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Abstract
Reflex sympathetic dystrophy (RSD) is simply an symptom complex, underlaid by any of multiple possible causes, that carries the illusion of a defined pathophysiology. Diagnostic and therapeutic procedures are programmed from this fantasy. The patient's re-sponse to these procedures, which in the case of sympathetic blocks has engendered the concept of sympathetically maintained pain (SMP), is most likely the expression of active placebo effect. Although animal models of nerve injury do provide important data on abnormal peripheral and central nervous system dysfunction, such discrete models misrepresent the broad clinical conditions of RSD-SMP. The issue is futher complicated by all-embracing definitions that retain the word sympathetic. Revision of current theories to explain RSD-SMP, and procedures to diagnose and attempt to treat these patients, are well overdue.
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