The Complex Regional Pain Syndrome (CRSD/RSD) is also known as Reflex Sympathetic Dystrophy (RSD) is a condition having chronic pain that influences one of the feet, hands, legs, or arms. The pain extends to the whole leg or arm. Usually, the start is initiated by physical injury, for instance, surgery, sprain, or fracture. CRPS/RSD is divided into type I and type II. Type II is linked with an injury in the nerves while type I is the most common, triggered by the damage of the tissues without involving nerve injury. 

SIGNS AND SYMPTOMS of RSD:

There are continuous CRPS/RSD symptoms; there is a severe pain that leads to the severity of the injury which gets worse as compared to the better over time. This disease is accompanied by:

• Alterations in the skin temperature: cooler or warmer compared to the opposite extremity
• Increased sensitivity of the skin
• Changes in the texture of skin: thin and shiny, and excessive sweating sometimes
• Alterations in the color of skin: often red, pale, purple, or blotchy
• Changes in the hair and nail growth patterns
• Motor disability with reduced ability to move the particular parts of the body
• Stiffness and swelling in the affected joints

ETIOLOGY AND PATHOGENESIS OF REGIONAL PAIN SYNDROME:

The pathogenesis and etiology related to Regional Pain Syndrome are not visible. Though, the latest pieces of research show that the following may be included in the pathogenesis of the disease:

SOMATIC NERVOUS SYSTEM: The sensory and pain disturbances in CRPS/RSD has been linked to the pathology of the sensory-somatic nervous system.

AUTOMATIC NERVOUS SYSTEM: Increased vasoconstriction-linked coldness and sweating of the affected limb are considered as a result of autonomic hyperactivity.

HYPOXIA: It is found in the individuals with CRSP/RSD. In the skin, increased lactate levels and reduced capillary oxygenation are shown. In the muscles, the signs of impaired high-energy phosphate metabolism and acidosis are noted. Hypoxia leads to free radical formation and acidosis, the well-known generators for the primary afferents for causing the severe sensations of pain.

INFLAMMATION: in the starting phase, RSD/CRPS is associated with the signs of local inflammation in the acute stage. In CRPS/RSD patients, the pro-inflammatory cytokines, for instance, IL-2, tumor necrosis factor-a, IL-1b, or interleukin-6 increases in the venous blood or affected extremities, while the anti-inflammatory cytokines, for example, tissue growth factor –b, or IL-4 decrease.

PSYCHOLOGICAL FACTORS: The behavioral aspects and psychological factors may lead to CRPS/RSD. The psychophysical mechanism that influences chronic pain in CRPS/RSD individuals is the anger expression mode. For instance, anger affects the intensity of pain. Another method in which CRPS/RSD can be a stress-induced discharge of catecholamines which it seemed as systematically increased in the patients of CRPS/RSD.

RSD – CONVENTIONAL TREATMENT:

As there is no perfect treatment for CRPS/RSD, the therapy is purposed at alleviating the symptoms of the pain so that the individuals can continue their healthy lives. The most commonly used treatments are:

• Psychotherapy
• Physical therapy
• Sympathetic nerve block: A technique includes the intravenous supervision of the phentolamine to mass the sensitive receptors. Another technology involves placing the anesthetic next to the spine for blocking the sympathetic nerves.
• Medications: multiple categories of medicines are utilized for treating CRPS/RSD, involving opioids, corticosteroids, antidepressants, antiseizure drugs, and topical analgesic drugs. Though, no drugs combination or single drug has offered the long-lasting improvement in the signs continuously.
• Intrathecal drug pumps: these instruments administer the medications to the spinal cord directly, so that the anesthetic mediator is reached to the targets of pain signals in the spinal cord at doses less than those needed for the oral administration.
• Spinal cord stimulation: the placing of stimulating the electrodes next to the spinal cord gives a pleasant itchy sensation in the area of the pain. This practice may assist individuals suffering from depression.
• Surgical sympathectomy: A technique that damages the nerves included in CRPS/RSD, it can be the best outcome, but it can also make CRPS/RSD

CHINESE MEDICINE (TCM for Regional Pain Syndrome):

Chinese medicine is in use for more than 3000 years in history. In the last years, it has become renowned in the western world, particularly for treating CRPS/RSD. Hence, Chinese medicine can help in addressing each aspect of CRPS/RSD; the usage of herbal medicine or acupuncture is exceptionally productive. Various pieces of research have shown Acupuncture for Regional Pain Syndrome can:

• Regulate the immune function
• Attenuate inflammation
• Improves or relieve depression, anxiety, and stress
• Reduce the pain level or relieve pain
• Increase the energy
• Improve the quality of sleep
• Enhances the quality of life
• Reduce depending on the inappropriate medicines

Regional Pain Syndrome treatment using acupuncture is the most effective alternatives to painkillers and steroids in the RSD clinic.

SCIENTIFIC RESEARCHES:

Over time, scientists in the world have researched multiple studies for exploring the mechanism of Acupuncture for Regional Pain Syndrome. The results reveal that the acupuncture acquires the scientific basis. Here is some evidence:

• Decreasing the contraction o muscles, hence reducing the muscle spasm
• Increased blood circulation to the areas of injury, thus, reducing the swelling of tissue and speeding up the recovery of the injury
• Increasing the release of natural pain-lowering endorphins
• Increase the anti-inflammatory cytokines and stop the production of pro-inflammatory cytokines, thus decreasing edema and inflammation
• Perform systemic and local immunomodulation
• Resist the conduction of sensory fibers in the algetic nerves
• Modulate neuroendocrinological factors
• Modifies the brain for producing the polypeptides that decrease the sensitivity of pain
• Increase the level of homovanilllic acid, dopamine, acetylcholinesterase, and serotonin; all assist in increasing the threshold of pain and leads to pain relief.

ACUPUNCTURE FOR REGIONAL PAIN SYNDROME:

According to the specific diagnosis of the patient, multiple acupoints must be applied. The electric acupuncture is utilized for individuals with CRPS/RSD. According to the proper diagnosis of the patient, the suitable acupoints selected for: 

• Blood obstruction
• Qi stagnation
• Cold retention to stagnate the flow of blood and qi
• Blood obstruction and qi stagnation
• Damp preservation for blocking yang qi
• Yin and yang deficiency

According to the location of the affected organ or tissue of the patient, as well as the characteristics of symptoms and signs of the patient, the additional points selected for:

• Severe pain
• Numb
• Stiff and swollen joints
• Severe edema
• Motor disability with reduced ability to move the affected parts of the body
• Insomnia due to excess pain

OTHER MODALITIES OF ACUPUNCTURE:

Moxibustion: it is one of the modalities of Chinese medicine. It improves the acupoints for realigning or adjusting stagnated qi that restore the normal flow of qi to the places where the illness or pain aroused from.

Acupoint injection: it is another modality of acupuncture, and it is a technique in which some of the liquid medications get injected to the acupoint. It is not allowed in Arkansas.

Cupping: it follows the pattern of the point choosing, used for the regular acupuncture treatment. During the therapy of cupping, the expert makes a vacuum through fire in a cup and applies the bowl into a specific point in the body, which draws some of the subcutaneous tissue and skin in the container. The cupping heats qi and enhances the flow of blood and qi in the meridians, hence, dispelling dampness and coldness and reducing the pains and swellings. The cupping increases the local circulation in the blood, improves the tissue threshold to the pain, removes the spasm, relaxed the tightness of the muscle and soothes the edema and pain. It is also used for making the immune system strong.

GuaSha: it is among the best modalities of Chinese medicine, which includes recurring pressured strokes over the lubricated skin with a smooth-edged ceramic or wood cup. The flat edge is present against the surface of the skin, pressed down and moved along the way down the muscles of the acupuncture meridians, through the skin surface. Gua Sha reduces fever, improves the local blood circulation, relax the ligaments, tendon, and muscles, attenuates fatigue, improves immobility, pain, and stiffness, heightens headaches, treat gynecological, urinary and digestive problems. 

Tui Na: it is the other modality, also renowned as a Chinese therapeutic massage and it is famous in the United States as the best healing addition. Tui Na uses the theory of Chinese medication as its primary principle. It has a diversity of multiple systems that focuses on some aspects of the laws for example gliding, rolling, percussion, kneading, pulling, friction, rocking, rotation, shaking and vibration by utilizing thumb, fingers, palm, knuckles, and elbow. It relaxed the tightened ligaments and tendons, eradicates coldness and warms meridians, opens up the channels and meridians, improves the circulation of blood, attenuated the pain, eradicates the edema, harmonized the stomach and strengthens the spleen.

In the practice of Chinese medicine, the first two critical steps are making the right diagnosis and selecting the correct herbal formula acupoints. The second essential thing during the treatment period is setting the acupoints, and maintaining the herbal formula, for instance, adding of the additional herbs to the original method of herbs, by the response of the patient to treatment. The third step is the combination of multiple modalities of acupuncture according to the diagnosis and situation of the patient. Different patterns when combined give a positive effect. 

REGIONAL PAIN SYNDROME Treatment using Acupuncture AT THE PHILADELPHIA ACUPUNCTURE CLINIC

Medical Doctor Victor Tsan leads the team of professionals at the Philadelphia Acupuncture Clinic. This team helped many people suffering from Regional Pain Syndrome using a combination of acupuncture and Homeopathic Medicine. So far this treatment is the most effective comparing to traditional use of painkillers and physical therapy. Book your appointment with Dr. Tsan to discuss your treatment plan and the best options.