The first descriptions of CRPS were documented during the America Civil War (1861-65) by Silas Weir Mitchell MD, a young US Army contract physician, who treated soldiers with gunshot wounds. In his book "Gunshots Wounds and Other Injuries", he described pain which persisted long after the bullets were removed from the bodies of soldiers. He noted that the pain was characteristically of a burning nature, and named it "causalgia"(Greek for burning pain)which he attributed to the consequences of nerve injury. He observes:
"...a painful swelling of the joints....may attack any or all articulations of a member. It is distinct from the early swelling due to the inflammation about the wound itself, although it may be masked by it for a time:nor is it merely a part of the general edema....Once fully established, it keeps the joint stiff and sore for weeks or months. When the acute stage has departed, the tissues become hard and partial anklyosis results."
Another military surgeon, Rene Leriche MD, (1879-1955), treated many WW1 soldiers who also had nerve damage. He documented the classic signs of CRPS and tried to alleviate the pain with a sympathectomy:
"A few months previously I had unexpectedly encountered one of these cases. I was struck by the resemblance which the condition had to that of a sympathetic disorder; the cyanosis, the sweating, the paroxysmal nature of the pains, the effect on the general mental state, the reference of painful phenomena to a distance---all pointed in that direction. And, remembering that the sympathetic, in its distribution to the limbs, follows the course of the arteries, I asked myself whether, in those cases of nerve injury complicated by arterial wounds, it was not the injury to the sheath of the vessel that determined their painful and trophic features---the wound of the sympathetic---... Starting from this point, I asked myself whether, by acting upon the perivascular sympathetic, I might be able to succeed in modifying the causalgia."
During WWII, William K. Livingston MD, (1892-1966), a military doctor, was working at Oakland Naval Hospital where he treated peripheral nerve injures of soldiers who had chronic pain. He wrote about the "vicious circle of pain as similar with vasoconstriction and atrophy". He compared this pain to "circus movements in the heart muscle." He also talked about "mirror images" of pain or sympathetic pain in which the limb contra lateral to the injury becomes sympathetic. Modern research has found interneuron connections that not only ascend and descend the pain pathways but result in abnormal neurotransmission also to the contralateral side.
In 1900, Sudeck, a surgeon from Hamburg proposed that Regional Sympathetic Dystrophy could be caused by an "exaggerated inflammatory response after injury or operation of an extremity". The signs and symptoms of acute inflammation were rubor, calor, dolor, tumor and functio laesa. This theory forms the basis of modern Dutch research and treatment; that RSD begins as inflammation.
In 1947, Steinbrocker renamed the disease "shoulder-hand syndrome". He also began using oral corticosteriods as treatment in 1953. Meanwhile, Serre in France and Kozin in USA, used nuclear scans e.g. bone scans using technetium labelled methylenediphosphonate and found diffuse disturbances in peri-articular areas. Later Kozin implemented the three phase nuclear scan which is still used today. Hannington-Kiff began using the intravenous regional blockade of the sympathetic nervous system with guanethidine in 1974. This treatment is still used today along with physical therapy.
Following these and other developments, the confusion over the names of this syndrome increased. Algodystrophie was used primarily in France, Sudeck's atrophy referred to the osteoporosis part of the disease. When the disease began as a result of nerve injury, it was called "causalgia" after Mitchell. If it began with non-nerve injuries, it could be called "mimocausalgia" or "minor causalgia." "Posttraumatic dystrophy" (Dutch term) referred to the specific event which caused RSD.
Other names surfaced in the literature such as "vasospastic", "neurotrophic" "neurovascular" or "reflex". The most common was "sympathetic". Roberts introduced the name "sympathetically maintained pain" in 1986 and it has become popular with pain researchers. This term is a condition where pain and hyperalgesia are relieved with a blockade.
Some common names in the literature for RSD/CRPS are:
algodystrophie algoneurodystrophy peripheral trophoneurosis Morbus Sudeck
algodystrophie major causalgia posttraumatic algodystrophy Sudeck's osteodystrophy
atrophie de Sudeck minor causalgia posttraumatic dystrophy pourfour du Petit syndrome
causalgie minor traumatic dystrophy posttraumatic neurodystrophy neurovascular dystrophy
In 1995, Michael Stanton-Hicks and a committee of RSD researchers decided to give RSD (Reflex Sympathetic Dystrophy) a new name:
Complex Regional Pain Syndrome. Why? If one name was decided upon, then further research could be done and confusion would be eliminated.
Now we have CRPS type 1 which is "RSD" and CRPS type 2 which is "causalgia." What is the difference? As of a 2006 discovery by Oaklander, both have the same exact symptoms and both are due to nerve injury. Some patients with this disease still call it "RSD" while the medical community refers to it as "CRPS". Both names are now used interchangeably.
There you are. Clear as mud!