Injuries happen regularly – we bang a toe, thump a knee, or sprain an ankle – but we attempt to hold on and continue on. While the first pain may be excruciating, it ,more often than not, goes away after a short time. In some people, this isn’t continuously the case. The pain remains, and it grows in intensity over time, to the point where it can be insufferable and really affect the quality of life of the individual. These abnormal injuries and the resultant chronic pain are the outcome of a disease called reflex sympathetic dystrophy (RSD) or complex regional pain syndrome (CRPS). Now, you may ask yourself “What is RSD?”!
RSD, short for Reflex Sympathetic Dystrophy, was first outlined by Dr. S. Weir Mitchell, a Philadelphia medico. He described and first discussed the ailment in “Injuries of Nerves and Their Consequences,” a study he published in 1872 that addressed the issue of chronic pain in a number of patients he had seen over time. Dr. Mitchell was widely known for his research on the human nervous system. He was a medical specialist and treated wounded troopers from the Union Army. He found a repeating ailment among those who had been hurt but whose wounds had healed, namely that they felt continuous chronic pain that appeared to spread through the body. Common indicators included a burning pain, sensitivity to touch and temperature fluctuations in the affected limbs.
In 1946, a doctor in Boston – James Evans – introduced the term “reflex sympathetic dystrophy” in defining a similar affliction he observed in patients who had no definite nerve injury. In 1994, the International Association for the Study of Pain (IAFSP), renamed the disease and gave it further definition. It was reclassified as “complex regional pain syndrome,” or CRPS, and was identified by two types: CRPS Types 1 and 2. CRPS Type 1 occurs when there is no known nerve injury while Type 2 does involve injury to a nerve in the nervous system. A 2002 report issued by the World Institute of Pain state that “excruciating pain is the hallmark of the disease.” He had now answered the question “What is RSD?”!
Even until the 1980s, scientists held that pain impulses uniformly affected the body. Over the past three decades, studies have now proven that the nervous system exhibits a more dynamic response to various varieties of pain. The nervous system is comprised of millions of nerve endings called neurons. Generally, these individual neurons form connections with other neurons, called synapses. These small neural connections create multiple pathways involving the spinal cord, the central component of the nervous system, and the brain. The path traveled by an individual impulse distinguishes the type of pain we feel, such as a pulsating pain, burning sensation or a dull aching pain. However, if a nerve sustains a nerve injury, changes in how that impacted nerve and neighboring nerves transmit pain can occur. This alteration is a disease, and pain in both the symptom and disease. The impacted nerves can begin to release proteins that cause edema (temperature fluctuations), redness, and swelling in adjacent tissue. This pathology is what makes identifying RSD so difficult.
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