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Overview of Reflex sympathetic dystrophy

Patients who have reflex sympathetic dystrophy describe symptoms including:

  • Stabbing and/or burning pain

  • Extremity swelling

  • Tenderness

  • Profuse sweating

  • Discoloration

  • Shiny or flushed skin

  • Joint stiffness

  • Muscle spasms

There are several other symptoms associated with RSD, but these are the most common.

The sympathetic nervous system is responsible for regulating involuntary functions of the body such as increased blood pressure and heart rate and constricting blood vessels. It is the abnormal responses that are said to cause the chronic pain associated with RSD. RSD often begins with burning pain present in the arms, fingers, palms of hands and/or shoulders. This condition is easily misdiagnosed as a painful nerve injury. In turn, the skin covering the affected areas will often become extremely sensitive, swollen and inflamed.

Although the exact cause of RSD is unknown, it is believed to develop as a result of direct injury to the nerves, surgery, trauma, infection, atherosclerotic cardiovascular disease or radiation therapy. Though it often begins as centralized in one part of the body, 92% of patients have reported a spread of the disease, and 35% of patients have reported symptoms throughout their whole body.

Complex regional pain syndrome (CRPS) has been classified and divided into two groups dependent on the resulting nerve lesions following the injury:

  • Type I, also known as reflex sympathetic dystrophy, reflex neurovascular dystrophy, Sudeck's dystrophy or algoneurodystrophy does not have visible nerve lesions.

  • Type II is also known as causalgia and leaves notable evidence of significant nerve damage. The chronic pain caused by Type II RSD has been described as a 42, with 50 being the maximum level of pain — rated higher than amputation and childbirth.

You may have developed reflex sympathetic dystrophy as a result of a forceful trauma to your leg or arm, for example, as a result of a fracture, crushed limb injury or amputation. A sprained ankle, infection, heart attack or surgery can also lead to developing RSD, as can emotional stress. Researchers don’t understand how these types of traumas or injuries can trigger reflex sympathetic dystrophy, but it might be because of inappropriate inflammatory reactions and a dysfunctional relationship between your peripheral and central nervous system.

The precise process of how RSD occurs is not understood completely. It's thought to include abnormal excitation and irritation of nervous tissue that leads to abnormal nerve impulses affecting skin and blood vessels. The peripheral nerves, brain, and involuntary nervous system also seem to be involved.

There are some conditions and circumstances that can trigger RSD, including:

  • Surgery

  • Injury

  • Degenerative neck arthritis

  • Heart disease

  • Brain disease like stroke

  • Breast cancer

  • Shingles

  • Shoulder problems

  • Barbiturates and drugs for tuberculosis

Symptoms of Reflex Sympathetic Dystrophy

RSD symptoms most commonly affect your shoulder or arm and sometimes your hip or leg. Symptoms seem to come on gradually, often starting with discomfort, gradual stiffness, weakness or a burning sensation in the affected area. But occasionally, the symptoms can come on suddenly, consisting of severe pain, extreme sensitivity and stiffness of the affected area.

Intense, chronic pain is the key symptom of RSD and tends to get worse with time. Normally, it affects your hands or feet, legs or arms and is accompanied by:

  • Increased sensitivity of skin when touching

  • Burning pain

  • Changes in skin color— often purple, blotchy, red or pale

  • Changes in temperature of skin — warmer to cooler in comparison to the other extremity

  • Changes in hair and nail growth patterns

  • Changes in the texture of skin — thin and shiny, and in some cases excessively sweaty

  • Motor disability and not being able to move affected body part

These are the common symptoms of RSD. However, there are other symptoms you may experience as well such as depression.

Effects of Reflex Sympathetic Dystrophy

Reflex sympathetic dystrophy can create many negative effects. The effects depend on the stage of RSD you have. 

Stage I: Acute

This stage can last several months. During this stage, you experience increased sensitivity to touch and burning pain. The pain with RSD is longer lasting and more constant than what you would expect with an injury. Joint stiffness and swelling typically follow, and your affected limb may increase in redness and warmth. You may also experience faster hair and nail growth than usual as well as profuse sweating.

Stage II: Dystrophic

This stage can last anywhere from three to 12 months. You’ll notice that your skin wrinkles disappear and you’ll experience more constant swelling. The temperature of your skin becomes cooler. Your pain is more widespread, nails become brittle and your stiffness increases. The affected area can also become more sensitive to touch.

Stage III: Atrophic

After one year, you move to stage III. During this stage, the skin of the affected area affected becomes dry, pale, shiny and tightly stretched. The area is stiff, and there's little hope of regaining motion in it. The condition may spread to other body areas, and your pain may decrease.

Common RSD effects include:


Out-of-proportion pain and mobility problems are the main characteristics of RSD. The first and main complaint that occurs in one or more of your limbs can be described as constant, severe, deep aching pain or burning. You will likely experience painful tactile stimulation of your skin with things like a light breeze or clothing increasing the sensation. Repetitive tactile stimulation such as tapping on your skin can cause increased pain with each tap. When you stop the repetitive stimulation, you may feel a prolonged pain sensation afterward known as hyperpathia.

Findings: Effects of Cannabis on Reflex sympathetic dystrophy

Cannabis can offer relief for RSD without psychoactive side effects. Strains of weed high in Cannabidiol (CBD) — even in the form of oils, edibles and tinctures — are beneficial in treating:

  • Relieving nerve pain

  • Reducing inflammation

  • Calming muscle spasms

  • Reducing joint stiffness

You can also use topical lotions to loosen your stiff joints and relieve pain. Cannabinol (CBN)-rich products help relieve nerve pain, muscle spasms and convulsions. You may get a mild sedative effect, which is perfect if you're struggling with insomnia. There are also antidepressant qualities in CBN called "natural aspirin," although it's much stronger.

If you're struggling with insomnia, you may benefit from heavier indica strains since they're high in Tetrahydrocannabinol (THC) and have more a sedative effect than sativa strains. Indica strains are also good for treating stress, anxiety and pain. 

Sativa strains are also high in THC, but they produce a more uplifting and energetic experience. They can be helpful if you're suffering from depression or don't have much of an appetite anymore. These strains are better in the daytime.

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