RSD PUZZLE #19
RSD and Other Organs
"Can RSD affect other internal organs?"
RSD is not usually limited to one part of an extremity or one extremity. Usually, the
pathological sympathetic function spreads to adjacent areas.
The first areas becoming involved are the pathway of the sympathetic nerves between the
end organ (e.g., foot or hand) and the spinal cord. This results in an inflammation and
irritation of the nerves all the way from the end organ to the spinal cord. This is
manifested by muscle spasm in the cervical and lumbar spine region, secondary back and
neck pain, headache, dizziness, and tinnitus (buzzing in the ears).
This provides excellent treatment opportunities. In the path of the areas of inflammation,
the posterior sensory nerve branches corresponding to the level of the involved nerves and
secretes substance P (a painful substance half the molecule of endorphine and
practically identical to jalopena pepper extract). This secretion of substance P under the
skin in the paraspinal regions can be identified by exerting equal pressure on the two
sides of the vertebra, and observing the so-called "red reflex". Pressure on the
normal areas causes no reddish discoloration. On the other hand, pressure on the areas of
sensory nerve irritation causes a reddish discoloration of the skin which is accompanied
by Travaill's Jump Sign. This area of reddish discoloration can be easily blocked and
dissipated by injection of local anesthetic such as Marcaine and if the condition is
chronic and severe, one can add a small amount of Celestone or Depo - Medrol® to it. This
nerve block provides excellent relief of pain and reversal of constriction of the blood
The next area of involvement of RSD is the spinal cord itself. This is manifested by
movement disorder, muscle spasm, weakness of the extremity, as well as urgency and
frequency of urination and disturbance of erection.
Invasive procedures such as the insertion of a spinal stimulator can flare-up such an
involvement of the spinal cord and it can cause "idiopathic paralysis" due to
flare-up and constriction of blood vessels to the spinal cord. The same can be noted in
rare cases of insertion of a catheter for sympathetic nerve blocks in the paravertebral or
The next is the visceral involvement with RSD. In RSD the skin is usually cold and the
deep structures are hot and have an exaggerated blood circulation. This results in
osteoporosis, fracture of the bones, areas of swelling and fluid formation between
the bones and joints identified on MRI, and severe pain as well as weakness in the deep
structures. This causes a high risk of amputation for the patient. Amputation is totally
unnecessary and should never be performed. Just simple weight bearing under the effect of
a strong analgesic such as Stadol along with the use of moist heat and epsom salt,
exercise and massage for the extremity to reverse the vasoconstriction on the surface and
to increase the circulation in the deep structures corrects this situation without the
need for amputation. Amputation in RSD is a slow, painful, gradual suicide.
The next structures being involved in some cases of RSD are the blood vessels to the
kidney with resultant episodes of sudden brief and temporary bleeding through the kidney
accompanied by a marked elevation of blood pressure. The same principle can cause attacks
of nose bleeds, severe headache, dizziness, passing out spells as well. Application of
Clonodine Patch in the area of the kidney in the flank (in the back) usually results in
good relief of such spasm and inflammation of the blood vessels. The patient should be
treated with Dibenzyline or Hytrin which are life saving in such patients.
The involvement of other sympathetic midline connections and plexi such as celiac
(abdominal pain, peptic ulcer, nausea, vomiting, and weight loss), superior and inferior
mesenteric plexi (diarrhea, abdominal cramps, and weight loss), and cardiac plexus (chest
pain, abnormal heart beat, tachycardia, and heart attack), and carotid and vertebral plexi
(severe vascular headaches, dizziness, tinnitus, attacks of falling spells, and syncopal
attacks), should be identified as such and should be treated with the help of Clonodine
Patch, Hytrin, or Dibenzyline as well as proper treatment applied to the source of RSD
(definitely avoiding ice, but encouraging exercise, moist heat, epsom salt and hot water,
and newer antidepressants as the best analgesics of choice for RSD).
The involvement of the same midline plexi (see the enclosed diagram) explains the reason
for the involvement of other organs symmetrical on the opposite side such as the opposite
hand or opposite foot or opposite side of the head in regard to headache and face pain or
involvement of the removed areas such as involvement of right hand because of left knee
Because of the above complex phenomenon and because of the fact that in RSD the
sympathetic nerves follow the path of the blood vessels rather than somatic nerve roots
resulting thermotomal rather than dermatomal sensory nerve distribution (mistaken for
hysterical sensory loss) may cause a complex clinical picture that baffles the clinician
and forces the clinician to blame the patient as being hysterical, hypochondriac, and
blaming the serious warning signs of RSD as "functional and not organic". The
end result is the deadly phrase "it is all in your head" which practically
almost all RSD have had to put up with in the course of their treatment. Then the patient
is sent to the psychiatrist who tries to shut the patient up with strong tranquilizers,
benzodiazepams, Haldol, Valium, Xanax, Halcion, Ativan, Tranxene, etc., with further
disastrous results by aggravating RSD due to inactivity, and due to the stress of strong
addicting benzodiazipams affecting the formation of brain's own endobenzodiazepams and
It is about time to learn and understand that sympathetic system is complex, bilateral,
diffuse. Its job is alerting mechanism to alert the entire body against stress and its
manifestations are complex and multifaceted.
Just because the bone scan is negative (at best 55-65% of RSD patients have positive bone
scans) it does not mean that the patient's symptoms and signs are a figment if
imagination (unfortunately approximately 80% of RSD patients are females and more likely
Yesterday I ran into one of my old classmates in a medical meeting and he said "I
hate RSD." I told him so do I and all the patients, but we have to understand and
H. Hooshmand, M.D.
1. Lee GW, Weeks PM: The role of bone scintigraphy in
diagnosing reflex sympathetic dystrophy. J Hand Surg [Am]. 1995; 20:458-463.