Reflex Neurovascular Dystrophy

Reflex Neurovascular Dystrophy

Reflex neurovascular dystrophy (RND) has two more names – reflex sympathetic dystrophy (RSD) and, probably the best known one, complex regional pain syndrome (CRPS). It is a complicated condition which results in very long-lasting chronic pain which gets worse over time.

The most noticeable features are pain of very high levels, inflammation, swelling and increased sensitivity. Furthermore, reflex neurovascular dystrophy also spreads over time. Very often it starts from one part of the body, usually a limb, and then spreads further. About 35% of patients report that symptoms have spread all over their bodies.

What is reflex neurovascular dystrophy?

The pain and inflammation that spread throughout the body do not have a clear cause. What the scientists know now is that it is associated with problems within the central nervous system and autonomic nervous system which is a part of the peripheral nervous system affecting the way many internal organs function.

This results in problems which can include various kinds of functional loss, and even disability. Many times reflex neurovascular dystrophy comes after some kind of a severe injury or a surgery, but since it is basically a painful result of a faulty nervous system, it can start on its own, without any damaging cause at the site.

Research shows that RND is not caused by any kind of a psychological problem, although issues such as depression and anxiety often accompany it. However, they are considered a result, rather than cause, since prolonged pain severely worsens the quality of life and hampers even basic functioning.


After learning what reflex neurovascular dystrophy is and that it is also called complex regional pain syndrome, it is clear that it is actually more like a set of interconnected medical signs and symptoms, rather than a disease on its own. This makes it even more widely spread and more difficult to treat.

Moreover, reflex neurovascular dystrophy is considered a part of amplified musculoskeletal pain syndrome, which is considered the feeling of acute or chronic pain with no clear cause.

It is thought that various kinds of nerve damage are the causes of reflex neurovascular dystrophy, but it is not present in all cases.

Reflex neurovascular dystrophy
RSD – Image powered by

Reflex neurovascular dystrophy has three distinctive stages, but it is thought that they are not always in sequence, but rather triggered by something. This means that the patients can have just one of the stages without necessarily progressing further.

The first stage includes the initial symptoms and goes as far as severe pain, swelling, joints problems, spasms in the muscles and changes in the colour and temperature of the skin.

The second stage comes with even more pain while swelling spreads beyond the initial site. The damage is noticeably more severe and affects the entire area which reduces hair growth and damages nails and bones. Muscle atrophy is also present in this stage.

The final stage goes beyond any possibility of reversing to the completely healthy state. Pain is even higher and impossible to control, skin and bones are damaged permanently, muscle atrophy is very common, tendons are also damaged and the limb is completely affected even to the point of being displaced in some cases.

Lastly, overactive immunity system can lead to reflex neurovascular dystrophy. The same goes for cytokine release, activation of glia cells and oxidative damage.

Reflex neurovascular dystrophy prognosis

Provided that the treatment has started in the early stages, treating reflex neurovascular dystrophy can provide significant results both in terms of relieving pain and dealing with the underlying cause.

The longer it lasts the more damage it causes and the more difficult it is to treat. This becomes so especially when the condition causes irreversible changes. Vast majority of patients experience spreading of the symptoms to the areas beyond the initial one.

In case it is treated successfully there is a high possibility of its reoccurrence after an injury. This calls for preventive steps and additional precautionary measures.

Reflex neurovascular dystrophy symptoms

The most obvious symptoms are neurogenic inflammation, vasomotor dysfunction and nociceptive sensitization. All of these things cause changes in the outer condition of the affected areas and increased pain and sensitivity.

Together with general pain, patients also suffer from burning and stabbing sensations and the inflamed limbs make it very painful to touch them, or even move.

CRPS – Image powered by

Swelling is a common thing, as are changes in colour and temperature of skin, while muscle spasms are less common but also present enough to merit a mention.

Aside from muscles and tissue, reflex neurovascular dystrophy can also affect bones and joints.

All of these symptoms come from a general systemic problem and they greatly vary in duration and severity. This also means that almost any organ inside the body can be affected.

As already mentioned, pain is the most common symptom and the one that is most easily noticeable. Psychological stress can also increase the feeling of pain.

Reflex neurovascular dystrophy in children and adults

Reflex neurovascular dystrophy does not depend on age, or gender, although it is far more present with women. The average age at the moment of diagnosis is 42, but many children have been affected by it, so it is by no means limited to adults only.

Actually, the number of adolescents with reflex neurovascular dystrophy is increasing, which means it is bound to reduce the average age at diagnosis.

Reflex neurovascular dystrophy treatment

As the occurrence of reflex neurovascular dystrophy is so widely spread, so are the treatment options. Similarly, the differences in the severity of symptoms also call for different levels of treatment.

Several forms of physical and occupational therapy, including things like electrical nerve stimulation and massage. They have shown success with the initial stages of reflex neurovascular dystrophy, but fail to deal with increased damage.

Speaking of medications, the uses of ketamine and bisphosphonates have shown results. The latter is a fairly new form of treatment that seems to reduce pain, but the research is lacking in number and scope to provide conclusive evidence. Ketamine, on the other hand, seems more tested. It is good for treating pain, but it will not improve function, or provide benefits against the underlying cause.

The same goes for any other painkiller. They often bring pain relief in the early stages of reflex neurovascular dystrophy, but they come with a set of side effects and do not do anything to provide general benefits, or prevent spreading.

Different forms of surgery are also present. These include stimulation of the spinal cord, which can help with pain, sympathectomy, which comes with a great number of risks and not enough confirmed benefits. In severe cases and as the last option, amputation is the final surgical solution. About 50% of patients will successfully eliminate pain after amputation, while others will still experience pain, be it pain at the amputation site or the phantom limb pain.

Lastly, palmitoylethanolamide (PEA) can be seen as a solution, both in terms of relieving pain and calming the inflamed tissue and serving as prevention. These effects come from the only ingredient in PEA, which is palmitoylethanolamide, an endogenous fatty acid which is used by the body to deal with pain, inflammation and tissue and cell recovery.

It works by affecting a number of different receptors inside the body which are spread all over the nerve system and tissues. These treat pain by reducing the expression of both iNOX and COX-2 and dealing with the endocannabinoid system. However, PEA also calms mast nad glia cells and affects receptors which regulate our immune response and inflammation levels. By relieving inflammation and blocking the pain sensation, PEA can make pain far more bearable, but also treat reflex neurovascular dystrophy in the healthiest and safest way possible, having no side effects, negative interactions or habituation issues.

Learn more about how PEA works here.