RSD is an abbreviation for the medical term Reflex Sympathetic Dystrophy, which is a medical condition whereby the patient feels extreme pain in one or more limbs usually lasting for several months. People with this medical condition also experience vasomotor, sudomotor, and motor changes along with the severe pain that’s often described as being disproportionate to the inciting injury. RSD is actually one form of the medical condition overall referred to as Complex Regional Pain Syndrome (CRPS). The more modern term used for RSD is CRPS Type 1, with its counterpart being referred to as CRPS Type 2 or Causalgia. The difference between the two types is in the cause of each.
The exact cause of RSD is yet to be determined but so far, some common injuries and medical conditions have been identified in relation with the onset of RSD. These include sprains, fractures, minor medical surgeries, strokes and many more. On the other hand, CRPS Type 2 is believed to be a result of significant nerve damage. In spite of this one major difference, RSD and CRPS Type 2 are identical in every other way, including symptoms and treatment. Due to the challenges in understanding the pathophysiology of RSD, the medical condition has also proven difficult to treat. There is no known cure for RSD. Regardless, several RSD treatment options have been developed over the years.
RSD Treatment Protocol
The best method available to treat RSD involves a combination of RSD treatment options. The RSD treatment protocol requires the combination of different types of treatment for the best chance of recovery. This suite of RSD treatments includes a variety of medications, physical therapy, psychotherapy, and occupational therapy. Together, these are meant to help the patient manage the chronic pain they have to deal with on a daily basis, improve the functionality of their affected limbs, control the negative emotions resulting from their medical conditions, and find ways to get back to their normal routine and activities.
RSD Treatment Options
Although the treatment options have shown to be effective in RSD treatment, the results often differ for each patient. This is why RSD treatment needs to be individualised, which means that the RSD treatment options should be tailored to each patient. To achieve this, the patient should constantly be monitored and their response to the treatments applied should be evaluated as often as possible to determine if the treatments are effective or need to be changed.
In some cases, the dosage of medications may need to be adjusted or the types of medications may need to be changed completely. With regards to physical therapy, the physical therapist will often need to adjust the amount and intensity of physical activities that the patient goes through to improve limb functionality. A physiotherapist may suggest more counselling to help the patient’s mental state or even recommend medications such as anti-depressants if necessary. Each RSD treatment option is explained further below.
RSD treatment medications
The primary objective of RSD treatment medications is pain management. RSD pain is the first and most prominent symptom that the patient experiences. Unfortunately, unlike some RSD symptoms such as swelling, the pain doesn’t subside over the course of time. In fact, it may even get worse with time especially if the condition goes untreated. In a majority of the patients, the pain is an everyday experience which makes it hard for them to do anything they would normally be able to; and in the event of flare ups which are periods of intense pain, the patient’s condition worsens. As a result, medications are a necessary part of treatment to help the patient through the excruciating pain and also to lessen the impact of the pain on their daily activities. Some of the common RSD treatment medications are given below, along with some necessary information about each.
Neridronate, also known as Neridronic Acid is a nitrogen-containing bisphosphonate most often recognised for its use in the treatment of bone disease. The efficacy of Neridronate in the treatment of RSD was actually discovered when a patient who was being treated for a different medical condition realised their RSD symptoms were improving as well. Neridronate is believed to offer long-term pain relief and functional recovery. After some trials and formal studies conducted by Doctor Silvano Adami which included features such as randomized and double-blind, the use of Neridronate in the treatment of RSD was approved by Italian and European health authorities. So far, it has proven to be most effective in the treatment of RSD/CRPS Type 1 and not in the other form of the medical condition.
- How does it work?
Four intravenous infusions are administered over the course of ten days. Calcium has a high affinity for bisphosphonates such as Neridronate, so the drug is easily taken up by the bones. When the Neridronate bonds to the bones, it stops the breaking down of bones which is a common occurrence of RSD as it progresses. The patient will feel significant improvement once the bone loss is halted by the administering of Neridronate.
It has been suggested that Neridronate works better if the treatment begins in the early stages of RSD. However, there has been some disagreement over this, with some doctors arguing that as long as the patient is still showing RSD symptoms, their condition will still be active and can be treated using Neridronate. According to studies and trials carried out by Doctor Adami et al, 82 RSD patients treated with Neridronate all completely recovered from the RSD disorder within three months. After a year, those same patients all showed no signs or symptoms referring to RSD which suggested that the RSD was in remission. As such, Neridronate has come to be considered as the closest thing to a cure for RSD.
To date, Neridronate is only licensed for RSD treatment in Italy which makes the accessibility of the drug a little more complex. Any RSD patient who desires to try the Neridronate treatment would need to go to Italy.
Due to the limited availability of Neridronate, the treatment is quite costly especially for patients outside Italy. In addition to the costs of the treatment itself, the patient will need to pay for the cost of travel and accommodation in Italy for the duration of the treatment. The total can come up to thousands of euros.
- Side effects
Neridronate can be administered orally as well, but this may lead to side effects such as jaw necrosis and irritation in the stomach and oesophagus. Other side effects of Neridronate treatment include light flu-like symptoms, dizziness, and lower calcium or Vitamin D levels in the blood. These can be taken care of with additional treatments such as Heliotherapy.
Ketamine is a strong anaesthetic which is often reserved as one of the last resorts in RSD treatment. If other medications and treatment options aren’t successful in relieving RSD pain, then Ketamine may be the next best bet. Patients have to be screened before Ketamine treatments are prescribed as some conditions such as schizophrenia and heart rhythm issues may worsen with the use of Ketamine.
- How it works
It is believed that RSD is associated with changes in the central nervous system which cause the body to transmit normally non-painful stimuli as something excruciatingly painful. This excruciating pain is possibly a result of activation of one of the nerve cell receptors known as the N-methyl-D-aspartate (NMDA) receptor. When Ketamine is administered intravenously, it blocks this receptor to keep it from transmitting stimuli as intense pain, hence providing pain relief to the patient.
Not every patient with RSD can be treated with Ketamine as mentioned above, but many can get real relief from their symptoms. The level and duration of relief varies for each patient. Some may feel better for one month, while others may have relief that lasts almost an entire year. The infusion may be repeated three to six months after the first treatment if the patient felt significant pain reduction. In the case of multiple infusions, there is a risk that Ketamine may temporarily increase liver enzymes so close monitoring of the liver function will be necessary.
An RSD patient can get Ketamine infusions from RSD treatment centers such as the Ketamine Health Center available in Miami, West Palm Beach, Orlando, and Weston; and the Cleveland Clinic in Ohio.
The costs for Ketamine infusions will vary according to the treatment center where the infusions are administered. For example, the Ketamine Health Center offers short-term and long-term infusion packages that can fit any budget but in general, the cost can range from a thousand to over three thousand dollars.
- Side effects
Some common side effects of Ketamine infusions include hallucinations, nausea, and nightmares. If a patient suffers from these side effects to an extreme level, the infusions may need to be stopped immediately.
This type of medication helps with pain relief and reducing fever through the effect of analgesia—a temporary relief from pain. There are many different types of analgesics, including over-the-counter (OTC) drugs and prescription drugs; and each type works in a different way to bring pain relief to the patient. First line analgesics and co-analgesics often used for RSD treatment include opioids, tri-cylic antidepressants, gabapentine, and carbamazepine.
- How it works
Analgesics act on the peripheral and central nervous systems which are responsible for the transmission of pain signals. Analgesics such as opioids reduce the pain signals sent by the nervous systems along with the brain’s reaction to those pain signals. Tylenol changes the way the body senses pain, and NSAIDs block the effects of prostaglandins hence reducing pain and swelling.
Analgesics often offer short term pain relief so they need to be taken continuously. The degree of pain relief from analgesics varies according to the type of analgesic used for RSD treatment. Some patients may find significant pain relief that lasts longer with some analgesics while other patients feel no relief at all from those same medications.
Since analgesics are commonly used drugs, they are more easily available. OTC analgesics can be purchased from most local pharmacies, along with prescription medications.
The cost varies for each type of analgesic but they are usually quite easily affordable.
- Side effects
The risks of side effects depends on the type of analgesics used. The most common side effects of using analgesics for RSD treatment are constipation, sedation, and on rare occasions, respiratory depression.
RSD patients often experience increased sensitivity to pain known as hyperalgesia. To combat this symptom, anaesthetics may be prescribed. Anaesthetics are a group of drugs that provide temporary loss of sensation or awareness hence decreasing the patient’s sensitivity to pain. Overall, the patient should feel temporary relief from pain when they take this type of medication.
- How it works
Anaesthetics provide a body-numbing effect so that you don’t feel pain from any stimulus. The drug blocks the nerves that connect the affected limb to the brain so that the nerves won’t carry pain signals to the brain, meaning the body won’t feel the pain.
As per their nature, anaesthetics offer temporary pain relief so the patient may need to take them continuously as long as they feel the RSD pain. As with analgesics, the effectiveness of anaesthetics differs according to the type used, as well as each individual patient.
Most anaesthetics are available locally.
Anaesthetic drugs are usually affordable for most patients.
- Side effects
Nausea is a common side effect of anaesthetics used for RSD treatment.
Other types of medications that may be used for RSD treatment include anti-inflammatory drugs to reduce swelling, anticonvulsants, calcitonin, corticosteroids, calcium channel blockers, and topical patches.
RSD treatment physical therapy
Physical therapy is a key part of RSD treatment as it helps to restore functionality of the affected limb in the patient. A physical therapist with RSD patient experience is recommended for this type of treatment to be successful. This professional will be able to create a program for the patient which will include exercises and certain treatments such as Graded Motor Imagery to help the patient retrain their mind along with their limbs in order to improve pain management. The physical exercises are often gentle in nature in the beginning so as not to worsen the patient’s pain. With time, the intensity may increase and be combined with desensitisation exercises to increase the patient’s pain threshold so they can better handle varying levels of pain.
RSD treatment occupational therapy
Occupational therapy involves the retraining of a patient recovering from a physical injury or a medical condition such as RSD that affects their physical abilities. The patient is trained to find new ways to do their daily activities, while taking into account their injury or pain. This type of therapy helps a patient be less dependent on caregivers which can go a long way in improving their mental state. RSD treatment physiotherapy is also recommended in addition to occupational therapy as it also involves training the mind to deal with the emotional stress that comes from living with chronic pain.
RSD treatment involves a lot of different drugs and therapies. It may feel overwhelming to the patient, especially when the overall costs for the treatments are taken into consideration. Some may opt to wait out the RSD condition as it sometimes fades away. This is risky though, because the longer the disease is left untreated, the harder it will be to treat it and recover. The best solution is to get treatment as soon as a diagnosis is made for a better chance at a full recovery.