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Reflex Sympathetic Dystrophy
How is it treated?
One of the most important aspects of rehabilitation is that of inclusion. A dedicated team that works consistently with the adolescent and family will facilitate communication and enable goals to be reached earlier. It is essential that the young person is worked up medically to ensure no ongoing disease process or trauma is present. If the pain is coexisting with a known illness then it is important that this is as stable as possible before rehabilitation.
Medical therapies
The number of analgesics and interventions used is a sign that there are no well controlled therapeutic trials in the arena of childhood chronic pain. It is becoming widely accepted, however, that any analgesic intervention should be alongside multidisciplinary therapy. It is unusual for analgesia to work alone.
Complementary therapies are commonly utilised by patients with chronic pain. The evidence supporting many of these therapies in children and adolescents is poor but many young adults find certain therapies such as acupuncture, massage and aromatherapy helpful.
Multidisciplinary rehabilitation
The aim of treatment is to enable the young person to return to age appropriate activities and lifestyle. Ideally this would be pain free but, in many cases, this is initially with the pain.
Physiotherapists, occupational therapists and psychologists are key players in the team. They will be the primary professionals supporting the young person and the family. The physician is there to provide support if needed, occasional analgesic advice and very rarely, direct intervention. Intensive physiotherapy may be given for a set period of time. The aim of this is accelerated mobilisation. However many cases of pain will require a gentle, paced approach. In all cases the increase of activity should be consistent despite the pain. Where possible the young person should work to devise their own ‘fitness plan’. Fun games can be included with an aim to return gradually to activities the young person previously enjoyed. Using a local gym rather than a hospital physiotherapy gym allows them to start to return to a more normal environment.
Working in this consistent, paced manner is extremely hard for the young person and their parents. The pain invariably continues at the beginning (if not throughout) and motivation is poor. Parental anxiety is understandably high and there is a fear that damage will be done. Psychological support during this time is key. The young person will need help setting goals, learning how to communicate pain to peers and family, keeping up motivation on ‘bad days’, managing low mood, dealing with anger and frustration and overcoming fears. Often they have not been at school for a long period of time and need help in preparing again for this difficult environment. In some cases there may be other mental health needs that can be identified and appropriately treated. Relaxation, advice on sleep and eating and advice on how to pace other areas of life can all be given by members of the team.
Most cases of complex regional pain syndromes in children have a favourable prognosis if early physiotherapy is initiated (with psychological support). A prolonged time to treatment and the presence of marked autonomic changes are not good prognostic indicators. Relapses of pain are relatively common but, in our experience, if the young person and their family recognise the onset of similar pains and put into practice physical and emotional strategies that have previously been taught then the impact of the pains can be significantly reduced.
How is it diagnosed?
| Inheritance patterns and prenatal diagnosis 
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