Knowledge Base

Reflex Sympathetic Dystrophy

What is Reflex Sympathetic Dystrophy?

Reflex sympathetic dystrophy, or complex regional pain syndrome, is a chronic pain condition. Doctors aren’t sure what causes it. In some cases the sympathetic nervous system plays an important role in sustaining the pain. Another theory is that reflex sympathetic dystrophyis caused by a triggering of the immune response, which leads to the characteristic inflammatory symptoms of redness, warmth, and swelling in the affected area.

What are the symptoms?

The key symptom of reflex sympathetic dystrophy is continuous, intense pain out of proportion to the severity of the injury, which gets worse rather than better over time. Reflex sympathetic dystrophy most often affects one of the arms, legs, hands, or feet. Often the pain spreads to include the entire arm or leg. Typical features include dramatic changes in the color and temperature of the skin over the affected limb or body part, accompanied by intense burning pain, skin sensitivity, sweating, and swelling. 

Is there any treatment?

Because there is no cure for reflex sympathetic dystrophy, treatment is aimed at relieving painful symptoms. Doctors may prescribe topical analgesics, antidepressants, corticosteroids, and opioids to relieve pain. However, no single drug or combination of drugs has produced consistent long-lasting improvement in symptoms. Other treatments may include physical therapy, sympathetic nerve block, spinal cord stimulation, and intrathecal drug pumps to deliver opioids and local anesthetic agents via the spinal cord.

What is the prognosis?

The prognosis for reflex sympathetic dystrophy varies from person to person. Spontaneous remission from symptoms occurs in certain individuals.  Others can have unremitting pain and crippling, irreversible changes in spite of treatment.

Related evidence

Gierthmühlen J, Binder A, Baron R. Mechanism-based treatment in complex regional pain syndromes. Nat Rev Neurol. 2014 Sep;10(9):518-28. doi: 10.1038/nrneurol.2014.140. Epub 2014 Aug 19.
Rockett M. Diagnosis, mechanisms and treatment of complex regional pain syndrome.Curr Opin Anaesthesiol. 2014 Oct;27(5):494-500. doi: 10.1097/ACO.0000000000000114.


Adapted with permission from the National Institute of Neurological Disorders and Stroke (NINDS), National Institutes of Health, Bethesda, MD 20892, USA.

Advice on the treatment or care of an individual patient should be obtained through consultation with a physician who has examined that patient or is familiar with that patient's medical history.

Last updated August 5, 2014