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The consensus statement of 2003 issued by the International Association for the Study of Pain recommends that psychological intervention be initiated for patients with reflex sympathetic dystrophy (RSD) experiencing pain for more than two months. Behavioral treatments may be used in the management of RSD to gain control over the pain by various methods which may enable the patient to reduce muscle spasms, pain, and improve sleep disturbances. Patients experiencing pain for longer than 6 months may require additional interventions.

The objectives of psychological treatment of the patient with RSD include:

• Helping the patient overcome learned disuse of the affected limb due to fear of pain or fear of injuring the limb
• Providing coping skills for living with pain
• Introducing ways to improve quality of life

Psychological counseling and group therapy is reported by many patients to have a positive role in therapeutic outcome for RSD as it helps them learn to manage their condition. An important aspect of treatment is learning to live with pain and establishing functional goals in order to maintain maximum independence. Counseling also helps patients cope with their self perception as handicapped and/or disabled and enables them to work on maximizing their functionality.

Psychological intervention has become more recognized recently as an integral part of management of RSD. The recommendations included below regarding psychological treatment for RSD are based on an article by S. Bruehl in Clinical Journal of Pain in 2006.

For more information about this publication, please click on the following link: http://www.ncbi.nlm.nih.gov/pubmed/16772797

Psychological management consists of three aspects:

• Education of the patient and family
• Psychological assessment
• Pain management skills

Education of Patient and Family

According to Bruehl, educating the patient and family about RSD should be initiated as soon as medical/rehabilitation therapy begins. They should be taught about:

• Negative effect of disuse and neglect of the affected extremity
• Importance of using the extremity in order to regain function
• Understanding the relationship between behaviors to protect the limb from pain and the resulting continuing severity of RSD
• Understanding that the patient must be an active participant in therapy which involves being ready to work through the increase of pain which may occur when each new level of therapy begins, as well as practicing learned skills and tasks that are assigned
• Helping the patient establish realistic expectations for therapy and rehabilitation, as well as their activities of daily living, social interactions, and probability of employment
• Addressing numerous misconceptions regarding their condition, such as: permanent loss of function; RSD is progressive and will soon affect their whole body; or if the limb hurts it should be "rested" and not used
• Helping patients understand that while in therapy they should be focusing on pain management and not cure; that the skills they are learning will help them be proactive and better manage the pain. While the RSD may pass or abate for some patients, there are many who continue to suffer symptoms and need encouragement to stay positive and in control of their situation.