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Reflex Sympathetic Dystrophy - Complications, Treatment, Prognosis, Prevention


Complications
If complex regional pain syndrome isn't diagnosed and treated early, the disease may progress to more disabling signs and symptoms. These may include:
Atrophy : If you avoid moving an arm or a leg because of pain or if you have trouble moving a limb because of stiffness, your skin, bones and muscles may begin to deteriorate and weaken.
Contracture: You also may experience tightening of your muscles. This may lead to a condition in which your hand and fingers or your foot and toes contract into a fixed position.

Treatment
There's no known cure for complex regional pain syndrome (CRPS), but a combination of physical treatments, medication and psychological support can help manage the symptoms.
Response to treatment of RSD is greater in the earlier stages of the condition than in the later stages.
Often, a combination of various therapies is necessary. Your doctor will tailor your treatment based on your specific case. Treatment options include:
Medications
Doctors use various medications to treat the symptoms of complex regional pain syndrome.
Pain relievers. Your doctor may prescribe stronger pain relievers if OTC ones aren't helpful. Opioid medications may be an option. Taken in appropriate doses, they may provide acceptable control of pain.
Antidepressants and anticonvulsants. Sometimes antidepressants, such as amitriptyline, and anticonvulsants, such as gabapentin (Gralise, Neurontin), are used to treat pain that originates from a damaged nerve (neuropathic pain).
Corticosteroids. Steroid medications, such as prednisone, may reduce inflammation and improve mobility in the affected limb.
Bone-loss medications. Your doctor may suggest medications to prevent or stall bone loss, such as alendronate (Fosamax) and calcitonin (Miacalcin).
Sympathetic nerve-blocking medication. Injection of an anesthetic to block pain fibers in your affected nerves may relieve pain in some people.
Intravenous ketamine. Studies show that low doses of intravenous ketamine, a strong anesthetic, may substantially alleviate pain. However, despite pain relief, there was no improvement in function.
Therapies
Applying heat and cold.
Applying cold may relieve swelling and sweating. If the affected area is cool, applying heat may offer relief.
Topical analgesics.
Various topical treatments are available that may reduce hypersensitivity, such as capsaicin cream (Capsin, Capsagel, Zostrix) or lidocaine patches (Lidoderm, others).
Physical therapy.
Gentle, guided exercising of the affected limbs may help decrease pain and improve range of motion and strength. The earlier the disease is diagnosed, the more effective exercises may be.
Transcutaneous electrical nerve stimulation (TENS).
Chronic pain is sometimes eased by applying electrical impulses to nerve endings.
Biofeedback.
In some cases, learning biofeedback techniques may help. In biofeedback, you learn to become more aware of your body so that you can relax your body and relieve pain.
Spinal cord stimulation.
Your doctor inserts tiny electrodes along your spinal cord. A small electrical current delivered to the spinal cord results in pain relief.

Prognosis
Response to treatment in patients with RSD is unpredictable. As previously mentioned, instituting treatment early in the course of the condition leads to better outcomes.
Prevented
There is some evidence that early immobilization of patients with stroke or heart attack can help decrease the chances of developing RSD. Also, there have been studies demonstrating a decrease in the risk of developing RSD in patients with bony fractures using daily Vitamin C supplementation.

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