

Treatments for RSD greatly vary. Certain interventions and medications may help relieve or treat symptoms. You may also seek physical therapy and psychotherapy in order to reduce the effects of RSD. You may find that your condition improves dramatically with treatment, but some people have to learn how to manage their symptoms.

Medical procedures

Interventions for RSD include:

  • transcutaneous electrical nerve simulation
  • biofeedback
  • peripheral nerve blocks
  • pump implantation
  • sympathectomy, either chemical or surgical, which destroys some of your sympathetic nerves
  • deep brain stimulation
  • electroacupuncture


A variety of medications are available for RSD, ranging from over-the-counter pain relievers and topical creams to prescription drugs from your doctor. These medications include:

  • anticonvulsants
  • antidepressants
  • beta-blockers
  • benzodiazepines
  • guanethidine
  • muscle relaxers

If your pain doesn’t seem to be going away, even after treatment, your doctor may suggest a surgery that is called a sympathectomy. During this procedure, a surgeon removes certain nerves around your blood vessels in order to help improve your blood flow. In any case, make sure to spot the symptoms on time in order to get an early treatment.