Reflex Sympathetic Dystrophy and Pregnancy

What Is Reflex Sympathetic Dystrophy?

Pregnancy has comes with a certain amount of pain. Most of the time, for most women, the pain is bearable and manageable, however, for some women who suffer with chronic pain, pregnancy can intensify things. Such is the case with reflex sympathetic dystrophy (RSD), also known as complex regional pain syndrome (CRPS). CRPS, according to Wikipedia, is a chronic progressive disease characterized by severe pain, swelling and changes in the skin. There is no cure. It goes on to say that the International Association for the Study of Pain has divided CRPS into two types based on the presence of nerve lesions following the injury.

Type I, formerly known as reflex sympathetic dystrophy (RSD), Sudeck's atrophy, reflex neurovascular dystrophy (RND) or algoneurodystrophy, does not have demonstrable nerve lesions.

Type II, Formerly known as causalgia, has evidence of obvious nerve damage.

What Causes RSD?

There is no known reflex sympathetic dystrophy causes, but injury and surgery have both been considered to be precursors in many, although not all, cases. When checking reflex sympathetic dystrophy, emedicine indicates that it has been recognized since the Civil War in America. The name, causalgia, (Type II) described intense, burning pain in an extremity after an injury. If recognized early enough it can be treated with pain management drugs, but it can be disabling if it is not identified and treated.

RSD Symptoms And Diagnosis

The key feature when examining RSD symptoms is the presence of pain in the affected limb or joint, with swelling, decreased range of motion and discoloration of and increased heat in the skin. As time goes on, the pain abates somewhat, but the swelling becomes a thickening of the skin and fascia with signs of atrophy and osteoporosis and the skin cools down. In the latter stages of the syndrome the pain continues, movement lessens even more and joint stiffness increases. A decrease in vascularity (blood flow) is evident.

Obtaining an RSD diagnosis is less difficult when the upper extremities are involved, and it is important to rule out other potential conditions or diseases that may have similar presenting symptoms. The accepted and preferred method of RSD diagnosis is radionuclide bone imagine (RNBI). Since there is no cure for this syndrome, RSD treatment is centered on pain relief. Topical analgesics, corticosteroids, antidepressants, and opioids are all used in some measure to relieve pain and help the sufferer cope. To date, no single drug or combination of drugs has proven to provide long-lasting improvement of the symptoms. In order to help restore function and mobility to the affected area, physical and occupational therapies are used and found to be effective in RSD treatment. Touch intolerance makes is difficult or impossible for some people to take part in any mode of physical therapy and the use of a light general anesthesia sometimes aids in such cases when attempting to restore a measure of mobility.

RSD and Pregnancy

It would seem that RSD would mean a woman with the syndrome could not or should not conceive and carry a pregnancy. What has to be kept in mind is that the drugs have a devastating effect upon the unborn baby, and the ability of the woman to deal with the pain without drugs is a difficult challenge at best. A detailed birth plan is advised, especially since the extreme pain of the syndrome can mean that labor pains may not even be felt. If the birth is a cesarean, then there is the risk of CRPS developing at the site of the surgery, spreading into the abdomen, uterus and ovaries. It is most critical that a woman find a good doctor if she is pregnant or planning a pregnancy with CRPS. If the doctor is not knowledgeable about the syndrome, he or she should be willing to learn. Women going through the trials of deciding upon pregnancy and dealing with CRPS while pregnant, can find some help in engaging the services of a cognitive behavioral therapy doctor who can help her find ways to deal with the anxiety and depression that often accompanies RSD.

Hope, Help, And Encouragement

There is little information available to date regarding pregnancy and RSD, however, there are many places on the internet where women who have RSD or CRPS blog with other women, sharing information, insights, and stories about their own experiences. Many have had children and provide encouragement and some answers for those seeking information, help, and hope. Each woman has her own unique experience with CRPS or RSD and pregnancy. Some women go into full remission with a pregnancy, others continue to have symptoms throughout the pregnancy and birth.