Treatment of Reflex Sympathetic Dystrophy

Additional Treatments for Reflex Sympathetic Dystrophy

Additional treatments for reflex sympathetic dystrophy (RSD) that may be used alone or combined with the treatments mentioned above include:

Topical Medications

There is very little focus on topical medications in RSD, however, there is anecdotal evidence that topical lidocaine may be effective for pain relief for some people with RSD. A variety of pain medications (e.g., lidocaine, fentanyl, and clonidine) are available as adhesive patches that release drug over an extended period of time for alleviation of pain. Due to potential side-effects of some of these drugs, the pain patches may not be appropriate for some patients.

Transcutaneous Electrical Nerve Stimulation (TENS)

Transcutaneous electrical nerve stimulation, also known as TENS, is a noninvasive treatment that sends an electrical current to nerves in a specific area to relieve pain, reduce stiffness, and improve mobility. A typical TENS unit consists of an electrical signal generator, a battery, and a set of electrodes. The electrode patches are placed on the skin at the area to be treated and a mild current is generated from the stimulator that runs through the electrodes to the area of pain. Portable TENS units are available for self-treatment with a small battery-operated stimulator that can be worn around the waist. The patient can turn the stimulator on or off as needed for pain control. It is important for a health care provider, such as a physical therapist, to carefully instruct the patient on the proper use and care of the TENS unit especially the correct placement of the electrodes. Complications of TENS units are rare with skin irritation at the site of electrode placement being the most common side-effect.

Contraindications to the use of a TENS unit include:

• Patients with an implanted pacemaker
• Women who are pregnant - risk of premature labor
• Patients with medical conditions that involve sensory impairment such as neuropathy or numbness, since placement of electrodes in those areas could cause burns

Acupuncture

Acupuncture may provide temporary pain relief in some RSD patients. Adverse effects may include:

• Bleeding
• Skin irritation
• Inflammation
• Poor wound healing
• Nerve irritation and/or injury
• Intensification of pain

Trigger Point Injections

Trigger points are tender muscles that cause pain in another area of the body when they are palpated or touched. A trigger point injection involves injection of a local anesthetic such as lidocaine or a corticosteroid medication into the "trigger point" to control and reduce pain.

Amputation

There is very little information in the medical literature about amputation as a treatment modality for RSD. Amputation is rarely performed as a treatment for RSD but may be considered under extreme circumstances, including:

• Patients with unremitting or uncontrolled pain who are refractory (do not respond) to medical and surgical therapy (sympathectomy)
• Patients who develop recurrent infection of the RSD-affected limb
• Improving residual function in patients with severe RSD who have significant functional impairment

A study published in 1995 in the British Journal of Bone and Joint Surgery reported on the outcomes of amputation in 28 patients with RSD. Of the 5 patients with untenable pain, amputation only relieved the pain in two of these patients. In contrast, amputation was found to be a relatively effective treatment for patients with recurrent infections or as a means of improving residual limb function. The authors of the study noted that recurrence of RSD in the stump following amputation occurred in most of these patients.

Repetitive Transcranial Magnetic Stimulation

Repetitive transcranial magnetic stimulation (rTMS) of the motor cortex is being studied as a way of reducing the intensity of pain association with RSD for some patients. The results of a small randomized clinical trial involving 10 patients with RSD reported promising results with respect to reduced pain intensity in 7 of 10 patients who were treated with this technique.

Hyperbaric Oxygen Therapy

Hyperbaric oxygen (HBO) therapy involves placing a patient into a special chamber called a hyperbaric chamber into which oxygen, under higher pressure than in the environment, is pumped. Hyperbaric oxygen therapy is currently used to treat a variety of different conditions including decompression sickness, carbon monoxide poisoning, and certain types of soft-tissue infections. The results of a small clinical trial published in 2004 involving 37 patients reported that HBO therapy was an effective and well-tolerated treatment modality for decreasing pain and swelling and increasing the range of motion for patients with RSD.