Treatment of Reflex Sympathetic Dystrophy

Treatment of Reflex Sympathetic Dystrophy in Children and Adolescents

Treatment options for children with reflex sympathetic dystrophy (RSD) have not undergone rigorous clinical trials. Children appear to respond to intensive physical therapy but there is also benefit to be derived from multidisciplinary treatment. Some children respond to transcutaneous electric nerve stimulation (TENS) and it is considered worthwhile as a treatment option due to its safety and its acceptance by children. As with adults, treatment decisions for children with RSD should have the objective of providing the opportunity for the child to participate in rehabilitation and tolerate aggressive physical therapy. There are no randomized trials studying efficacy of medication in children and many clinicians try to avoid their use due to adverse effects. Some clinicians use sympathetic nerve blocks to facilitate rehabilitation. It is important for the timing of the treatment to be coordinated with the physical therapist to take advantage of the available window of opportunity for aggressive treatment. Spinal cord stimulation may be effective for children and is preferable to sympathectomy since it is reversible and nondestructive. Sympathectomy may be reserved for children who are refractory to other treatment and may lose function because of coexisting symptoms.

It is generally thought that children do not necessarily have an easier course of RSD than adults and they may be more willing to tolerate more intensive physical therapy resulting in relief or recovery from symptoms. The rate of recurrence of RSD among children and adolescents is thought to be higher than for adults, however, they respond well with the initiation of treatment.

For more in-depth information about RSD in children and adolescents, please click on the following link: http://www.ncbi.nlm.nih.gov/pubmed/16772799