Reflex Sympathetic Dystrophy (RSD) aka Chronic Regional Pain Syndrome (CRPS)
Reflex Sympathetic Dystrophy (RSD) also known as Chronic Regional Pain Syndrome (CRPS) also known as Causalgia also known as Reflex Neurovascular Dystrophy (RND)
Social Security disability benefits (SSD or SSI) can be available for this sometimes chronic condition when it doesn’t go away within 12 months. The Social Security Administration (SSA) considers complex regional pain syndrome (CRPS) to be synonymous with reflex sympathetic dystrophy (RSD). If you are suffering with RSD/CRPS you need the benefit of an attorney who understands the nature and severity of your condition. Disability attorneys who have practiced Social Security law, workers compensation law or personal injury law for any length of time eventually come across a client who is suffering with RSD. It has been my experience that RSD frequently manifests itself following a catastrophic orthopedic injury or soon after surgical intervention. I have also dealt with cases resulting in RSD following electrocution, gunshot wounds, minor and major car accidents, diabetes and minor orthopedic injuries resulting in pain that spread from one area of the body to another.
During the Civil War doctors began documenting and studying the soldiers who’s pain did not end after their wounds had healed. At first, this was often referred to as “phantom pain.” In the years since then various names have been given to this condition including Causalgia, Sudecks Atrophy, Algodystrophy, Post Traumatic Pain Syndrome or Dystrophy, Shoulder Hand Syndrome, Pain – Dysfunction Syndrome, Reflex Neurovascular Dystrophy, Traumatic Vasospasm, and finally, as it is called now, Complex Regional Pain Syndrome (CRPS). CRPS type I was formerly known as RSD and CRPS type II was known as causalgia.
While not every person has all of the same symptoms, the major symptoms that most RSD’ers
1: Constant burning pain which is often described as having a hot poker being stuck into you. The pain is known to be out of proportion for the type of injury suffered. After the injury or trauma, the sympathetic nervous system seems to react abnormally and send incorrect messages throughout the body.
2: Inflammation while not always present, presents itself as pitting or non-pitting edema.
3: Skin changes which include, but are not limited to, temperature changes, skin or tissue atrophy, increased hair and nail growth or hair and nail loss, dryness, rashes, increased sweating, and an over sensitivity to touch.
4: Spasms in the muscles and or blood vessels, tremors and dystonia.
5: Diminished motor function and the eventual development of dystrophy and/or atrophy.
6: Bone changes
7: Emotional disturbances including insomnia, depression, concentration and short term memory difficulties.
STAGES OF RSD :
While not everyone agrees to the different stages, it is believed that RSD presents itself in three stages. Not all of the clinical features for the various stages of RSD are experienced by each patient nor does the rate of progression remain the same for each of us. Stage 1 and 2 symptoms begin to appear within a year. Some patients do not progress to Stage 3. Many of us will find that our Stage 1 and Stage 2 symptoms may fade as the disease progresses to Stage 3. Some of us also experience Stage 2 or 3 symptoms going back to the early stage with our response to individual treatments.
* Onset of severe, pain limited to the site of injury
* Increased sensitivity of skin to touch and light pressure (hyperasthesia).
* Localized edema (swelling)
* Muscle spasms
* Stiffness and limited mobility
* At onset, skin is usually warm, red and dry and then it may change to blue (cyanotic) in appearance and become cold and sweaty.
* Increased sweating (hyperhydrosis).
In mild cases this stage lasts a few weeks, then subsides spontaneously or responds rapidly to treatment.
Average duration of Stage 1 is 3 months ( but PLEASE keep in mind that duration of stages and symptoms experienced in each stage can be different for all of us).
Early and correct treatment during this stage will often result in remission.
* Pain becomes even more severe and more diffuse
* Edema (swelling) spread and may change from a soft to hard (brawny) type
* Hair may become coarse then scant, nails may grow faster then grow slower and become brittle, cracked and heavily grooved
* Spotty wasting of bone (osteoporosis) occurs early but may become severe and diffuse
* Muscle wasting begins
* Increased thickness of the joint
Stage 2 may last from 3 to 6 months in many patients
* Marked wasting of tissue (atrophic) eventually become irreversible
* For many patients the pain becomes intractable and may involve the entire limb.
* Atrophy of the muscles
* Extremity may become weak, have limited motion and may become ankylosed.
* Contraction of flexor tendons may occur and subluxations can be produced.
* Bone deossification may have become marked and diffused.
* A small percentage of patients have developed generalized RSD affecting the entire body.
The diagnosis of RSD tends to be frustrating for many patients. RSD is often misdiagnosed or not diagnosed quickly enough since it remains a poorly understood disease. Many medical professionals are not familiar with RSD and the delays in diagnoses and treatment often close us out of our chance for remission. RSD is diagnosed primarily through observation of the symptoms, especially those of constant burning pain that is considered disproportionate to the injury, inflammation, spasms and movement disorder, changes in tissue ( dystrophy and atrophy), and insomnia. The diagnosis is often obtained after ruling out other possible causes for the pain and symptoms. While some changes will sometimes show on tests such as thermograms, bone scans or X-rays, these will often NOT show any signs of RSD and should not be used to rule out RSD in most cases.
How Is Complex Regional Pain Syndrome Treated?
Because there is no cure for CRPS, the goal of treatment is to relieve painful symptoms associated with the disorder. Therapies used include psychotherapy, physical therapy, and drug treatment, such as topical analgesics, narcotics, corticosteroids, osteoporosismedication, antidepressants, osteoporosis medicines, and antiseizure drugs.
Other treatments include:
• Sympathetic nerve blocks: These blocks, which are done in a variety of ways, can provide significant pain relief for some people. One kind of block involves placing an anesthetic next to the spine to directly block the sympathetic nerves.
• Surgical sympathectomy: This controversial technique destroys the nerves involved in CRPS. Some experts believe it has a favorable outcome, while others feel it makes CRPS worse. The technique should be considered only for people whose pain is dramatically but temporarily relieved by selective sympathetic blocks.
• Intrathecal drug pumps: Pumps and implanted catheters are used to send pain-relieving medication into the spinal fluid.
• Spinal cord stimulation: This technique, in which electrodes are placed next to the spinal cord, offers relief for many people with the condition
It has been my experience that clients often benefit from seeking treatment from pain management clinics that take a multi-disciplinary approach to treatment, including but not limited to treatment by a team of mental health professionals, anesthesiologists, physiatrists and neurologists.
Regardless of whether you have a Social Security disability claim, a personal injury claim or a workers compensation claim, I strongly urge you to consult with a seasoned attorney familiar with the long-term consequences of a devastating diagnosis of RSD/CRPS.