Is reflex sympathetic dystrophy a valid concept?

1997 ◽  
Vol 20 (3) ◽  
pp. 447-448 ◽  
Author(s):  
Mikael Elam
Keyword(s):  
Reflex Sympathetic Dystrophy ◽  
Reflex Change ◽  
Sympathetic Discharge

Patients with reflex sympathetic dystrophy (RSD) affecting one limb show similar sympathetic traffic in nerves supplying the affected and unaffected limb, despite unilateral autonomic effector dysfunction. This argues against the notion that RSD is mediated by a reflex change in the pattern of sympathetic discharge and underlines the fact that autonomic effector disturbances give little information about underlying nerve traffic. [blumberg et al.]

A Historical Review of Complex Regional Pain Syndrome in the “Guides Library”

2009 ◽  
Vol 14 (6) ◽  
pp. 1-9
Author(s):  
Robert J. Barth
Keyword(s):  
Differential Diagnosis ◽  
Complex Regional Pain Syndrome ◽  
Reflex Sympathetic Dystrophy ◽  
International Association ◽  
Historical Review ◽  
Pain Syndrome ◽  
Sixth Edition

Abstract Complex regional pain syndrome (CRPS) is a controversial, ambiguous, unreliable, and unvalidated concept that, for these very reasons, has been justifiably ignored in the “AMA Guides Library” that includes the AMAGuides to the Evaluation of Permanent Impairment (AMA Guides), the AMA Guides Newsletter, and other publications in this suite. But because of the surge of CRPS-related medicolegal claims and the mission of the AMA Guides to assist those who adjudicate such claims, a discussion of CRPS is warranted, especially because of what some believe to be confusing recommendations regarding causation. In 1994, the International Association for the Study of Pain (IASP) introduced a newly invented concept, CRPS, to replace the concepts of reflex sympathetic dystrophy (replaced by CRPS I) and causalgia (replaced by CRPS II). An article in the November/December 1997 issue of The Guides Newsletter introduced CRPS and presciently recommended that evaluators avoid the IASP protocol in favor of extensive differential diagnosis based on objective findings. A series of articles in The Guides Newsletter in 2006 extensively discussed the shortcomings of CRPS. The AMA Guides, Sixth Edition, notes that the inherent lack of injury-relatedness for the nonvalidated concept of CRPS creates a dilemma for impairment evaluators. Focusing on impairment evaluation and not on injury-relatedness would greatly simplify use of the AMA Guides.

Reflex Sympathetic Dystrophy: A Comprehensive Review

2002 ◽  
Vol 14 (3-4) ◽  
pp. 16 ◽  
Author(s):  
Alex Moroz ◽  
Alex Leali ◽  
Mathew Lee ◽  
Angela Liu
Keyword(s):  
Reflex Sympathetic Dystrophy ◽  
Comprehensive Review

IMAGING IN REFLEX SYMPATHETIC DYSTROPHY

Hand Clinics ◽  
1997 ◽  
Vol 13 (3) ◽  
pp. 431-442
Author(s):  
Serge Sintzoff ◽  
Serge Sintzoff ◽  
Bernard Stallenberg ◽  
Celso Matos
Keyword(s):  
Reflex Sympathetic Dystrophy

Supraspinal inhibition of a cutaneous vascular reflex in the cat

1964 ◽  
Vol 207 (2) ◽  
pp. 303-307 ◽  
Author(s):  
B. J. Prout ◽  
J. H. Coote ◽  
C. B. B. Downman
Keyword(s):  
Carotid Sinus ◽  
Spinal Reflexes ◽  
Descending Pathways ◽  
Skin Response ◽  
Reflex Arc ◽  
Vascular Reflex ◽  
Carotid Sinus Nerve Stimulation ◽  
Sympathetic Discharge ◽  
Stimulation Of ◽  
Cerebellar Stimulation

In cats anesthetized with chloralose-urethane mixture, stimulation of an afferent nerve evoked a vasoconstrictor reflex (VCR) and a galvanic skin response (GSR) in the pads of the feet. Stimulation of the ventromedial medullary reticular substance at the level of the obex abolished the VCR and the GSR. VCR could also be reduced by occlusion during prolonged stimulation of another spinal or visceral afferent pathway. Medulla stimulation was effective without itself causing a sympathetic discharge to the paw, showing that inhibition rather than occlusion was operative. Anterior cerebellar stimulation also inhibited the VCR. Carotid sinus nerve stimulation did not abolish the VCR. It is concluded that the effective mechanism includes a bulbospinal inhibitory path projecting on a spinal vasoconstrictor reflex arc. This arrangement is similar to the descending pathways inhibiting other spinal reflexes but the VCR-inhibitory path can be activated independently of them.

scholarly journals Complex Regional Pain Syndromes: Including “Reflex Sympathetic Dystrophy” and “Causalgia”

1997 ◽  
Vol 25 (2) ◽  
pp. 113-125 ◽  
Author(s):  
S. M. Walker ◽  
M. J. Cousins
Keyword(s):  
Autonomic Dysfunction ◽  
Reflex Sympathetic Dystrophy ◽  
International Association ◽  
Scientific Data ◽  
Pain Clinic ◽  
Variable Component ◽  
Sympathetically Maintained Pain ◽  
Pain Syndromes ◽  
Regional Pain Syndromes ◽  
Complex Regional Pain Syndromes

“Reflex sympathetic dystrophy” and “causalgia” are now classified by the International Association for the Study of Pain as Complex Regional Pain Syndromes I and II. Sympathetically maintained pain is a frequent but variable component of these syndromes, as the sympathetic and somatosensory pathways are no longer functionally distinct. Pain is the cardinal feature of CRPS, but the constellation of symptoms and signs may also include sensory changes, autonomic dysfunction, trophic changes, motor impairment and psychological changes. Diagnosis is based on the clinical picture, with additional information regarding the presence of sympathetically maintained pain or autonomic dysfunction being provided by carefully performed and interpreted supplemental tests. Clinical experience supports early intervention with sympatholytic procedures (pharmacological or nerve block techniques), but further scientific data is required to confirm the appropriate timing and relative efficacy of different procedures. Patients with recurrent or refractory symptoms are best managed in a multi-disciplinary pain clinic as more invasive and intensive treatment will be required to minimize ongoing pain and disability.

Treatment of reflex sympathetic dystrophy (R.S.D.) of the upper limb by means of spinal cord stimulation (S.C.S.)

Pain ◽  
1990 ◽  
Vol 41 ◽  
pp. S78 ◽  
Author(s):  
J. Pallaces ◽  
M.J. Pallares ◽  
P. Fenollosa ◽  
V. Chover ◽  
T. Santonja ◽  
...  
Keyword(s):  
Spinal Cord ◽  
Upper Limb ◽  
Spinal Cord Stimulation ◽  
Reflex Sympathetic Dystrophy

Rethinking reflex sympathetic dystrophy

Pain Forum ◽  
1996 ◽  
Vol 5 (4) ◽  
pp. 257-261
Author(s):  
Sandra R. Chaplan
Keyword(s):  
Reflex Sympathetic Dystrophy

Effects of spinal cord transection on sympathetic discharge in decerebrate-unanesthetized cats

1989 ◽  
Vol 257 (6) ◽  
pp. R1506-R1511 ◽  
Author(s):  
L. C. Weaver ◽  
R. D. Stein
Keyword(s):  
Blood Pressure ◽  
Spinal Cord ◽  
Heart Rate ◽  
Spectral Analysis ◽  
Spinal Cord Transection ◽  
Renal Nerves ◽  
Frequency Range ◽  
Renal Nerve ◽  
Sympathetic Discharge ◽  
Nerve Discharge

Previous experiments in our laboratory have shown that discharge of splenic, mesenteric, and splanchnic nerves is well maintained after spinal cord transection in chloralose-anesthetized cats (8, 9, 11). The primary purpose of this investigation was to determine if maintained sympathetic discharge could be observed after spinal transection in the absence of chloralose anesthesia. In cats anesthetized with alphaxalone-alphadolone, changes in splanchnic discharge, blood pressure, and heart rate caused by decerebration and removal of the forebrain were observed. This procedure decreased blood pressure, increased heart rate, and had no immediate effect on sympathetic discharge or its rhythm (assessed by power density spectral analysis). One hour after decerebration and termination of anesthesia, splanchnic discharge had increased by approximately 36%. Next, effects of spinal cord transection on discharge of splanchnic, mesenteric, and renal nerves were observed in the decerebrate-unanesthetized cats. Splanchnic discharge decreased by 50%, mesenteric nerve discharge was unchanged, and renal nerve discharge decreased by 97%. Therefore, splanchnic nerve discharge was not as well maintained in decerebrate-unanesthetized cats as it had been in chloralose-anesthetized animals, and the remaining splanchnic discharge appeared to affect mesenteric nerves preferentially. Finally, spectral analysis of the splanchnic discharge demonstrated that before cord transection, most of the signal was in the 0- to 6-Hz frequency range, whereas after transection the proportion of signal in this frequency range was significantly reduced and the proportion in higher frequencies (7-25 Hz) was significantly increased. This loss of low-frequency rhythmicity is consistent with findings in our previous studies in chloralose-anesthetized cats.

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