Hi, keepsmilin:

Quote: "So what does stage 4 RSD consist of??"

A document titled "Spread of Complex Regional Pain Syndrome (CRPS)", written by H. Hooshmand, M.D. and Eric M. Phillips, from the Neurological Associates Pain Management Center in Vero Beach (Florida), says the following about stage 4 of RSD:

STAGE IV:

1) Failure of the immune system, reduction of helper T-cell lymphocytes and elevation of killer T-cell lymphocytes.

2) Intractable hypertension changes to orthostatic hypotension.

3) Intractable generalized edema involving the abdomen, pelvis, lungs, and extremities.

4) Ulcerative skin lesions which may respond to treatment with I.V. Mannitol, I.V. Immunoglobulin, and ACTH treatments. Calcium channel blockers such as Nifedipine may be effective in treatment.

5) High risks of cancer and suicide are increased.

6) Multiple surgical procedures seem to be precipitating factors for development of stage IV.

Stage IV is almost the flip side of earlier stages, and points to exhaustion of autonomic and immune systems. Ganglion blocks in this stage are useless and treatment should be aimed at improving the edema and the failing immune system. Sympathetic ganglion blocks, alpha blockers, including Clonidine, are contraindicated in stage IV due to hypotension. Instead, medications such as Proamantin (midodrin) are helpful to correct the orthostatic hypotension.

[B]Stages[B] Stage IV: Irreversible disturbance of plasticity; autonomic failure
Signs/Symptoms Systemic autonomic failure; visceral edema; irreversible low BP; MRSA; elephantiasis; cancer

This is all I have as information about stage 4. I might have more information at home. I will check tonight. Of course, I do not understand all the technical terms used in this document.

Thanks for your kind words.