History of RSD
The history and the discovery of RSD (Reflex Sympathetic Dystrophy) Syndrome and its symptoms have typically been associated with wars. While there is no doubt that RSD from physical stress and injury existed earlier, it was left up to war physicians to assign pathology to it. Silas Weir Mitchell, an army doctor during the Civil War, described the symptoms of "burning pain" left in soldiers long after the bullets have been removed. He attributed these residual and long lasting pains to major nerve injury. Weir was the first to call RSD causalgia (currently, specifically known as CRPS-2), which is Greek for "burning pain." He wrote that, "Under such torments, the temper changes, the most amiable grow irritable, the soldier becomes a coward, and the strongest man is scarcely less nervous than the most hysterical girl." Weir accurately reflected the symptoms. (PARC, 2004). Mitchell accurately described the symptoms associated with the disorder as feeling of heat in the afflicted area where the skin tone changed to a glossy, rash-like appearance. He also described, very accurately, the secondary, psychological symptoms of the disease.
World War I, army surgeon Rene Leriche first treated causalgia by administering numbing medication to the parasympathetic nerve endings associated with the region of pain. This was the first time the parasympathetic nervous system was implicated in the disorder. Later, William Livingstone, also working with the defense services described the symptoms of RSD with greater accuracy. He also identified, in injured soldiers, the spread of the symptoms -- mirror pains on the opposite side of the body. This proved that there the origins of the disorder are at higher centers in the brain.
The history and the discovery of RSD can also be traced, parallelly to other countries. Sudeck and Keinbock found and confirmed the symptoms of RSD and also showed that disuse of parts of the body due to pain could cause osteoporosis. In France, in 1890, the physician Charcot, attributed the symptoms of RSD to psychosomatic origins. We know now that this is not true. Nonetheless, Charcot contributed a great deal to the school of thought in accurately describing the symptoms of RSD. In 1947, Steinbrocker named RSD, "shoulder-hand" syndrome. (PARC, 2004).
Definition of RSD
While RSD Regional Sympathetic Dystrophy has been readily named after earlier attempts based on the symptoms of the condition, identifying a specific cause of the disease and treating it effectively has been very difficult. This is because the incidence of RSD is difficult to pinpoint. The symptoms vary in severity. The aftereffects are also largely varied. Though RSD is often caused by injuries from high velocity impact such as bullets and shrapnel, on occasion it arises from no known injury. Treatment is difficult because the symptoms are usually masked and misdiagnosis occurs often. (Schwartzman & McLellan, 1987).
RSD has been better defined by the acronym, CRPS (Complex Regional Pain Syndrome). There are two types of CRPS. CRPS Type 1 is also known as RSD. For the purpose of this, only CRPS Type 1 will be explored. CRPS Type 2 is known as causalgia. The two types should not be used interchangeably. Though the symptoms are most often the same within internal variations in severity and aftereffects, what distinguishes RSD (CRPS 1) from Causalgia or CRPS 2 is that the former is due to no identifiable nerve injury and the latter is due to a severe nerve injury as was identified in soldiers.
The precipitating causes of RSD are difficult to identify because even remote innervations to the sympathetic nervous system can cause symptoms. Causative factors are even more difficult to identify because the sympathetic nervous system coordinates and controls many of the involuntary functions necessary to sustain life. The most easily identifiable cause is trauma. The difficulty here is that a minor injury, which most patients ignore when the initial pain goes away, may also trigger symptoms of RSD. Heart disease and myocardial infarctions are other known causes, as are cervical spine- and other spinal cord disorders. Infections and trauma from surgery may also cause RSD. Cerebral lesions are difficult to identify externally, though they have been implicated. Repetitive motion disorders such as carpal tunnel syndrome can also cause symptoms of RSD. (Bonica, 1988).
Both types of CRPS are associated with cardinal and secondary symptoms. Very often, psychological factors such as depression are directly attributed to the disorder. (Ciccone, Bandilla, & Wu, 1997). To date however, there has been no identifiable psychological symptom for RSD. Researchers have concluded that depression that arises from...
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