Hypersensitivity and Chronic Regional Pain Syndromes: Sympathetic Reflex Dystrophy

Paul L. Reller L.Ac. / Last Updated: August 03, 2017

A variety of painful or uncomfortable symptoms may occur that are different from the normal sensation of pain and often very alarming or debilitating. These symptoms often come in episodes with sudden inexplicable onset, are difficult to relieve, and go away just as inexplicably. This is of course very alarming and often leads to much anxiety. I hope to give you a little information that helps to explain what might cause these symptoms so that you can take a proactive approach to correcting the causes and perhaps deal with these strange symptoms more objectively.

Nerve related pain, or neuralgia, can take many forms. Usually there is a burning or sudden shooting pain (lancinating), often with a sharp sensation like pins and needles sticking you (dysesthesia), or with numb tingling sensation (paresthesia).; It may also take the form of painful sensitivity to light touch or temperature changes (allodynia), exaggerated pain response (hyperalgia), or alarming pain response (hyperpathia). It may accompany various autoimmune disorders, such as rheumatoid arthritis, vascular or circulatory disorders, such as those involving small blood clots or thromboemboli, reactions to drugs or pesticides, chronic inflammatory conditions, nervous system disorders, such as reflex sympathetic dystrophy, or in most cases, show no clear cause (idiopathic). This array of possibilities and difficulty with diagnosis makes these symptoms that much more alarming and creates even more anxiety. Patients often see a number of specialists that give them no clear answers, or worse, are dismissed by frustrated doctors who are unable to help them or give them a quick wrong diagnosis, such as sciatica or carpal tunnel. The medical business often likes to try to placate the patient with a little pain medication and physical therapy, or worse, steroid shots. Their alternative is to spend a lot of money to find the real diagnosis, and then often have little to offer in terms of standard treatment.

Many diseases and syndromes with unknown cause (idiopathic) are thought to be the result of a number of chronic health problems rather than a single cause. The word syndrome is assigned to a condition that has no specific disease mechanism, and the word means that this condition is merely a collection of symptoms that appears to affect a large number of patients in a similar presentation. Modern medicine is not adept at treating problems that require a holistic approach, focusing its attention on using treatments that do specific actions, rather than treating a set of problems that are interconnected. Allopathic treatments focus on blocking specific mechanisms of symptom cause and usually ignore restoration of homeostasis, or normal physiological function. Often, an array of specific pharmaceutical treatments is given as the problems worsen, with the resulting addition of harsh side effects adding to the problem of chronic ill health. While intelligent medical doctors realize that the patient should reduce medications and regain healthy function, they are not trained to help in this regard. The patient needs to understand the need for a full program of care and rehabilitation and take a proactive approach. This process doesn't happen overnight.

The patient needs to know 2 things to proceed with getting well when confronted with difficult and complex pain and hypersensitivity syndromes. The first is basic information about what makes these symptoms described above occur in the body, and the second is a little information about the possible syndromes or diagnoses that are possible so that you may begin searching for a true diagnostic answer. You must keep in mind that the therapy for many of these syndromes is similar. For most, there is little effective drug or medication therapies that work, and no surgical approaches. Many medical manuals have recommended trigger point needling, myofascial release, physical therapies, stress reduction, cognitive and behavioral therapies, and positive changes in diet and lifestyle as the only alternative and suggest a multidisciplinary approach to treatment for most of these syndromes. This requires some time and work on the part of the patient, but it will pay off. Don't delay this treatment protocol while you wait for a diagnosis and some miraculous cure. There may be a new effective and necessary treatment waiting for you, but for now, do all that you can to get healthy and continue to pursue correct diagnosis by seeing specialists and running tests.

The thing that you must avoid in these various hypersensitivity disorders is unnecessary stress and worry, which will aggravate the nerve related condition. You must convince yourself that you will calmly proceed to understand your condition and do all the right things to heal. The M.D. will often suggest an anti-anxiety medication. There are healthier ways to calm anxiety, but if you must resort to these, try taking them for a short time and be sure to reduce dosage slowly as you go off of the medication. The most important aspect of healing from these difficult disorders is to seek a more step-by-step objective approach and patiently resolve the various underlying contributing factors that drive the disease process, though. A Complementary and Integrative Medicine (CIM) physician, such as a Licensed Acupuncturist and herbalist, can provide this important part of the care, more time spent with the patient to help build the mind-body holistic approach that is needed.

Reflex Sympathetic Dystrophy (RSD):

One of the poorly understood disorders that is diagnosed to account for the symptoms described above is called Reflex Sympathetic Dystrophy. Like a number of diagnoses for difficult diseases, this name merely reflects what appears to be going on in the body rather than something objective that is specifically found wrong with the tissues or the chemistry. The National Institute of Arthritis and Musculoskeletal Skin Diseases of the National Institute of Health states: "Currently, little is known about the cause of this disorder, which leads to frequent misdiagnosis, and ultimately the condition is mistreated or goes untreated." The term Reflex refers to the episodic nature of the symptoms that are triggered by a usually benign occurrence, such as cold air, light touch, abrasive clothing, or emotion. The term Sympathetic refers to the reflexive part of our nervous system that usually regulates overt responses to danger or excitement. The term Dystrophy refers to a loss of nutritive flow to the tissue, either by the nerve or blood vessels being obstructed or pinched, or because of a systemic metabolic or nerve related deficiency. The sympathetic nervous system is coupled with the parasympathetic nervous system in what we call the autonomic nervous system, which automatically runs everything in your body and is regulated in the brain and spinal cord, which is called the central nervous system, or CNS. When there is an imbalance between the sympathetic and parasympathetic nervous systems, we may see inappropriate responses and sensations in the body.

What causes these reflexive responses? It is known that chronic pain and myofascial syndromes may eventually cause autonomic nerve dysfunction. Myofascial refers to the muscle, myo, and the connective tissue, fascia, and the dysfunction involves constant neural firing due to sustained contracture and/or weakness. The sustained firing, rather than the normal firing and relaxation, may eventually cause the balance between the sympathetic and parasympathetic systems to go awry. The sympathetic nerve response in the muscles involves the constriction and dilation of the blood vessels. This is a reflex response which you have no conscious control over. When the vessels are suddenly constricted or dilated, there may be sudden pain response, as well as hypersensitivity and unusual nerve stimulation due to changes in swelling, temperature or the concentration of inflammatory chemicals. The sympathetic nerve response to the skin involves regulation of sweat or dryness, tightening and reaction of the hairs to stimulation.

Since the ultimate regulation of these nervous systems occurs in the part of the brain called the hypothalamus, there will be an attempt by the body to correct all of this nervous dysfunction. Often, the hypothalamus may struggle, because it is greatly affected by the emotional part of the brain, the limbic system, as well as the hormonal part of the brain, the endocrine system. The degree of complexity in understanding such brain dysfunction is enormous. There is a slight possibility that there is something wrong with the brain tissue itself, such as a tumor or scar tissue, but this is a rare occurrence. The specialist may initially schedule a brain CT scan to rule out such rare disorder, but you shouldn't by overly alarmed by this test. It will almost always confirm that there is no problem with the brain tissue. Likewise, MRI tests of the spine may be prescribed. EMG tests of the peripheral nerve conduction may also be performed to narrow the diagnostic choices. A thermogram, bone scan, or a sympathetic block may be used to diagnose. There is no definitive objective way to diagnose, and so this evidence is used to support the diagnostic opinion.

While Reflex Sympathetic Dystrophy is the most likely cause of allodynia (hyperactive pain response due to central nervous system sensitization) and other unusual symptoms, there are a few diagnoses that must be considered as possible causes as well, and a careful and thoughtful differential diagnosis must be considered and analyzed. Raynaud's Syndrome involves a reaction to cold temperature with painful lack of circulation to the hands and forearms. Rheumatoid arthritis involves a sudden painful swelling hot pain to the hands. Thromboangitis obliterans involves the accumulation of small emboli in the smaller arteries, obstructing and diverting flow, resulting in episodic pain, sensitivity and numbness, usually at the thigh. Peripheral neuropathy may occur in specific limbs due to thoracic outlet syndrome, reaction to medication, diabetes, or a protein imbalance. Thoracic Outlet Syndrome is a common disorder of repetitive postural stress that holds the deep muscles of the neck and shoulder in constant contracture that decreases circulation to the extremities, and contributes to cervicobrachial lesions and neural impingement. Exposure to heavy metals and pesticides may eventually cause these symptoms as well. The list is long, and these should be explored.

These disorders occur because of an accumulation of health problems combined with excess stress. The body only has energy to deal with so many problems. Often, the patient ignores the mounting problems and continues to work very hard, often with a growing problem of poor sleep and rest, and possibly an insufficient diet. Since the problems are chronic, the patient is often in denial. Chemical imbalances create a pattern of poor nerve and blood supply to the extremities and the body tries to counter with an excess nerve conduction. This results in a hypersensitivity reaction similar to the allergic response that is triggered by an unusual period of physiological stress.

The road back to health demands increased rest and attention to a number of types of therapies for awhile. Failure to adopt a wholehearted approach that is holistic will only hinder the recovery. A decision to change the diet and lifestyle, get frequent treatments, take all the necessary herbs and supplements, and not allow oneself to get anxious and depressed will result in success. You may not fully recover, but you will get to a state that is workable and allows you to go on with your productive life with the most minimal discomfort and debility possible. My experience is that every patient may achieve a full recovery if they work hard at it. Feel free to discuss these issues and facts with me at any time in the future, and I hope that you will allow me to guide your therapy and recovery.

The Confusing History of Hypersensitivity Syndromes, variety in Terminology, and even adamant denial of the existence of such disorders

Reflex Sympathetic Dystrophy Syndrome is now the term used by most experts to describe this all-too-common rheumatic disorder that has been denied proper diagnostic assessment and treatment for many decades. In the past, various disease names were used to describe the disorder. Sudeck's Atrophy, also now called Shoulder-Hand Syndrome, Algodystrophy, and Chronic Regional Pain Syndrome, are just some of the names used to describe Reflex Sympathetic Syndrome and Causalgia, which was a term used to describe the condition noted during the American Civil War by Dr. Silas Weir Mitchell. Both vasomotor (neural vascular abnormalities such as swelling) symptoms and sudomotor (sympathetic cholinergic affects on the sweat glands) symptoms were commonly noted, as well as pain, dysesthesia, and paresis, all thought to be localized to a lesion in the peripheral nervous system. In recent decades, MRI studies have shown that these syndromes have a systemic affect, involving not only the peripheral dysfunctions, but cognitive, motor and nociceptive (pain, tough and temperature sensation) effects. There is compelling evidence that the glutamate receptors called NMDA receptors were involved at the brain stem and areas of the brain to increase hypersensitivity. A number of physiological effects have also been documented that relate to aftereffects of trauma, disease or environmental toxicities, including immune cytokine imbalance, neurogenic inflammation, andrenoreceptor pathology, oxidative damage, as well as sympathetic dysfunction. In the past, the syndrome was usually diagnosed in patients age 35-45, often after a traumatic event or disease, but in recent decades, more younger adults, adolescents, and even infants are now diagnosed with Reflex Sympathetic Dystrophy Syndrome. There is much speculation that the obvious reluctance to diagnose these syndromes, probably because there was no objective tests in diagnosis, and no effective treatments, had led to the lack of confirmed diagnoses in younger patients.

By 2014, the Budapest Clinical Diagnosis Criteria for Complex Regional Pain Syndrome, or Reflex Sympathetic Dystrophy Syndrome, noted the criteria for diagnosis as continuing pain that is disproportionate to any inciting event, with at least one symptom in 3 of 4 categories of sensory, vasomotor, sudomotor/edema, and motor/trophic: 1) hyperesthesia and/or allodynia, 2) temperature assymetry, skin color changes, and/or skin color assymetry, 3) edema, sweating changes, and/or sweating assymetry, and 4) decreased range of motion, motor dysfunction (weakness, tremor, dystonia), and/or trophic changes (growth in hair, nails or skin). Osteoporosis, increased bone metabolism and arterial hyperperfusion on bone scan, and MRI findings of muscular edema, atrophy, fibrosis, fatty infiltration, interstitial edema, soft-tissue edema, vascular hyperpermeability, bone marrow edema, joint effusion, skin thickening and/or skin thinning are commonly noted in tests. There is still little explanation for these symptoms, though, in standard medical texts, and an insistence that these syndromes, classified under at least 5 different names in the past, mainly occurred only after trauma. There is now a consensus that treatment must by multidisciplinary, involving orthopedists, pain specialists, physiotherapists, occupational therapists, and psychological services. Clinically, now that these Chronic Regional Pain Syndromes, or Reflex Sympathetic Dystrophy Syndromes, are finally being recognized in diagnosis, physicians are seeing more and more cases that do not follow a physical trauma to the affected limb. The array of presentations of this poorly understood set of hypersensitivity syndromes is great, though, often with symptom presentation coming and going.

A prevalent current theory of the pathophysiology of these syndromes involves a period of excessive afferent (outgoing) sympathetic activity at the spinal cord ganglion with induces increased efferent (incoming to the brain) activity, with supersensitivity to catecholamines (adrenaline or epinephrine, norepinephrine, dopamine) induced by partial autonomic denervation, and exess hyperexcitability at sensory nerves in the spinal cord or brain axons. This complex set of dysfunctions causes release of neuropeptides at the peripheral nerve endings that cause the common symptoms. The increased pain signals may also alter pain processing in the brain. While standard medicine offers eventual nerve gangion blocks, surgical or chemical nullifying of the sympathetic nerves affected, radiofrequency ablation of the nerves at the spinal cord, and drugs to stop osteoporosis (biphosphonates), and drugs to block sympathetic signals or alpha-adrenergic blockers, all of these treatments come with considerable adverse side effects and disability. On the other hand, Complementary Medicine offers and array of treatments that can be tried and integrated into care, along with TCM physiotherapies, that could offer substantial benefits without adverse effects. Acupuncture and electroacupuncture have been proven to work by various mechanisms, both local and central, with modulation of the centers for pain perception as one potential mechanism, and studies proving that these central effects modulate many of the symptoms we see in these syndromes. Added to this are an array of herbal and nutrient chemicals that are neuroprotective, promote neural regrowth, and provide antioxidant, antifibrotic, and autonomic modulating effects. Topical herbs and nutrients may affect the peripheral metabolic and inflammatory dysfunctions as well. Of course, these therapies should be provided by a knowledgeable Complementary Medicine physician, or Licensed Acupuncturist and herbalist, and integrated into standard care. Since these therapies offer an array of treatment protocols for this complex set of syndromes, with no adverse side effects, there should be no reason to avoid this aspect of therapy. To date, standard medicine almost always discourages this integration of TCM, though. It is usually the choice of the patient to utilize this resource.

Therapeutic approaches in Complex Regional Pain Syndromes and Hypersensitivity Disorders

Obviously, a short article on the web cannot address the complexities of therapy involved in this set of syndromes. Each type of syndrome must first be diagnosed correctly, and then each individual case must be treated according to the individual problems presented. This involves an integrated medical approach, where the patient is persistent with diagnostic tests and exams by the right specialists, and also persistent with seeking the right therapists. Often, the best diagnostic experts are not the physicians that offer the best therapies. What is widely acknowledged now is that evidence in recent years suggest a broad array of dysfunctions, affecting local tissues, the peripheral nervous system, the autonomic nervous system, and the central nervous system, and suggesting that a holistic approach to therapy is essential.

The knowledgeable Licensed Acupuncturist is able to provide a variety of therapies in a multidisciplinary approach, and work with M.D.s and other physicians to present both a wider diagnostic perspective, as well as an array of effective therapies that complement each other. The patient that takes a proactive approach and manages the integrative care will achieve the most success. This means that the patient becomes knowledgeable on the syndrome, is persistent with the proper diagnostic tests and exams, and obtains copies of these test results to present to various physicians with different specialties. The Complementary Medicine physicians may include the Licensed Acupuncturist, who may be able to combine various physiotherapies with expert herbal knowledge, nutrient therapies, acupuncture, and the time spent teaching the patient appropriate self-administered therapies and changes in diet and lifestyle. The treatment approach may be supported with the latest scientific study, where herbal and nutrient medical research has expanded immensely and is available on the internet.

Often, a variety of problems must be addressed in a coordinated manner. If there are a number of causative or aggravating factors perpetuating the chronic regional pain syndrome or hypersensitivity disorder, attention to only one factor will not stop the problem from continuing. Mechanical physical stresses must be relieved with myofascial release, soft tissue mobilization, and neuromuscular reeducation. Acupuncture stimulation may play an important role in this, as well as other aspects of the syndrome. Alone, the acupuncture may have limitations of benefit, but combined with the appropriate manual soft tissue therapies, the benefits may be dramatic. Likewise, herbal and nutrient medicine may contribute important mechanisms of therapeutic correction, but without the contribution of manual physiotherapies, the effects may be incomplete.

Chemicals in specific herbs are well documented, and the activities of these chemicals have been explored, and often confirmed in human clinical trials. Research continues to uncover specific physiological mechanisms related to the symptom causes, and connect these tissue and immune dysfunctions to specific herbal chemicals. The patient cannot be expected to understand all of the complexities of the physiology in research, but the Licensed Acupuncturist has received a thorough eduction in an approved medical college, and is able to understand the research and find the right herbal chemicals to achieve the necessary results. The United States government and the National Institutes of Health operate various research databases with this information, the most prominent being the PubMed database, which now comprises more than 19 million scientific study citations for biomedical articles published on MEDLINE and various medical and life science journals, as well as links to countless full-text articles on medical research.

An example of holistic protocol in the treatment of chronic regional pain syndrome; treatment of Sympathetic Reflex Dystrophy

One example of a syndrome in the category of chronic regional pain syndromes is Reflex Sympathetic Dystrophy. The name reflects the mechanism of the problem, not the actual disease, or cause. Reflex refers to the fact that this is a nerve and vascular reflex to a stimuli, sympathetic refers to the autonomic nervous system, which is not consciously controlled, and is a balanced nervous system response where the sympathetic and parasympathetic nerve signals create a functional balance of organs, muscle responses, etc. Dystrophy refers to a malnutrition to tissues of blood nutrients and/or nerve signals. Modern medicine understands that this is a syndrome where normal physiological responses act reflexively in a dysfunctional manner, and the tissues affected are denied normal blood nutrients and nerve stimuli. We still do not know the exact physiological cause, or causes, but we have observed that the syndrome often has on onset after strong trauma or physiological stress. The syndrome may vary from a severe debilitating upper extremity painful swelling and weakness, to an episodic lower extremity pain and numbness, and is usually accompanied by other autonomic nerve symptomology. Since this is a complex disorder, the treatment strategy in Complementary Medicine must address a more complex array of physiological problems to be successful. Since these various dysfunctions work together as a whole to create the symptoms, the physician cannot just address just one dysfunction. This has been tried in allopathic medicine for decades with limited success. A holistic treatment protocol is needed.

Scientific study has identified that strong sensory sympathetic nerve stimuli to the central nervous system at the spinal cord creates a strong efferent, or exiting, response from the spinal cord to the affected limb. The nerves exhibit a supersensitivity that has probably occurred over long period of time, as well as a loss of autonomic nerve receptors, or denervation. The symptoms occur when these affected nerves are highly stimulated and release excess neurotransmitters at the nerve endings that sometimes stimulate drastic swelling and nerve ending hypersensitivity. A feedback mechanism may also affect the nervous system at the brain or spinal cord, causing an array of other symptoms and perpetuating the dysfunctional responses. Scientific study does show that excess catecholamines are released because potassium triggers an exagerrated dopamine response. Catecholamines are chemicals that may serve as neurotransmitters and hormones, and constantly are produced to regulate the nervous and endocrines responses. Adrenaline is an example of a catecholamine. Decreased catecholamines at nerve endings seem to stimulate a reflexive high release at the beginnings of the nerves, at the spinal cord.Treatment with drugs called sympathomimetic amines, which are like catecholamines, are sometimes tried, but the adverse side effects of these drugs are often alarming.

This type of scientific study, though, suggests that a number of treatment approaches with a holistic protocol combining herbal chemicals, nutrient medicines, acupuncture and even physiotherapy may be effective. Nerve supersensitivity implies that a myofascial syndrome existed prior to the onset of the reflex sympathetic dystrophy. Myofascial release and clearing of accumulated calcium ions and other oxidant stress at trigger points, and restoration of more normal muscular nerve flow will contribute to a correction of the syndrome. Various herbal chemicals block calcium pumps to decrease potassium stimulation, increase peripheral circulation, and thus normalize catecholamines at the spinal cord and peripheral nerve endings. Other herbal chemicals help normalize inflammatory responses that are involved in the dysfunction, and even more herbal chemicals can decrease specific enzyme activities associated with the abnormal inflammatory responses. A successful treatment in standard medicine in the past used an herbal chemical, reserpine, from Rauwolfia serpentina, to effectively decrease the cataecholamine response and decrease peripheral symptoms. Since herbs contain an array of chemicals, many more physiological responses can be achieved with the proper herbal formulas than with synthetic pharmaceuticals, which are created to have narrow responses in the body. Given the many areas of the body affected, a broad step-by-step approach is needed to restore normal functions. Acupuncture may have a broad array of beneficial effects, helping to regulate the autonomic nervous responses and balance the sympathetic and parasympathetic responses, to restore blood and nerve circulation via stimulation, to calm excess immune responses, and to calm the central nervous system.

Since a restoration of normal physiological response is needed on sympathetic reflex dystrophy, called a return of homeostasis, or homeostatic mechanisms, this array of treatments in Traditional Chinese Medicine is ideally suited to solve the problem. Restoration of homeostasis is the goal in TCM. Scientific study of disease mechanisms and matching to herbal chemical databases helps the physician to choose the right herbs and supplements to achieve an array of goals in this regard. The more access the TCM physician has to internet databases of medical research, the more application of herbal chemicals to specific physiological goals may be achieved. By combining an array of therapies in a protocol, the complex regional malfunction may be addressed in a holistic manner, so that various problems that work together can be addressed simultaneously. In this way, the physiological systems can be normalized and the autonomic reflex stopped and circulation restored via an array of therapies that work together in the treatment.

An added benefit to the TCM therapeutic protocol in Reflex Sympathetic Dystrophy is that the patient may need rehabilitation after the homeostatic mechanisms are restored. In severe cases there is muscle wasting, focal osteoporosis, and arthritic changes that need to be addressed. Allopathic medicine, with its focus on a narrow pharmaceutical approach, cannot deliver all of the therapy that the patient needs. What is needed is an integration of Complementary Medicine into the standard protocol, with the M.D. specialists utilizing these amazing therapeutic possibilities of TCM to achieve the best end goal for the patients. In other words, utilization of Complementary and Integrative Medicine for these neuropathic syndromes seems in order. Of course, there is no single miraculous herb to look for, or some miraculous cure from just a couple of superficial acupuncture treatments, but a thorough and persistent course of therapy combining the various treatment modalities in an intelligent and individualized course of therapy presents a great possibility for success in treating these syndromes that currently standard medicine has little to offer and little history of success.

Information Resources / Additional Information and Links to Scientific Studies

  1. As standard medicine increasingly acknowledges syndromes of hypersensitivity, such as Reflex Sympathetic Dystrophy (a syndrome of impaired nutrients to areas of the sympathetic nervous system causing a pathological reflex response to stimuli or nervous stress), often grouped under the term Chronic Regional Pain Syndrome (CRPS), which was created to downplay the complex array of confusing symptoms seen in these syndromes, which involve much more than just pain, researchers around the world are finally conducting studies that find objective proof of the complex effects of such hypersensitivity syndromes. In 2014, researchers at Ariel University, in Tel Aviv, Israel, found a consistent connection between disorders of psychological distress and incidence and severity of symptoms in these Chronic Regional Pain Syndromes (CRPS). Here, 60 adults were studied, and strong associations were found between CRPS and incidence of psychological distress and alexithymia, a disorder characterized by a difficulty for the patient to identify and distinguish emotions, resulting in emotional dysfunction, social detachment, and difficulties relating interpersonally, often showing little empathy for others and difficulty in emotional expression and responses. This personality disorder has been shown to exist in perhaps 10 percent of the human population in some demographics, and is comorbid with autism, PTSD, anorexia nervosa, bulimia, major depressive disorder, panic disorder and fibromyalgia, as well as CRPS: http://www.ncbi.nlm.nih.gov/pubmed/25280824
  2. By 2015, research into the pathological mechanisms of hypersensitivity syndromes have uncovered an array of potential explanations. Here, experts at Heidelberg University, in Germany, have found that neuroplasticity, or the ability of the nervous system to change and adapt, may be involved in hypersensitivity during the transition between acute pain and chronic pain sensory processing, with maladaptive changes at the spinal cord creating a syndrome of hypersensitive chronic pain and dysesthesia. Traditional Chinese Medicine has long focused on the spinal cord and spine in treating these disease mechanisms, with acupuncture stimulation of the Du meridian and mobilization of the spine with Tui na: http://www.ncbi.nlm.nih.gov/pubmed/25789427
  3. A 2015 study at the Stanford University School of Medicine found that Chronic Regional Pain Syndrome (CRPS) is commonly onset after surgery or trauma, and that women experience the syndrome much more than men. To explain this phenomenon researchers found that in laboratory animals females showed lower pain thresholds in the CNS after surgery or trauma, and exaggerated motor responses and signs of motor dysfunction. The study showed that spinal cord expression of glutamate receptor NR2b was greater in females. Such study demonstrates the need for a holistic integrated approach in therapy: http://www.ncbi.nlm.nih.gov/pubmed/26070658
  4. A 2002 study at the University Hospital of Zurich, in Switzerland, found that integration of acupuncture into the care of patients with Reflex Sympathetic Dystrophy significantly improved peripheral edema: http://www.ncbi.nlm.nih.gov/pubmed/17039194
  5. Reflex Sympathetic Dystrophy Syndrome has been described by many names, adding to confusion in diagnosis, patient understanding and treatment. Sudeck's Syndrome was a term used to denote the syndrome observed after trauma or stroke, and later referred to as Shoulder-Hand Syndrome, which is an inadequate term, obviously. This randomized controlled human clinical trial in 2013, at Fujian University of TCM, in China, shows that this syndrome is treated effectively with standard acupuncture, as well as physiotherapy and rehabilitative training, which are often combined in TCM (Traditional Chinese Medicine) treatment. The treatment consisted of daily treatments in courses of 7 days, repeated 4 times, with breaks between the courses, as is typical in the hospitals and clinics in China. The points used were LI10, 11, 15, and LU9, with ST36, and SJ5 (usually on the opposite limb). The group randomly assigned to the acupuncture therapy achieved significantly better outcomes than the group just receiving the therapeutic training. There was no group with no treatment to compare, because no patient with this condition would agree to no treatment, obviously: http://www.ncbi.nlm.nih.gov/pubmed/24494280
  6. A 2012 randomized controlled human clinical trial of treatment for Shoulder-Hand Syndrome, a term for classic Reflex Sympathetic Dystrophy, involving pain, edema, and hemiplegia, showed that a combination of standard acupuncture and physiotherapy produced significantly better outcomes than rehabilitative therapy alone: http://www.ncbi.nlm.nih.gov/pubmed/23297553
  7. A 2016 study at the Fudan University School of Medicine, in Shanghai, China, showed that the pathology of neuropathic pain, a debilitating symptom that is not effectively treated in standard medicine to date, and is still poorly understood, involves complex complement immune responses related to a group of chemokines called High Mobility Group Box 1 (HMGB1) which act at Toll-like Receptors (TLR), receptors for Advanced Glycation Endproducts (RAGE), CXX Motif Chemokines receptors, and NMDA (glutamate) receptors in the brain and spinal cord. Such study shows that a more holistic and broader approach must be taken to effectively treat neuropathic pain and allodynia: http://www.ncbi.nlm.nih.gov/pubmed/27294160
  8. A 2015 randomized controlled study at the Shandong University of Traditional Chinese Medicine, in Jinan, China, showed that electroacupuncture stimulation at the points LI11, P6 and SP8 significantly decreased HMGB1, TLR4, and other markers of central nervous system inflammation, and improved symptoms of neurological injury: http://www.ncbi.nlm.nih.gov/pubmed/26617842
  9. A study of bee venom acupuncture for treatment of Complex Regional Pain Syndrome, or Reflex Sympathetic Dystrophy and Causalgia, by experts at Daejeon University and the Dunsan Korean Hospital, found that this simple therapy, where diluted bee venom is placed at key acupuncture points, often just under the skin, and normal acupuncture stimulation is practiced as well, was shown to provide significant benefits in treating CRPS. This therapy is now also proven effective for a number of difficult neurological diseases, including Parkinsonism and ALS: http://www.ncbi.nlm.nih.gov/pubmed/25780722
  10. A 2015 study at the China Academy of Chinese Medical Sciences, in Beijing, China, showed that electroacupuncture stimulation at the points ST36 and GB34 produced significant relief of neuropathic pain after 1-2 weeks of frequent treatment by affecting the pain pathways in the hippocampus and the ERK and p38MAPK pathways: http://www.ncbi.nlm.nih.gov/pubmed/26161123
  11. A 1993 study at the University of Sheffield Medical School and the World Health Organization Collaborating Center for Metabolic Diseases found that one type of hypersensitivity syndrome termed Algodystrophy occurred in 28 percent of patients after a Colles fracture (upwardly displaced complete fracture of the radius near the wrist). Algodystrophy involves pain, tenderness, vascular instability, swelling, and stiffness in an affected limb, and 6 months after onset, still exhibited severe stiffness in 80 percent of patients, pain and tenderness in 50 percent, and swelling and vascular instability in 20-30 percent of patients. Patients who failed to recover still had these symptoms at 1 year, with 50 percent of patients with significant stiffness of the limb and joints at one year from onset. Algodystrophy was described as a poorly recognized condition, and is fairly synonymous with classic Sympathetic Reflex Dystrophy: http://rheumatology.oxfordjournals.org/content/33/3/240
  12. A 2013 meta-review of published scientific studies of treatments for generalized and regional pain syndromes, including fibromyalgia, chronic fatigue syndrome, and Complex Regional Pain Syndromes (including Reflex Sympathetic Dystrophy), by Istanbul University in Turkey, Department of Physical Medicine and Rehabilitation, based on published guidelines of the Union of European Medical Specialists, shows that a multidisciplinary approach is supported, with physical therapies, cognitive behavioral psychotherapy, targeted exercises, meditative movement therapies, and acupuncture all supported by evidence. Soft tissue mobilization and manipulation (e.g. Tui Na) for myofascial pain syndrome is supported by evidence, and emerging evidence to support transcranial electrical stimulation is cited. All of these modalities are combined in Traditional Chinese Medicine, and a knowledgeable Licensed Acupuncturist can use soft tissue physiotherapies (Tui Na), instruction in therapeutic activities (Qi Gong), acupuncture, and electroacupuncture (e.g. scalp and ear electroacupuncture), integrating these with other physicians: http://www.ncbi.nlm.nih.gov/pubmed/24084413
  13. A 2011 case study of a 34 year old patient with Chronic Regional Pain Syndrome, at the Coastal Carolina Neuropsychiatric Center, in Jacksonville, North Carolina, U.S.A., treated with a standard short course of acupuncture, showed significant benefit from this therapy, prompting the Medical Doctors at this clinic to call for more research in this regard. Such study shows that acupuncture stimulation and Traditional Chinese Medicine is finally being taken seriously in standard care: http://www.ncbi.nlm.nih.gov/pubmed/21208130
  14. A 2009 study of a Chinese Herbal Formula for chronic neuropathic pain. at Juntendo University School of Medicine, in Tokyo, Japan, found that the common formula Yokukansan was more effective for neuropathic pain than the pharmaceuticals commonly prescribed, such as tricyclic antidepressants, carbamazepine, gabapentin, and opioid pain medications. The range of neuropathic syndromes encompassed Complex Regional Pain Syndrome, Shingles (herpetic pain), trigeminal neuralgia, and other neuralgias. Studies of the formula effects in laboratory animals with induced neuralgias showed a decreased expression of 5-HT 2A receptors in the prefrontal cortex. and neuroprotective effects on myelin sheaths. The Yokukansan formula consists of Atractylodis lanceae (Cang zhu), Poria (Fu ling), Cnidii (She chuang zi), Angelica (Dang gui), Bupleurum (Chai hu), Uncaria (Gou teng) and Glycyrrhizae (Gan cao), and is a common historical formula for nerve pain: http://www.ncbi.nlm.nih.gov/pubmed/19860227