Reflex neurovascular dystrophy
Amplified Musculoskeletal Pain Syndrome (formerly known as Reflex Neurovascular Dystrophy (RND) and currently referred to as Complex regional pain syndrome (CRPS)) is a painful neurovascular disorder. In amplified pain, a very slight sensation can become unbearable pain as the nervous system sets up a feedback loop similar to a microphone getting too close to a speaker. The stimulus goes from the nerve to the spinal cord and then short-circuits to the autonomic nerves that control the blood vessels. This leads to lack of blood flow (ischemia) so the tissues do not get enough oxygen and there is a build-up of acids that lead to pain. This new pain signal is then again short-circuited to the autonomic nerves which again decrease the blood flow. This vicious cycle is how the pain is amplified.
RND can be triggered by musculoskeletal inflammatory diseases such as arthritis, injuries, or have no discernible trigger. It can be exacerbated by stress. Stress may continue to play a major role in RND even after the child has RND under control.
The treatment for amplified pain/RND is extreme physical and occupational therapy in conjunction with counseling. There are several such programs, including the Children’s Hospital of Philadelphia (University of Pennsylvania),; Boston Children's Hospital (Harvard University); The Children's Institute of Pittsburgh in Pittsburgh, Pennsylvania; The Pediatric Rehab Unit at Randall Children's Hospital at Legacy Emanuel in Portland, Oregon; Children's Specialized Hospital in New Brunswick, New Jersey; and Mercy Children's Hospital in Kansas City, MO. In a typical course of therapy, the child is put through five to seven hours of therapy a day for 2-3 weeeks. This includes intensive physical, occupational, and pool and/or yoga therapy. While painful, such therapy helps to improve blood flow and breaks the amplified pain cycle. These programs have long term success rates as high as 88%