Reflex sympathetic dystrophy

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Abstract
Reflex sympathetic dystrophy (RSD) is a condition characterized by localized or diffuse pain, usually with associated swelling, trophic changes and vasomotor disturbance [1]. Allodynia, hyperhydrosis, and nail or hair growth changes may also occur. Motor abnormalities have been reported [2], in particular, tremor, involuntary movement and muscle spasm. Contractures may occur in the later stages. Involvement may be either unilateral or bilateral. Most commonly recognized is peripheral disease [3], although RSD may affect any region of the trunk or limbs. There is often a history of trauma, occasionally of such low significance that it may be overlooked by the patient. Symptoms may occur up to 6 months after injury [4]. Other triggering factors have been reported. Several drugs have been implicated, for example, phenobarbitone, phenytoin, isoniazid [5], and the immunosuppressive agents cyclosporin [6] and tacrolimus [7], as has surgery or a neurological event, particularly with peripheral manifestations. Rapamycin is currently under investigation as an immunosuppressive agent administered after solid organ transplantation. A recent report associated this drug with bone pain, osteolysis on plain radiographs and high uptake of tracer on isotope bone scanning. Resolution of symptoms occurred on withdrawal or reduction of rapamycin, or following administration of the bisphosphonate pamidronate [8]. Concurrent medical conditions may predispose to RSD, and diabetes mellitus, hyperthyroidism, hyperparathyroidism and type IV hyperlipidaemia have all been associated. RSD may occur at any age, and is well recognized in children, where vasomotor changes may be particularly marked [9–11]. Chronic pain in a poorly understood condition may cause depression and isolation, and although a higher rate of psychological abnormalities has been reported, this appears to be little different from other patient groups who suffer chronic pain [12, 13].

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