Reflex Sympathetic Dystrophy Medication

  • Author: Don R Revis Jr, MD; Chief Editor: Herbert S Diamond, MD   more...
 
Updated: Jan 19, 2012
 

Medication Summary

Several drugs, either alone or in combination with sympathetic blockade, may be efficacious in prolonging the duration of symptomatic relief. Some of these drugs reduce the activity of the sympathetic nervous system, whereas others are primarily anti-inflammatory.

Next

Sympatholytics

Class Summary

These medications reduce the activity of the sympathetic nervous system.

View full drug information

Clonidine (Catapres)

 

Stimulates alpha2-adrenoreceptors in brain stem, activating an inhibitory neuron, which in turn results in reduced sympathetic outflow. These effects result in a decrease in vasomotor tone and heart rate.

View full drug information

Guanethidine (Ismelin)

 

Prevents release of norepinephrine from adrenergic nerve endings in response to sympathetic stimulation. Decreases sympathetically mediated vasoconstriction.

View full drug information

Phenoxybenzamine (Dibenzyline)

 

Produces a long-lasting blockade of alpha-adrenergic receptors in smooth muscle and exocrine glands. Blocks epinephrine-induced and norepinephrine-induced vasoconstriction.

View full drug information

Prazosin (Minipress)

 

Dilates both arteries and veins by blocking postsynaptic alpha1-adrenergic receptors.

Previous
Next

Anti-inflammatory agents

Class Summary

Although little evidence exists for systemic inflammation in reflex sympathetic dystrophy (RSD), prominent local inflammation with pain, tenderness, swelling, redness, and loss of function is present.

View full drug information

Prednisone (Deltasone, Meticorten, Orasone)

 

May decrease inflammation by reversing increased capillary permeability and suppressing PMN activity.

Previous
Next

Endocrine agents

Class Summary

These agents may inhibit osteoclastic bone resorption.

View full drug information

Calcitonin (Miacalcin, Osteocalcin)

 

Lowers elevated serum calcium levels in patients with multiple myeloma, carcinoma, or primary hyperparathyroidism. Can expect a higher response when serum calcium levels are high. Onset of action is approximately 2 h following injection, and activity lasts for 6-8 h. May lower calcium levels for 5-8 d by about 9% if administered q12h. IM route is preferred at multiple injection sites with dose >2 mL. It can also be administered via intranasal spray.

Calcitonin is also an effective agent to treat metabolic bone disease such as osteoporosis. Through some unknown mechanism, it appears to have an analgesic effect on bone pain, such as occurs with osteoporotic vertebral collapse. The mechanism by which calcitonin relieves the symptoms of RSD is unknown.

Previous
Proceed to Follow-up
 
 
Contributor Information and Disclosures
Author

Don R Revis Jr, MD  Consulting Staff, Department of Surgery, Division of Plastic and Reconstructive Surgery, University of Florida College of Medicine

Don R Revis Jr, MD is a member of the following medical societies: American College of Surgeons, American Medical Association, American Society for Aesthetic Plastic Surgery, and American Society of Plastic Surgeons

Disclosure: Nothing to disclose.

Coauthor(s)

Elliot Goldberg, MD  Dean of the Western Pennsylvania Clinical Campus, Professor, Department of Medicine, Temple University School of Medicine

Elliot Goldberg, MD is a member of the following medical societies: Alpha Omega Alpha, American College of Physicians, and American College of Rheumatology

Disclosure: Nothing to disclose.

Specialty Editor Board

Robert E Wolf, MD, PhD  Professor Emeritus, Department of Medicine, Louisiana State University School of Medicine in Shreveport; Chief, Rheumatology Section, Medical Service, Overton Brooks Veterans Affairs Medical Center

Robert E Wolf, MD, PhD is a member of the following medical societies: American College of Rheumatology, Arthritis Foundation, and Society for Leukocyte Biology

Disclosure: Nothing to disclose.

Francisco Talavera, PharmD, PhD  Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Medscape Salary Employment

Lawrence H Brent, MD  Associate Professor of Medicine, Jefferson Medical College of Thomas Jefferson University; Chair, Program Director, Department of Medicine, Division of Rheumatology, Albert Einstein Medical Center

Lawrence H Brent, MD is a member of the following medical societies: American Association for the Advancement of Science, American Association of Immunologists, American College of Physicians, and American College of Rheumatology

Disclosure: Abbott Honoraria Speaking and teaching; Centocor Consulting fee Consulting; Genentech Grant/research funds Other; HGS/GSK Honoraria Speaking and teaching; Omnicare Consulting fee Consulting; Pfizer Honoraria Speaking and teaching; Roche Speaking and teaching; Savient Honoraria Speaking and teaching; UCB Honoraria Speaking and teaching

Alex J Mechaber, MD, FACP  Senior Associate Dean for Undergraduate Medical Education, Associate Professor of Medicine, University of Miami Miller School of Medicine

Alex J Mechaber, MD, FACP is a member of the following medical societies: Alpha Omega Alpha, American College of Physicians-American Society of Internal Medicine, and Society of General Internal Medicine

Disclosure: Nothing to disclose.

Chief Editor

Herbert S Diamond, MD  Adjunct Professor of Medicine, Division of Rheumatology, University of Pittsburgh School of Medicine; Chairman Emeritus, Department of Internal Medicine, Western Pennsylvania Hospital

Herbert S Diamond, MD is a member of the following medical societies: Alpha Omega Alpha, American College of Physicians, American College of Rheumatology, American Medical Association, and Phi Beta Kappa

Disclosure: Merck Ownership interest Other; Smith Kline Ownership interest Other; Zimmer Ownership interest Other

References

  1. Stanton-Hicks M, Janig W, Hassenbusch S, et al. Reflex sympathetic dystrophy: changing concepts and taxonomy. Pain. Oct 1995;63(1):127-33. [Medline].

  2. Kemler MA, van de Vusse AC, van den Berg-Loonen EM, et al. HLA-DQ1 associated with reflex sympathetic dystrophy. Neurology. Oct 12 1999;53(6):1350-1. [Medline].

  3. Sebastin SJ. Complex regional pain syndrome. Indian J Plast Surg. May 2011;44(2):298-307. [Medline]. [Full Text].

  4. Coderre TJ, Bennett GJ. A hypothesis for the cause of complex regional pain syndrome-type I (reflex sympathetic dystrophy): pain due to deep-tissue microvascular pathology. Pain Med. Aug 2010;11(8):1224-38. [Medline].

  5. Goebel A. Complex regional pain syndrome in adults. Rheumatology (Oxford). Oct 2011;50(10):1739-50. [Medline].

  6. Cimaz R, Matucci-Cerinic M, Zulian F, Falcini F. Reflex sympathetic dystrophy in children. J Child Neurol. Jun 1999;14(6):363-7. [Medline].

  7. Badri T, Ben Jennet S, Fenniche S, Benmously R, Mokhtar I, Hammami H. Reflex sympathetic dystrophy syndrome in a child. Acta Dermatovenerol Alp Panonica Adriat. Jun 2011;20(2):77-9. [Medline].

  8. van Hilten BJ, van de Beek WJ, Hoff JI, et al. Intrathecal baclofen for the treatment of dystonia in patients with reflex sympathetic dystrophy. N Engl J Med. Aug 31 2000;343(9):625-30. [Medline].

  9. Gobelet C, Waldburger M, Meier JL. The effect of adding calcitonin to physical treatment on reflex sympathetic dystrophy. Pain. Feb 1992;48(2):171-5. [Medline].

  10. Kemler MA, Barendse GA, Van Kleef M, et al. Electrical spinal cord stimulation in reflex sympathetic dystrophy: retrospective analysis of 23 patients. J Neurosurg. Jan 1999;90(1 Suppl):79-83. [Medline].

  11. Kemler MA, Barendse GA, van Kleef M, et al. Spinal cord stimulation in patients with chronic reflex sympathetic dystrophy. N Engl J Med. Aug 31 2000;343(9):618-24. [Medline].

  12. Driessens M, Dijs H, Verheyen G, Blockx P. What is reflex sympathetic dystrophy?. Acta Orthop Belg. Jun 1999;65(2):202-17. [Medline].

  13. Johnson JP, Obasi C, Hahn MS, Glatleider P. Endoscopic thoracic sympathectomy. J Neurosurg. Jul 1999;91(1 Suppl):90-7. [Medline].

  14. Lundborg C, Dahm P, Nitescu P, et al. Clinical experience using intrathecal (IT) bupivacaine infusion in three patients with complex regional pain syndrome type I (CRPS-I). Acta Anaesthesiol Scand. Jul 1999;43(6):667-78. [Medline].

  15. Oaklander AL, Fields HL. Is reflex sympathetic dystrophy/complex regional pain syndrome type I a small-fiber neuropathy?. Ann Neurol. Jun 2009;65(6):629-38. [Medline].

  16. Oerlemans HM, Perez RS, Oostendorp RA, Goris RJ. Objective and subjective assessments of temperature differences between the hands in reflex sympathetic dystrophy. Clin Rehabil. Oct 1999;13(5):430-8. [Medline].

  17. Pandita D, Danielson BD, Potti A, et al. Complex regional pain syndrome type-1: a rare complication of arteriovenous graft placement. J Rheumatol. Oct 1999;26(10):2254-6. [Medline].

  18. Poncelet C, Perdu M, Levy-Weil F, et al. Reflex sympathetic dystrophy in pregnancy: nine cases and a review of the literature. Eur J Obstet Gynecol Reprod Biol. Sep 1999;86(1):55-63. [Medline].

  19. Reuben SS, Steinberg RB, Madabhushi L, Rosenthal E. Intravenous regional clonidine in the management of sympathetically maintained pain. Anesthesiology. Aug 1998;89(2):527-30. [Medline].

  20. Schwartzman RJ. New treatments for reflex sympathetic dystrophy. N Engl J Med. Aug 31 2000;343(9):654-6. [Medline].

  21. Schwartzman RJ, Maleki J. Postinjury neuropathic pain syndromes. Med Clin North Am. May 1999;83(3):597-626. [Medline].

  22. Severens JL, Oerlemans HM, Weegels AJ, et al. Cost-effectiveness analysis of adjuvant physical or occupational therapy for patients with reflex sympathetic dystrophy. Arch Phys Med Rehabil. Sep 1999;80(9):1038-43. [Medline].

  23. Viel E, Ripart J, Pelissier J, Eledjam JJ. Management of reflex sympathetic dystrophy. Ann Med Interne (Paris). Apr 1999;150(3):205-10. [Medline].

  24. Wesselmann U, Srinivasa NR. Reflex sympathetic dystrophy and causalgia. Anesth Clin North Am. 1997;15:407-27.

 
Previous
Next
 
 
 
 
All material on this website is protected by copyright, Copyright © 1994-2012 by WebMD LLC.
This website also contains material copyrighted by 3rd parties.

DISCLAIMER: The content of this Website is not influenced by sponsors. The site is designed primarily for use by qualified physicians and other medical professionals. The information contained herein should NOT be used as a substitute for the advice of an appropriately qualified and licensed physician or other health care provider. The information provided here is for educational and informational purposes only. In no way should it be considered as offering medical advice. Please check with a physician if you suspect you are ill.