Regional Pain Syndrome (CRSD/RSD), also known as Reflex Sympathetic Dystrophy (RSD), is characterized by chronic pain that influences one of the feet, hands, legs, or arms. The pain extends to the whole leg or arm. Usually, a physical injury, such as surgery, a sprain, or a fracture, causes the start. CRPS/RSD is divided into types I and II. Type II is associated with a nerve injury, whereas type I is the most prevalent and results from tissue damage without a nerve injury.

SIGNS AND SYMPTOMS of RSD:

There are continuous CRPS/RSD symptoms; there is severe pain that leads to the severity of the injury, which gets worse as compared to the better over time. There are accompanying symptoms for this disease:

• 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 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. However, 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 have been linked to the pathology of the sensory-somatic nervous system.

AUTOMATIC NERVOUS SYSTEM: Increased vasoconstriction-linked coldness and sweating of the affected limb result from autonomic hyperactivity.

Hypoxia is found in individuals with CRSP or RSD. It is characterized by increased lactate levels and reduced capillary oxygenation in the skin. Muscles show signs of impaired high-energy phosphate metabolism and acidosis. Hypoxia leads to free radical formation and acidosis, which are well-known generators of the primary afferents that cause severe pain sensations.

INFLAMMATION: in the starting phase, RSD/CRPS is associated with the signs of local inflammation in the acute stage. IL-2, tumor necrosis factor-a, IL-1b, and interleukin-6 are pro-inflammatory cytokines that rise in the veins or affected limbs of people with CRPS/RSD. On the other hand, tissue growth factor and IL-4 fall in those same areas.

Psychological Factors: The behavioral and psychological factors may lead to CRPS or 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 by which CRPS or RSD can be treated is the stress-induced discharge of catecholamines, which seemed to be systematically increased in the patients with CRPS or 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 that includes administering phentolamine to mass the sensitive receptors. Another technique involves placing the anesthetic next to the spine to block the sympathetic nerves.
• Medications: multiple categories of medicines are utilized for treating CRPS/RSD, involving opioids, corticosteroids, antidepressants, antiseizure drugs, and topical analgesic drugs. However, no drug combination or single drug has continuously improved the signs.
• Intrathecal drug pumps: These instruments administer the medications directly to the spinal cord, allowing the anesthetic mediator to reach the targets of pain signals in the spinal cord at doses less than those needed for oral administration.
• Spinal cord stimulation: stimulation of 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 has been in use for more than 3,000 years. It has recently become renowned worldwide, particularly for treating CRPS and RSD. Hence, Chinese medicine can help address each aspect of CRPS/RSD; herbal medicine or acupuncture is exceptionally productive. Various pieces of research have shown that acupuncture for regional pain syndrome can:

• Regulate the immune function.
• Attenuate inflammation
• Improves or relieves 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 dependence on inappropriate medicines

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

SCIENTIFIC RESEARCHES:

Over time, scientists worldwide have researched multiple studies to explore the mechanism of acupuncture for regional pain syndrome. The results reveal that acupuncture has a scientific basis. Here is some evidence:

• Reducing the contraction of muscles, hence reducing the muscle spasm
• Increased blood circulation to the areas of injury, thus reducing tissue swelling and speeding up the recovery of the injury.
• Increasing the release of natural pain-lowering endorphins
• Increase the production of 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 levels of homovanillic acid, dopamine, acetylcholinesterase, and serotonin; all increase the pain threshold and lead to pain relief.

ACUPUNCTURE FOR REGIONAL PAIN SYNDROME:

According to the patient’s specific diagnosis, multiple acupoints must be applied. Electric acupuncture is utilized for individuals with CRPS or RSD. According to the proper diagnosis of the patient, the suitable acupoints were selected for: 

• Blood obstruction
• Qi stagnation
• Cold retention stagnates 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 the 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 is one of the modalities of Chinese medicine. It improves the acupoints for realigning or adjusting stagnated qi, which restores the normal flow of qi to the places where the illness or pain originated.

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

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

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

Tui Na is the other modality, renowned as a Chinese therapeutic massage and 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 focus on some aspects of the laws, for example, gliding, rolling, percussion, kneading, pulling, friction, rocking, rotation, shaking, and vibration by utilizing the thumb, fingers, palm, knuckles, and elbow. It relaxes the tightened ligaments and tendons, eradicates coldness and warms meridians, opens up the channels and meridians, improves blood circulation, attenuates the pain, eradicates the edema, harmonizes the stomach, and strengthens the spleen.

The first two critical steps in Chinese medicine are making the right diagnosis and selecting the correct herbal formula. The second essential thing during the treatment period is setting the acupoints and maintaining the herbal formula; for instance, adding herbs to the original method of herbs will affect the patient’s response to treatment. The third step is combining multiple modalities of acupuncture according to the diagnosis and situation of the patient. Different patterns, when combined, have a positive effect. 

Acupuncture treatment for regional pain syndrome is available 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 by combining acupuncture and Homeopathic Medicine. So far, this treatment is the most effective compared to the traditional use of painkillers and physical therapy. Book your appointment with Dr. Tsan to discuss your treatment plan and the best options. Contact us at (267) 403-3085 for more information.