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Stage One
Stage one is called the acute stage and can last one to three months.
Some characteristics are warmth, coolness, burning pain, edema, increased sensitivity to
touch, increased pain, accelerated hair/nail growth, tenderness or stiffness in the joint,
spasms, limited mobility, some bony changes may be visible on X-Ray, abnormal amount
of pain for the injury. In this stage there is decreased sympathetic activity. For the patient,
she, typically a she, may feel as if their limb is on fire and is amazed when it actually feels
cool to the touch (this is due to the lack of blood flow to the extremities).
Stage Two
Stage two is called the Dystrophic Stage and can last three to six months.
Pain is constant, as in stage one, and throbbing, burning, aching, crushing in nature and is
exacerbated by any stimuli. The affected limb may still be edematous, cool, cyanotic
(discolored), or mottled (different shades). Nails are brittle and ridged. Pain and stiffness
persists. Muscle wasting may begin.
Patient usually starts experiencing short-term memory problems, as well as increased pain
from noises and/or vibrations, and other changes in the limbic system; these include the
inability to concentrate, find the right word when speaking. X-Rays may reveal signs of
osteoporosis. Patients may start to repeat themselves.
Some Doctors will try and use tools such as x-rays, Bone Scans, thermograms, and
others during Stage 2 and Stage 3 to confirm a diagnosis of RSDS. **Understand that
while these tests MAY show the presence of RSD, they are rarely conclusive and they
should not be used as the sole determining factor in whether a patient does or does not
have RSD. The only positive way of diagnosing RSD/CRPS is a physical exam by a
Doctor knowlegeable in RSDS.** These other tests should only be used as one of many
tools to aid in that diagnosis. They are also useful in tracking the progress of the disease
over the course of the time.
Stage Three
Stage three is called the atrophic stage and can last an unlimited amount of time. Pain as
usual is typically constant but can increase or decrease, depending on the person, and the
RSDS may spread to other parts of the body. At this stage irreversible tissue damage
may occur. Skin becomes cool, thin, and shiny.
Contraction of the extremity may occur as well as atrophy of the limb (decreased joint
movement). Skin atrophies (wasting away) and loss of movement or mobility may also
occur. X-Rays may show marked demineralization and increased osteoporosis.
At this stage many RSD patients are not likely to be effectively treated with blocks as the
percentage of SIP (Sympathetically Independent Pain) is now much greater than the
percentage of SMP (Sympathetically Mediated Pain), meaning the majority of the pain
signals are now originating in the brain and not at the original RSD site where a local block
would help.
Pumps are usually discussed at this stage but there are other treatments available
and more are coming all the time.
Stage Four
n this Fourth Stage, RSD is resistant to many forms of treatment and many
Physicians would now recommend a Pump, DCS/SCS, Ketamine Protocols.
Also in this stage there is an involvement of the inner organs.
Please do not allow any Doctor to amputate the affected limb unless it is a medical
necessity due to gangrene or the like. While it is infrequent, there are some uneducated
Doctors out there who are performing amputations in an effort to eliminate the RSD pain.
This is not only barbaric it is ineffective. It not only does not work but it also in most
cases will exacerbate the RSD and increase the spread rate.
