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March 1988

Reflex Sympathetic Dystrophy

Arch Neurol. 1988;45(3):243-244. doi:10.1001/archneur.1988.00520270013006

To the Editor.  —Two aspects of the recent review of reflex sympathetic dystrophy (RSD) presented by Schwartzman and McLellan invite comment.1First, the statement that RSD is "a syndrome of burning pain, hyperesthesia, swelling, hyperhidrosis, and trophic changes in the skin and bone of the affected extremity" obscures the fact that not all of these signs and symptoms are present in all cases of RSD. The essential features of RSD are as follows: (1) a spontaneous burning pain accompanied by (2) a painful sensation to gentle touch in the affected area (allodynia or hyperpathia); and (3) relief of these pains by sympathetic block.2 Secondary signs such as dystrophic tissue and bone loss do not occur until later stages of the disease, and probably result from chronic disuse and extreme guarding behavior.3,4 Sympathetic hyperfunction is also not a prerequisite for the diagnosis of RSD, as many patients with RSD have normal