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Reflex Sympathetic Dystrophy or RSD is also known as Complex Regional Pain Syndrome ( CRPS ) Type 1 .
RSD or CRPS Type 1 is image in almost all historic period grouping from 2 years to over 90 age with mean age of the illness being 42 years . This disease is 3 times more common in female than male . Reflex Sympathetic Dystrophy or RSD or CRPS Type 1 is often seen following trauma have by automobile ( car ) accident , workplace stroke or domestic injuries.1
Triggers of RSD : RSD is often seen postdate peripheral voiced tissue injury in 2 to 5 % patient . RSD is also keep following cerebrovascular accident and hemiplegia in 13 to 70 % patients .
What Causes Severe Pain In RSD?
Pain is induce by inflammation and hyper - sensitisation of peripheral tissue paper as well as spinal nerves and fundamental sensitising .
What Are The Inflammatory Changes In RSD That Cause Pain?
CRPS Type 1 is the inveterate illness that follows gentle tissue injury and firing . Inflammation make vasodilation result in protein transudation and oedema . Chronic ( recollective standing ) flaccid tissue excitement triggers neurogenic irritation take mettle receptor ( nociceptors ) and sensory nerve fiber . In contrast , CRPS case 2 stimulate primary neurogenic inflammation and junior-grade subdued tissue instigative change .
What Causes Peripheral Hyper Sensitization In RSD Patients?
seditious changes in peripheral sonant tissue paper following non - remedial injury triggers the symptom of pain in CRPS Type 1 or RSD . Pain is junior-grade to excitement during the initial phase . afterwards neuropathic botheration is do by hypersensitization of pain receptors and nerve fibers by ischemic vascular variety of soft tissue . Pain intensity is severe secondary to hyperactivity of sense organ , sensational nervousness , large-hearted system , and central skittish system .
Is It Possible To Confirm The Inflammatory Changes Of RSD By Lab Studies?
laboratory studies of peripheral tissue fluid , blood , and cerebrospinal fluid have register comportment of inflammatory neuropeptides such as calcitonin gene - related peptide , inwardness P , and pro - incitive cytokines such as tumour necrosis factor - alpha in patients have with chronic CRPS Type 1 and 2 . Lab field of study also suggest increase endothelin-1 and diminished nitric oxide levels within seditious secretions.2
What Kind of Ischemic Vascular Changes (Blood Supply To Tissue) Leads To Chronic Severe Pain In Later Stages Of RSD?
The ischemia ( restriction of stemma supplying ) of indulgent tissue and adjacent bones final result in lack of adequate O ( hypoxia ) to soft tissue and off-white . Hypoxia causes secretions of overweening chemical like lactic Elvis in skin , hypodermic tissue and muscle resulting in severe pain . Lack of adequate oxygen to peripheral tissue also causes tissue changes like peel colour , nail texture , osteoporosis of bones and swelling of soft tissue paper spark off increased pain.3
Why Does Pain Continue In RSD (CRPS Type 1) Despite Inflammation Being Treated?
mark of easy tissue follow wound , injury , extensive burn or redness final result in destruction of face receptors and sensory nerves . pit is affiliate with microscopic pathological destruction and sphacelus of peripheral mild tissue . CRPS of Type 1 is observed after soft tissue injury and not any major nerve injury . Peripheral soft tissue inflammation , mortification and pock do peripheral nerve vexation and sensitising of pain sensory receptor , which initiates neuropathic hurting resulting in CRPS type 1 .
What Is Neuropathic Pain In RSD?
innervation and hypersensitivity of pain receptors , spinal neuron , and sensational spunk fiber stimulate continuous serious intractable pain . Hypersensitive botheration receptors are circularize over hide , muscles , bones and viscera . hard pain in the ass is generated when these hypersensitive sensory receptor are stimulated by simple touch , pressure or irritant . Equally hypersensitive sensory boldness from supersensitized pain receptor to spinal cord bear pain in the neck impulse .
Why Neuropathic Pain Becomes Chronic And Difficult To Treat?
Neuropathic pain is associated with hypersensitivity of peripheral receptors and nerve fibers , boldness cell within spinal cord and central sensitisation .
What Causes Hypersensitivity Of Nerves In Spinal Cord In RSD?
Interneurons in spinal electric cord exchanges entropy with different conterminous spunk cubicle by direct various courier neurotransmitter . Neurotransmitter productions by spinal and interspinal neuron are erratic in patient role suffering with CRP and often exaggerate intensity of pain impulses . Modified pain in the ass impulse ( intonation ) within spinal cord are transmitted by different sets of ascending sensory nervus from spinal cord to genius and in high spirits pain center . Continuous customary secernment of neurotransmitters by sensitized interneuron in spinal cord , mediate and exchange entropy between interneuron . Exaggerated exchange of neurotransmitter answer in sending continuous painfulness impulsion to higher nuisance centre even after peripheral cause of pain is abolished or restricted .
What Is Central Sensitization In RSD?
Several studies had suggested RSD or complex regional pain syndrome ( CRPS ) is associated with functional reorganisation in the primary somatosensory cortex ( S1)2 . Hyperactivities of sensory and motor cerebral cortex were observed in patient bear with CRPS in research field . Cortical hypersensitivity propose central sensitisation . Chronic neuropathic nuisance is associated with hyperactivity of pain centerfield in thalamic neurons and limbic system . supersensitized limbic system interferes with eternal sleep , mood and appetency . Central sensitisation also trigger off autonomic nerves activation .
What Is Autonomic Nervous System Activation?
Autonomic mettle activation results in clinical manifestation of symptoms spot as autonomic dysfunction . Autonomic dysfunction in CRPS causes initial increment of pelt temperature , erythema , tissue edema and subsequently cold hide temperature , evaporation cutting of the pelt and bluish discolouration . Autonomic dysfunction is also acknowledge as vasomotor changes , sudomotor change , and atrophic changes .
What Are Vasomotor Changes?
Vasomotor changes are celebrate in blood vessels of conflagrate soft tissue paper because of hyper activities of hypersensitive autonomic system of rules . Initially the peripheral profligate vessel are dilated causing erythema and pinkish red discolouration of cutis . Later rip vessels are constricted resulting in cyanotic purple hide . The changes are preponderantly seen in small arteries .
What Are Sudomotor Changes In RSD?
Sudomotor nerves are the motorial nerves of sweat secretory organ . Stimulation of sweat gland by sudomotor nerve cause secretion of sweat . In C-reactive protein the sudomotor nerves are hyperactive .
What Are Trophic Changes?
Trophic changes observed are secondary to ischemia ( reduce oxygen supplying ) of skin , hair , subcutaneous tissue , and pearl . The autonomic trophic alteration also know as neurogenic atrophy or neurotropic atrophy secondary to vasoconstriction ( narrowing of parentage vessel ) and ischemia ( less stemma supplying ) .
Also Read :
consultation :
Demographic and aesculapian parameter in the ontogenesis of complex regional pain syndrome type 1 ( CRPS1 ):
prospective bailiwick on 596 patient role with a fracture .
Beerthuizen A , Stronks DL , Van’t Spijker A , Yaksh A , Hanraets BM , Klein J , Huygen FJ .
Pain . 2012 Jun;153(6):1187 - 92 . doi : 10.1016 / j.pain.2012.01.026 . Department of Medical Psychology and
Psychotherapy , Erasmus MC , Rotterdam .
Increased endothelin-1 and diminished nitric oxide levels in blister fluid of patient with intermediate cold-blooded eccentric
complex regional pain in the neck syndrome type 1 .
Groeneweg JG , Huygen FJ , Heijmans - Antonissen C , Niehof S , Zijlstra FJ .
BMC Musculoskelet Disord . 2006 Nov 30;7:91 .
Department of Anesthesiology , subdivision Pain Treatment Center , Erasmus MC Rotterdam .
ivory loss in the contralateral symptomless hand in patient role with complex regional pain syndrome character 1 .
Karacan I , Aydin T , Ozaras N.J Bone Miner Metab . 2004;22(1):44 - 7 .
SSK Vakif Gureba Hospital Physical Medicine and Rehabilitation Clinic , Istanbul , Turkey .
