Arm and hand pain: Reflex Sympathetic Dystrophy


Arm pain, Chronic pain, Hand pain, Understanding pain / Friday, April 23rd, 2010

handhotReflex Sympathetic Dystrophy (RSD) is a neurological condition usually resulting from abnormal healing of an injury to the extremities. Pain becomes out of proportion to the severity of the initiating factor that can be anything from surgery to prolonged immobility. A subtype (Type I) of Complex Regional Pain Syndrome (CRPS), RSD is characterized by burning pain, redness, swelling and sweating in the affected area, it is thought to be caused by a mistake the nervous system makes in interpreting a painful soft tissue injury that gets caught in a self-sustaining sympathetic nervous system response loop. It must be diagnosed and treated early (within 3 months) for consistently successful results. The more time elapses, the more difficult it is to treat. The mistake the nervous system made needs to be corrected to stop the progress of the disorder toward a lifelong disabling chronic pain syndrome.

Treatment strategies include medical management and desensitization therapies at first to get the hypersensitive system and pain under control. Stress and anxiety about the injury and fear of movement needs to be managed because it can worsen the condition. Often the patient is too sensitive to be touched, so self-treatment using gentle pressure can be taught. With the redness and swelling, movement and stretching can help by pumping blood and fluids through the tissue to remove the heat and the pain-causing chemicals that are the byproducts of inflammation. Since movement can hurt, gradual increases in activity taken in baby steps may be necessary. Any kind of movement will help, even random movement.

Neuromuscular Therapy can bring relief when touch can be tolerated using sustained pressure, gentle stretching and lymph drainage techniques. Friction is not used as in the traditional strokes of massage therapy. Gentle sustained pressure for 10-20 seconds is used instead to relieve the muscle spasms and tension that usually accompany RSD and to press out pain-causing acids. Lymph drainage techniques don’t rub the skin, but rather move it gently and slowly over the underlying superficial fascia to create a pumping action in the lymphatic vessels. If touch is intolerable, lymph can be pumped by working far away from the affected area and even on the opposite limb to take advantage of the “contralateral lymphatic reflex.” (ref. Bruno Chickly, M.D.)

This is a series on arm and hand pain from my Neuromuscular Therapy center near Boston. If you missed the beginning, go back to the “Checklist of Causes.”

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