Reflex Sympathetic Dystrophy, Fibromyalgia And Spread
While occasionally someone afflicted with Fibromyalgia is told he may have Reflex Sympathetic Dystrophy (RSD), it is not uncommon for someone with RSD to be told he has Fibromyalgia. Unfortunately, this only adds confusion to those with either of these disorders.
The hallmark of RSD is cold sensitivity in the presence of vasomotor and sudomotor change (abnormal skin color and sweating), which may progress to edema (swelling), contracture (loss of range of motion), and bone loss. Symptoms usually begin after an identifiable, causative event. In patients with RSD, the weather-sensitive component may manifest itself as pain that increases with barometric change. This is a noticeable worsening and a major feature in those with RSD.
In contrast, Fibromyalgia patients may also have weather sensitivity; however, this problem is not a hallmark feature of the disorder. Fibromyalgia patients tend to have more generalized pain, earlier complaints of fatigue, and a history of immune system over-activity or persistent infection when compared to the RSD patient. Fibromyalgia patients are less likely to have an inciting event that they can relate their symptoms to.
Despite these variations, there may be considerable overlap between the two diagnostic groups. For example, an RSD patient whose symptoms seem to have spread may look very much as if they have Fibromyalgia. This is because the new areas of pain may have no obvious inciting event, are less likely to be associated with contracture or bone loss, and are often associated with increasing fatigue.
While it is important to evaluate new symptoms to determine if there has been a progression of RSD, spread can usually be proven in only a minority of cases. New symptoms may:
- represent an unrelated problem
- provide evidence that the disease has developed into Chronic Regional Pain Syndrome (CRPS) that is independent of sympathetic pain
- be a clue that there is hidden infection or immunologic compromise.
If the previously mentioned hallmark changes for RSD occur, or if thermographic or bone scan findings confirm objective findings, then true spread of RSD can be diagnosed. Likewise it should be recognized that a Fibromyalgia patient’s symptoms might progressively worsen to the point that the sympathetic component becomes dominant and RSD features develop. While this is not common, if it does happen, treatment should be aggressive.
Although there can be considerable overlap between patients with sympathetic pain who do not develop full blown RSD and Fibromyalgia patients who are weather-sensitive, a skilled clinician should be able to differentiate between the two conditions in the majority of cases.