History

"Complex regional pain syndrome'' is the term recommended to the IASP to replace the term "reflex sympathetic dystrophy'' (RSD) on the grounds that it does not represent a reflex, it does not need a sympathetic component, and there is not necessarily dystrophy. However, RSD is still the search term used by the National Library for Medicine/Medline and a patient support group (www.rsds.org). One of the best historical perspectives of pain related to nerve damage was provided by Sunderland.4 This consisted of clinical observations from a senior and experienced neurologist rather than scientific data. They included observations relevant to CRPS, as well as causalgia. He noted:

• greatest incidence after lesions of the medial cord of the brachial plexus, median, sciatic, and intercostal nerves;

• immediate onset of pain;

• hyperesthesia and allodynia;

• spread to neighboring uninjured areas;

• gradual resolution;

• failure to relieve pain by neural blockade.

Sympathetic blockade sometimes provided temporary relief. It is implied that CRPS is a disorder of a single extremity, although there are case reports of migratory CRPS5'6 and whole-body CRPS.7

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