Listen CAREFULLY TO THE PATIENT! Inability to tolerate even light touch, & swelling often occurs in the affected limb(s) as does alteration in sweating and temperature. Often in fast onset and rapid progress to the latter stages, the limbs begin to contract and distort. 77% are 100% disabled. An EMG electrical test is an OBJECTIVE measure of how the pain fibers are working (or not,properly). The test does hurt, but is good for "ammunition" for disability or legal issues. It is a lifelong and quite disabling condition. Not all RSD is easily diagnosed (It took 8 years for me, and I had it before that but did not seek tx). It can get better, but eventually usually gets worse. At times (like now) it takes my breath away. Most start after an accident or sprain-sometimes no precipitating factor. There's some question that it may be related to other neurological predispositions. Affected areas are usually a different color, from bluish to reddish, excessive sweating (or lack of it) in varying limbs. The skin is exquisitely sensitive, and at times where one thinks they've been touched is actually in another place. Usually the pain is constant, stabbing hot or cold electric, but at the same time numb.It's usually so severe that sleep disorders and depression is frequent. Often PT is recommended too soon which can exacerbate the flare. Prednisone / anesthetic injections in the corresponding area in the spine can be helpful. But some cases are "poorly sympathetically mediated"-the foot doesn't get complete relief the anesthetic. These are more difficult to treat.

"Complex regional pain syndrome (CRPS) is a chronic progressive disease characterized by severe pain, swelling and changes in the skin. The International Association for the Study of Pain has divided CRPS into two types based on the presence of nerve lesion following the injury. Type I, also known as reflex sympathetic dystrophy (RSD), Sudeck's atrophy, reflex neurovascular dystrophy (RND) or algoneurodystrophy, does not have demonstrable nerve lesions. Type II, also known as causalgia, has evidence of obvious nerve damage. The cause of this syndrome is currently unknown. Precipitating factors include injury and surgery, although there are documented cases that have no demonstrable injury to the original site." "CRPS types I and II share the common diagnostic criteria shown below. Spontaneous pain or allodynia is not limited to the territory of a single peripheral nerve, and is disproportionate to the inciting event. There is a history of edema, skin blood flow abnormality, or abnormal sweating in the region of the pain since the inciting event. No other conditions can account for the degree of pain and dysfunction. The two types differ only in the nature of the inciting event. Type I CRPS develops following an initiating noxious event that may or may not have been traumatic, while type II CRPS develops after a nerve injury. No specific test is available for CRPS, which is diagnosed primarily through observation of the symptoms. However, thermography, sweat testing, x-rays, electrodiagnostics, and sympathetic blocks can be used to build up a picture of the disorder. Diagnosis is complicated by the fact that some patients improve without treatment. A delay in diagnosis and/or treatment for this syndrome can result in severe physical and psychological problems. Early recognition and prompt treatment provide the greatest opportunity for recovery. The International Association for the Study of Pain (IASP) lists the diagnostic criteria for complex regional pain syndrome I (CRPS I) (RSDS) as follows: The presence of an initiating noxious event or a cause of immobilization Continuing pain, allodynia (perception of pain from a nonpainful stimulus), or hyperalgesia disproportionate to the inciting event Evidence at some time of edema, changes in skin blood flow, or abnormal sudomotor activity in the area of pain The diagnosis is excluded by the existence of any condition that would otherwise account for the degree of pain and dysfunction. According to the IASP, CRPS II (causalgia) is diagnosed as follows: The presence of continuing pain, allodynia, or hyperalgesia after a nerve injury, not necessarily limited to the distribution of the injured nerve Evidence at some time of edema, changes in skin blood flow, or abnormal sudomotor activity in the region of pain The diagnosis is excluded by the existence of any condition that would otherwise account for the degree of pain and dysfunction. The IASP criteria for CRPS I diagnosis has shown a sensitivity ranging from 98-100% and a specificity ranging from 36%-55%. Per the IASP guidelines, interobserver reliability for CRPS I diagnosis is poor. Two other criteria used for CRPS I diagnosis are Bruehl's criteria and Veldman's criteria which have moderate to good interoberserver reliability. In the absence of clear evidence supporting 1 set of criteria over the others, clinicians may use IASP, Bruehl’s, or Veldman’s clinical criteria for diagnosis. While the IASP criteria are nonspecific and possibly not as reproducible as Bruehl’s or Veldman’s criteria, they are cited more widely the literature including treatment trials." Source and further information: http://en.wikipedia.org/wiki/Reflex_sympathetic_dystrophy