Complex region pain syndromes (CRPS) is the modern term for Reflex Sympathetic Dystrophy (RSD) since the sympathetic nervous system is not integral to the pathology of the disease, which is usually caused by trauma.  Usually, the pain is not in the area of one peripheral nerve and is primarily peripheral to the injury.

Although local sympathetic anesthetic blockcade has been called the gold standard of treatment, the scientific evidence for this is not well established. (Cochrane Database Syst Rev 2005 Oct 19;4:CD004598).  Thoracoscopic sympathectomy is claimed of benefit at the University of Maryland in an uncontrolled report of 397 cases (Ann Thorac Surg 2005 Sep;80(3):1063-6). 

Treatments for CRPS type 1 supported by evidence of efficacy and little likelihood for harm are: topical DMSO cream, IV or oral bisphosphonates, and limited courses of oral corticosteroids. Despite some contradictory evidence, physical therapy and calcitonin (intranasal or intramuscular) are likely to benefit patients. Due to modest benefits and the invasiveness of the therapies, epidural clonidine injection, intravenous regional sympathetic block with bretylium, and spinal cord stimulation should be offered only after careful counseling. Therapies to avoid due to lack of efficacy, lack of evidence, or a high likelihood of adverse outcomes are IV regional sympathetic blocks with anything but bretylium, sympathetic ganglion blocks with local anesthetics, systemic IV sympathetic inhibition, acupuncture, and sympathectomy (J Fam Pract 2005 Jul;54(7):599-603).

Some cases of CRPS type 1 in post-stroke upper extremity hemiplegia (also known as shoulder-hand syndrome) can be prevented by early inpatient rehabilitation and avoidance of shoulder trauma to the affected arm. Some cases of post-fracture CRPS type 1 can be prevented with 500 mg vitamin C daily started upon diagnosis of fracture and continued through healing (J Fam Pract 2005 Jun;54(6):524-32).

Spinal Nerve Stimulation Helped: In a prospective trial of 29 patients with complex regional pain syndrome type I (CRPS I) responsive to sympathetic nerve block, spinal cord stimulation reduced both deep pain and allodynia permanently from 10 to 0-2 on a 10 cm visual analogue scale (VAS) (p<0.01). During the inactivation tests, reoccurrence of pain up to 8 VAS (quartiles 6-8) was measured. Considerable impairments in daily living activities, objectified by the pain disability index, were also restored (p<0.01). After a follow-up period of 36 months, 12 of 16 patients with affected upper limb showed significant increase of the fist grip strength from 0 to 0.35 (quartiles 0.1-0.5) kg compared with 0.9 (quartiles 0.7-1.1) kg on the unaffected side (p<0.01). Eight of ten patients with lower limb disability resumed walking without crutches. Previous pain medication was significantly reduced (p<0.01). Spinal cord stimulation in sympathetically maintained complex regional pain syndrome type I with severe disability. A prospective clinical study. Harke H, et al. Krefeld, Germany. . Eur J Pain 2005 Aug;9(4):363-73

Alendronate (Fosamax) High Dose Helps: In an 8-week DB PC study of 40 patients with posttraumatic complex regional pain syndrome type I (CRPS I) of the lower extremity, oral alendronate 40 mg/day resulted in a marked and sustained improvement in levels of spontaneous pain, pressure tolerance, and joint mobility, as well as a significant reduction in urinary levels of type I collagen N-telopeptide at weeks 4 and 8. The improvement was maintained at week 12. Twelve patients from each treatment group volunteered for the 8-week open trial, and all of them had a positive response to alendronate. Role of alendronate in therapy for posttraumatic complex regional pain syndrome type I of the lower extremity. Manicourt DH, et al. Universite Catholique de Louvain, Brussels, Belgium. . Arthritis Rheum 2004 Nov;50(11):3690-7