Complex Regional Pain Syndrome Type 1 (Reflex Sympathetic Dystrophy) Follow-up

Updated: Mar 09, 2021
  • Author: T P Sudha Rao, MD; Chief Editor: Herbert S Diamond, MD  more...
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Knowing the triggers for complex regional pain syndrome (CRPS), especially extremity immobilization for any cause, and recognizing the disease process early and instituting prompt therapy are the most important aspects of prevention.

A retrospective cohort study in 542 patients who underwent subacromial shoulder surgery found that prophylactic use of vitamin C, 500 mg/day orally for 50 days postoperatively, reduced the risk of developing CRPS 1 by more than 50%. The incidence of CRPS 1 in patients who received vitamin C, versus those who did not, was 7% versus 13% (P = 0.009). [35]



Disease progression may lead to an unusable stiff extremity that is constantly painful. This leads some patients to commit suicide.



RSD is rare in children, but it carries a much better prognosis in children than in adults. [36, 37]   Prognosis is also better with early institution of treatment.

A study by Bean and colleagues suggests that psychological factors may influence recovery from CRPS. In a prospective study of 66 patients with type 1 CRPS, those patients with lower anxiety and pain-related fear at baseline had the lowest pain intensity over the 12-month study period. These researchers proposed that those psychological variables could be considered as targets for early treatment. [38]

Royal College of Physicians guidelines list the following psychosocial risk factors (so-called yellow flags), which may be present initially or may develop during the course of treatment, and which may guide referral for more comprehensive care [12] :

  • Iatrogenic factors (ie previous negative experiences with health professionals)
  • Poor coping strategies (eg ongoing ‘guarding’ of the limb despite education)
  • Involvement in litigation/securing benefits (note that this may affect progress with treatment in some patients, but there must be no assumption that this applies in every patient)
  • Overuse of appliances
  • Distress
  • Anxiety/depression
  • Unwillingness to set goals
  • Passivity in treatment sessions
  • Inaccurate beliefs despite education
  • Fear avoidance
  • Negative family influences

Patient Education

The clinician should ensure that the patient understands this confusing disease entity. Patient education information on RSD is available from the National Institutes of Heatlh at Complex Regional Pain Syndrome. In addition, encouragement and family support are important for maintaining the physical therapy program and treatment regimen.

For patient education information, also see Complex Regional Pain Syndrome and the Complex Regional Pain Syndrome Directory.