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Reflex Sympathetic Dystrophy (RSD)

RSD is a clinical syndrome that includes spontaneous pain, painful hypersensitivity to nonnoxious stimuli such as light touch or moving air, and evidence of ANS dysfunction in the form of excessive coldness and sweating of the involved body part. The foot, knee, hand, and forearm are the more common sites of involvement. Local trauma, which may be minor in degree, and surgical procedures on joints or bones are common precipitating events. The term dystrophy applies to atrophic changes that may occur in the skin, soft tissue, and bone in the painful areas if the condition goes untreated for many months. A full explanation of the pathogenetic mechanisms is still lacking. Local axon reflexes in traumatized nociceptive neurons and reflex activation of the sympathetic nervous system are thought to be contributors. Repeated blockade of sympathetic neuron action by local anesthetic injection into the paravertebral ganglia serving the involved body part, followed by mobilization of the body part in a physical therapy program, are the mainstays of treatment. RSD is now termed Complex Regional Pain Syndrome Type I.

Higher centers provide facilitating or inhibiting influences to the spinal cord reflex centers. The ability to voluntarily suppress the urge to urinate when the sensation of bladder fullness is perceived is an example of higher CNS centers inhibiting a spinal cord reflex. Following injury to the cervical or upper thoracic spinal cord, micturition may occur involuntarily or be provoked at much lower than normal bladder volumes. Episodes of hypertension and piloerection in spinal cord injury patients are another example of uninhibited autonomic reflexes arising from the spinal cord.

and medial prefrontal areas of the cerebral cortex are the respective sensory and motor areas involved with the regulation of autonomic function. The amygdala in the temporal lobe coordinates the autonomic components of emotional responses.

The areas of the cerebral hemispheres, diencephalon, brainstem, and central path to the spinal cord that are involved with the control of autonomic functions are collectively termed the central autonomic network (see Fig. 6.7).

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