Expanding the Rehabilitation Team for Patients With Reflex Sympathetic Dystrophy

Case management (medical and vocational) and life care planning are important strategies that are indicated for intervention with individuals diagnosed with Reflex Sympathetic Dystrophy (RSD) or as the evolving term is utilized, Complex Regional Pain Syndrome (CRPS). The case managers and life care planners should be extensions to the multidisciplinary team.

The demographics of individuals with RSD/CRPS reveal the following:

1. Six million individuals with RSD/CRPS live in the United States ¹
2. 65% of these individuals contract the disease in their thirties and forties ¹
3. RSD can start as young as three years of age ²

The duration of RSD/CRPS varies. It may last from weeks in mild cases followed by years of remission, even indefinitely in some cases. Other cases are more chronic with remissions and exacerbations varying from weeks and months to years.³

The facts of RSD/CRPS are:²

• 70% of individuals with RSD/CRPS develop depression
• 50% of individuals with RSD/CRPS have seriously contemplated suicide
• 40% of individuals with RSD/CRPS have seen greater than 10 physicians since onset of symptoms
• RSD/CRPS "spreads" to other parts of the individuals body in 80% of individuals

Problems and effects of RSD include:³

• Extreme pain
• Lifelong pain for some individuals
• Prolonged family disruption
• Disability and unemployment
• Misdiagnosis of pain syndrome
• Improper treatment and therapeutics
• Multiple surgeries
• Ineffective procedures
• Diminished quality of life
• Increased costs of healthcare
• Inexperienced healthcare providers
• Unnecessary litigation

Improper treatment with poor outcomes may be the result of misunderstanding and/or misdiagnosis of RSD/CRPS. The rehabilitation goals for individuals with RSD/CRPS are amelioration of suffering, reversal of disease course, return to gainful employment, avoidance of surgical intervention, and quality of life enhancement.

Treatments are varied including pharmacological management; blocks; biofeedback and guided imagery; dietary; hyperbaric oxygen; intrathecal pumps and spinal stimulators; physical medicine; and pain management. The multidisciplinary team has proven to be the most effective means of rehabilitating individuals with RSD/CRPS. 4 Expanding the team to include case managers and life care planners will enhance the team effectiveness in minimizing the problems and effects listed above.

RESOURCES

1. www.rsdhope.org
2. Available upon request
3. Reflex Sympathetic Dystrophy/Complex Regional Pain Syndrome (RSD/CRPS): Clinical Practice Guidelines. Second Edition. Anthony F. Kirkpatrick, MD, PhD Editor. October 15, 2000.

Consider Rehabilitation Advisors, Inc. quality interventions with your team for treatment of individuals with RSD/CRPS. For further information on the benefits of medical case management, vocational counseling, and/or life care planning contact Betty Reid, RN, at the address listed below.