Complex regional pain syndromes—reflex sympathetic dystrophy and causalgia

Reflex sympathetic dystrophy (RSD) was the term applied to a variety of unrelated disorders having strikingly similar clinical features.The problem with the term RSD is that not all cases meet the classical case scenario.The umbrella term Complex Regional Pain Syndromes (CRPS) now includes causalgia and RSD and excludes sympathetically mediated pain, neuropathic pain, inflammatory pain, and phantom pain. Complex Regional Pain Syndromes includes the features of inflammation, autonomic, cutaneous, motor and dystrophic changes which distinguish this from other forms of neuropathic pain. Because the pathophysiology of CRPS is predominantly a hyperactivity of the regional sympathetic nervous system, pain management in such patients should focus on interrupting the activity of the sympathetic nervous system.The interruption can be produced by different modalities classified as pharmacologic, nerve blocks, sympathectomy, physical therapy and psychological therapeutic measures. Physical therapy to regain function is an important endeavor for CRPS patients. In spite of acute and vigorous therapeutic modalities practiced on these patients, early and multidisciplinary treatment holds the best promise.