Complex regional pain syndrome type I (reflex sympathetic dystrophy)

Rarely does a syndrome undergo an intentional name change to reduce misunderstanding about its etiology and treatment. The disorder still commonly referred to as reflex sympathetic dystrophy (RSD) is as controversial as any seen by neurologists. The unusual and sometimes dramatic tissue changes observed in the affected distal extremity has led to names as varied as "minor causalgia," "traumatic angiospasm," "peripheral acute trophoneurosis," and"postinfarctional sclerodactyly." Reflex sympathetic dystrophy as a three word term suffers from three flaws. First, it implies that the problem is a reflexive response to an insult, a simplistic and nonspecific extension of the"vicious circle" theory. Second, it suggests that the sympathetic nervous system causes the pain, and implies by extension that sympathetic blockade relieves the pain. Available techniques for blocking the sympathetic nervous system are not selective; local anesthetic blocks of the sympathetic chain may also relieve pain by spreading to sensory nerves, by systemic redistribution of local anesthetic, and by placebo effects.1 In addition, many patients who otherwise meet the definition of …