Reflex Sympathetic Dystrophy, Complex Regional Pain Syndrome, are conditions still not fully understood and sometimes difficult to diagnose. Although the symptoms were detailed over 100 years ago, the mechanism of the condition still remain unclear.


Reflex Sympathetic Dystrophy, has over the years, been referred to by many different names, these include Sudeck's Astrophy, Algodystrophy and most recently, Complex Regional Pain Syndrome (CRPS) Complex Regional Pain Syndrome type 1 is when the the condition does not reveal any detectable nerve damage. CRPS type 2 is diagnosed as such, when there are clearly nerve lesions.


Reflex Sympathetic Dystrophy is a multi-symptom condition, some of the main attributes being, pain, abnormal regulation of the blood flow, sweating, oedema of the skin and active passive movement disorder, including physiological tremor. Sufferers may also experience several other abnormalities, these include, rapid and abnormal growth to the nails on the affected limb and abnormal hair growth to the limb.


To be diagnosed with RSD, a person does not have to exhibit all the symptoms mentioned, the only one common factor being pain.


Whilst the condition is difficult to diagnose, the medical profession are now becoming more aware of the symptoms and are discovering more advanced ways in diagnosing the condition. The use of MRI and Raioisotope scans can help in the diagnosis of the condition, but the use of such scans alone doesn't provide all of the answers.


Although the condition is not fully understood, it is generally thought that a group of nerve fibres called the 'sympathetic nerve system' is in some way involved in the development of the condition.


RSD FACTS


PROBLEMS ASSOCIATED WITH RSD/CRPS: Depression; Sleep disturbance; Suicidal Tendencies; Anxiety; Loss of Libido; Reduced Memory Retention; Mood Swings; Isolation; Despair; Reduced Quality of Life.


DEPRESSION AND RSD


It has been documented that depression and anxiety can often occur with persistent pain disorders. RSD/CRPS sufferers are no exception. Moreover, over recent years there has been an increase in pain clinics offering psychological help. This is due to the fact that; "Recognition that chronic pain is a complex neurophysiological, behavioural and psychological phenomenon has led to the development of innovative treatment programs. The programs share one common assumption: If chronic pain is complex, then a combination of treatment techniques are required to successfully treat patients." (Keefe 1982)


Depression can add to to the disability of RSD. Depression should be treated by way of therapy or/and drug prescription. If you feel depressed contact your G.P. as soon as possible. Help and information is also available from the charity 'Mind.' they can be contacted on 08457 660163 or at www.mind.org.uk





'SOCIAL PROBLEMS ASSOCIATED WITH RSD'


Depression associated with RSD cannot be attributable to only the pain; the changes it sometimes brings to the life of the sufferer are numerous and often devastating.

‘Social’

The social activities many sufferers previously enjoyed can be greatly reduced or even completely stopped. This could be for any one of several reasons; the not wanting to spoil other peoples enjoyment, maybe because they can no longer keep up with them; or not feel like contributing to the conversation. One of the main reasons given for ‘Dropping Out’ is to avoid answering the question “What’s wrong with you?” and trying to explain the condition, over and over again. Unfortunately because of these problems, people may become isolated and lose friends.

‘Family’

Being unable to become fully involved in family activities, maybe playing with ones children or grandchildren is restricted and the feeling of guilt because of this. Avoiding family functions is sometimes considered an easier option than trying to explain the facts about the condition and how they feel.

‘Economic’

The economic impact caused by the condition can be immense, reduced employment or being unable to work at all and having to rely on benefits, and the feeling of guilt this can bring about. The restrictions on what one or ones family are able to afford through the reduction in income, perhaps having to forsake holidays, new clothes etc. all these problems can affect ones self-esteem.

‘Personal’

The overwhelming fear of the affected limb being more painful through contact, as it frequently is, can present many problems, this may extend to the rejection of any type of physical contact including that of a partner. This fear can be especially depressing when it prohibits a person playing with, or even cuddling their children or grandchildren etc.

‘Self Belief’

One of the most often noted problem is a person’s own doubt as to what it is that they are actually suffering from. This is hardly surprising, when there are so many conflicting theories being expressed as to its cause, the prognosis and above all, the scepticism that some doctors have, to the actual existence of the condition. Unfortunately, there still exist people, qualified medical professionals, who for reasons best known to themselves, prefer to bury their head in the sand, to completely ignore the overwhelming medical evidence that has been discovered with regard to the condition. Bearing in mind all the problems the sufferer has to try to overcome, the affect on their social, financial, family and working lives, and the sometimes non-acceptance of the actuality of the illness by their doctor, “There is little wonder that depression becomes an integrated symptom of Reflex Sympathetic Dystrophy.”


DIAGNOSING DEPRESSION IN RSD/CRPS


(1)Feeling depressed; sad, empty or tearful. (2) Loss of interest in all or almost daily activities. (3) Weight gain or loss, appetite is less or greater than usual. (4) Sleep problems (5) Agitated or slowing down so that others notice. (6) Tired and lacking energy (7) Feeling worthless and excessively guilty (8) Trouble concentrating or thinking clearly (9) Suicidal thoughts.


‘SOME FACTS OR ASSUMPTIONS WITH REGARD TO RSD/CRPS.’

(1) Not all cases of RSD/CRPS progress, sometimes the condition stabilises and some patients improve or make a full recovery, with or without treatment (fact). The general consensus within the specialised field on the condition is, that the earlier the condition is diagnosed and the appropriate treatments administered, the greater is the chance of success, the general guideline being within the first 50 days of the onset of the symptoms (assumption).

(2) It is a reasonable assumption that how the condition has behaved over a period of years, marks out how the condition ‘might’ behave in the future.

(3) The vast majority of RSD patients have a normal lifespan (fact).

(4) Only a small percentage of RSD sufferers end up in a wheelchair permanently (fact).

(5) Although it is well chronicled that many patients suffer from depression brought about by the symptoms of the condition, there is no evidence that the suicide rate shows any higher proportion than any other section of society or groupings of specified illnesses (fact).

(6) There is no evidence that the condition is or can be hereditary, although there are neuropathies, which are hereditary and have a genetic basis, but these instances are very rare and there aren’t any reliable statistics available that indicate RSD can be hereditary (fact).

(7) A vitamin deficiency is an assumption held by some within the medical fraternity that contributes greatly to the development of the condition. Although many neuropathies can be attributed in some part to certain vitamin deficiencies, the lack of such vitamins with regard to the acceleration of RSD has yet to be determined either way, although lack of vitamin B12 (Thiamine) is known to damage the peripheral nerve system (fact).





140 YEARS OF PAIN


A great advancement in the recognition of 'Neuropathic Pain' came about when Silas Weir Mitchell a surgeon working with the Union forces in the American War Of Independence, became increasingly aware that some of the casualties suffering from gunshot wounds, developed "A painful and distressing condition." Mitchell recognized that the pain was not in keeping with the injuries sustained and that the pain varied varied, "From a trivial burning, to a state of torture that can hardly be credited."Mitchell noted that the pain was persistent and often changed with time."


In his writings of 1864, Mitchell stated, "That conventional pain relief techniques were ineffective." He also concluded that further surgery to the affected area did not help, and that treatments addressed to the nerves were ineffective.


Although Mitchells findings were not conclusive, they opened the door to the recognition of many 'Neuropathic' conditions, which affect the 'peripheral' and 'sympathetic' nerve systems.