eMedicine Specialties > Neurology > Headache and Pain

Reflex Sympathetic Dystrophy: Follow-up

Author: Eugenia-Daniela Hord, MD, Instructor, Departments of Anesthesia and Neurology, Massachusetts General Hospital Pain Center, Harvard Medical School
Coauthor(s): Sajjad Mueed, MD, Consulting Staff, Department of Medicine, Division of Neurology, Carle Clinic Association
Contributor Information and Disclosures

Updated: Apr 18, 2006

Follow-up

Further Inpatient Care

  • In CRPS type 1/RSD, inpatient care typically is reserved for patients with refractory pain or infections of the atrophic limb, patients requiring surgery, and sometimes patients requiring procedures.

Further Outpatient Care

  • Patients with CRPS type 1/RSD should receive care in a pain clinic in which appropriate evaluation and treatment can minimize discomfort and degree of disability.

Transfer

  • Patients should be referred to a pain clinic as soon as CRPS type 1 is suspected on clinical grounds.

Deterrence/Prevention

  • Early treatment of pain appears to decrease the frequency of chronic disease and later complications.

Complications

  • Osteoporosis
  • Limitation of active movement in joints
  • Infections
  • Nodular fasciitis of the palmar or plantar skin

Prognosis

  • Approximately 80% of the patients with CRPS type 1/RSD have complete spontaneous relief of signs and symptoms within 18 months; however, no criteria have been established to predict from the very beginning who will have a spontaneous cure and who will not. Some of the patients whose symptoms do not resolve spontaneously still may be cured by treatment.
  • Of patients who develop refractory CRPS type 1/RSD, 50-80% have disability secondary to pain and/or limited range of motion. The main disabilities are limitations in activities of daily living (ADL).
  • Long duration of symptoms and signs, the presence of trophic changes, and the presence of primarily cold RSD are associated with higher chances of poor outcome and disability.

Patient Education

  • Patients should be informed that, even while wearing a cast, they will undergo mild passive range of motion exercises. After the cast is removed, physical therapy and occupational therapy should be started early, and some ADLs should be resumed as soon as possible following the recommendations of the physical therapist and occupational therapist.

Miscellaneous

Medicolegal Pitfalls

  • Underestimating symptoms that suggest CRPS type 1/RSD is risky, because they sometimes could be associated with emotional load or depression. Patients' complaints should always be taken seriously and appropriate referral performed.

Special Concerns

  • Diagnosis is based on the clinical picture, with additional information regarding the presence of SMP or autonomic dysfunction provided by carefully performed and interpreted supplemental tests.
  • The diagnosis of conversion disorder or malingering should be a diagnosis of exclusion made only after careful evaluation by a pain specialist.
  • Opinions that CRPS type 1/RSD occurs mainly in people with psychiatric problems, although never proven, have done patients a lot of harm because their complaints often are not taken seriously.
 


More on Reflex Sympathetic Dystrophy

Overview: Reflex Sympathetic Dystrophy
Differential Diagnoses & Workup: Reflex Sympathetic Dystrophy
Treatment & Medication: Reflex Sympathetic Dystrophy
Follow-up: Reflex Sympathetic Dystrophy
References
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References

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Further Reading

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Keywords

acute peripheral trophoneurosis, algodystrophy, causalgia, chronic traumatic edema, mimocausalgia, neurovascular posttraumatic painful syndrome, neurovascular reflex dystrophy, neurovascular reflex sympathetic dystrophy, posttraumatic chronic edema, posttraumatic osteoporosis, posttraumatic pain syndrome, posttraumatic sympathetic dystrophy, RSD, shoulder-hand syndrome, spreading neuralgia, Sudeck atrophy, sympathalgia, thermalgia, traumatic angiospasm, traumatic vasospasm, complex regional pain syndrome type 1

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Contributor Information and Disclosures

Author

Eugenia-Daniela Hord, MD, Instructor, Departments of Anesthesia and Neurology, Massachusetts General Hospital Pain Center, Harvard Medical School
Eugenia-Daniela Hord, MD is a member of the following medical societies: American Academy of Neurology and American Pain Society
Disclosure: Nothing to disclose.

Coauthor(s)

Sajjad Mueed, MD, Consulting Staff, Department of Medicine, Division of Neurology, Carle Clinic Association
Sajjad Mueed, MD is a member of the following medical societies: American Academy of Neurology, American Association of Neuromuscular and Electrodiagnostic Medicine, American Epilepsy Society, and American Society of Neuroimaging
Disclosure: Nothing to disclose.

Medical Editor

Jorge E Mendizabal, MD, Consulting Staff, Corpus Christi Neurology
Jorge E Mendizabal, MD is a member of the following medical societies: American Academy of Neurology, American Headache Society, National Stroke Association, and Stroke Council of the American Heart Association
Disclosure: Nothing to disclose.

Pharmacy Editor

Francisco Talavera, PharmD, PhD, Senior Pharmacy Editor, eMedicine
Disclosure: Nothing to disclose.

Managing Editor

Glenn Lopate, MD, Associate Professor, Department of Neurology, Division of Neuromuscular Diseases, Washington University School of Medicine; Chief of Neurology, St Louis ConnectCare, Consulting Staff, Barnes Jewish Hospital
Glenn Lopate, MD is a member of the following medical societies: American Academy of Neurology, American Association of Neuromuscular and Electrodiagnostic Medicine, and Phi Beta Kappa
Disclosure: Nothing to disclose.

CME Editor

Matthew J Baker, MD, Consulting Staff, Collier Neurologic Specialists, Naples Community Hospital
Matthew J Baker, MD is a member of the following medical societies: American Academy of Neurology
Disclosure: Nothing to disclose.

Chief Editor

Nicholas Y Lorenzo, MD, Chief Editor, eMedicine Neurology; Consulting Staff, Neurology Specialists and Consultants
Nicholas Y Lorenzo, MD is a member of the following medical societies: Alpha Omega Alpha and American Academy of Neurology
Disclosure: Nothing to disclose.

 
 
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