From:
Chronic
Pain: Reflex Sympathetic Dystrophy Prevention and Management
CRC Press,
Boca Raton, Florida
H.
Hooshmand, M.D.
Etiology of RSD
Contrary to general impression, trauma is not at the
top of the list in the etiology of RSD (Table 12). Other diseases are more likely to be
complicated by RSD. The factors that contribute to the development of RSD in different
illnesses are
1. Chemical, e.g., chemical burns are quite
frequently accompanied by RSD.
2. Anatomical, such as disruption of myelin in
diabetic neuropathy.
3. Vascular, such as disturbance of microcirculation
in diabetic neuropathy.
4. Electrical, such as causalgia, electrical
injuries, bullet injuries, sharp object injuries.
5. Infection, e.g., postherpetic neuralgia.
6. Demyelination, multiple sclerosis and diabetes.
7. Hyperpathic pain generated by diseases such
coronary artery insufficiency and heart attacks that result in shoulder-hand syndrome.
Chemical burns are at the top of the frequency list,
followed by postherpetic neuralgia, electrical injuries, and diabetes (Table 12).
Table 12
Etiology of RSD
| Etiology of RSD |
RSD/total
a |
Percent |
Chemical burns
(causalgia) |
4/5 |
80 |
| Postherpetic (neuralgia)
(face, eyes, trunk) |
31/39 |
79 |
| Electrical injuries (causalgia) |
33/42 |
72 |
| Spinal cord tumor |
4/17 |
57 |
| Diabetic neuropathy
b
(neuropathic pain) |
18/54 |
33 |
| TMJ disease |
3/11 |
27 |
| Posttraumatic |
101/482 |
21 |
| Cervical spondylosis |
42/328 |
12 |
| Multiple sclerosis |
20/182 |
11 |
| Atyplical facial pain |
|
(2.4) |
| Trigeminal neuralgia |
|
(4.5) |
| Extremities RSD |
|
(3) |
| Dysautonomic attacks |
|
(1) |
| Diarrhea |
|
|
| Coronary disease |
6/69 |
9 |
| Stroke
Thalamic
infarct with thalamic pain, RSD of disuse in spastic extremity |
18/223 |
8 |
a Incidence of RSD was
determined with the help of thermography. To estimate the figures without the use of
thermography, divide by 4.
b Stewart et al.58
found sympathetic involvement in 80% of such patients.
