Dott. Piñal: “La distrofia simpatica riflessa non esiste, è una “truffa”, un trucco in cui nascondere ciò che va oltre la nostra conoscenza”

5 aprile, 2013


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Under the name of syndrome of reflex sympathetic dystrophy (for its acronym in English, RSD and CRPS * 1) a whole series of symptoms are grouped – continuous pain, redness, burning, swelling, etc. – that usually appear in patients who have previously suffered some type of trauma or fracture.

Also known as Sudeck’s atrophy or complex regional pain syndrome, its diagnosis points to clinical problems ‘of unknown origin’. Dr Piñal goes a step further and questions its own existence as a specific pathology.

Dr, what is your medical perspective on reflex sympathetic dystrophy?

The pathologies that are grouped under this label are characterized by a painful hyper-response of the patient to a spontaneous aggression, a trauma, for example, or to a surgical action. Unfortunately, it is a ‘disease’ with a high degree of patient’s self-guiltness

In essence, when this syndrome is diagnosed what we’re telling the patient is that his body is reacting incorrectly, that his pain is the result of a “malfunctioning” of his own organism without apparent cause. My experience tells me that this is not the case (…).

From my point of view, what the diagnosis of sympathetic reflex dystrophy entails is our inability as physicians to identify the real underlying problem. If the comparison is allowed, now that we no longer invoke the gods as the origin of our evils, the RSD serves us as an ‘excuse’ for our own shortcomings.

Could you be more explicit?, Dr

Most of the patients that we see in the clinic after diagnosis of reflex sympathetic dystrophy present another pathology not detected. Problems that could have been identified with the appropriate tests, through an exhaustive exploration, through arthroscopy, etc.

In short, it is – in 100% of cases – a matter of medical competence. In my opinion, the number of patients with Sudeck’s atrophy decreases proportionally to the knowledge of the surgeon who treats them.

An anecdote. When at University, one of my professors, referring to fevers without cause or etiology (FUO), told us that fevers of unknown origin were ‘more unknown to some than to others’. Differences aside, is what happens in the context that occupies us, hiding the true solutions to the suffering and pain of many people.

For Dr Piñal, fractures treated or inadequately operated on in the area of the wrist are at the origin of many diagnoses of reflex sympathetic dystrophy. Top image: management of osteochondral fragments in fracture of distal radius, according to his technique. At: ‘Technical Tips for (Dry) Arthroscopic Reduction and Internal Fixation of Distal Radius Fractures’ (

What happens to the people diagnosed, then? (…)

By supposedly ‘missing’ treatment, by the misdiagnosis we are talking about, patients are sent to the pain units. There they are given analgesic medication – to try to alleviate their discomfort – and also neurological, in order to raise their pain threshold, that is, limit the body’s ability to feel it.

Symptoms and solutions?

In both cases, the same ones of the pathologies that reflex sympathetic dystrophy  ‘masks’. As regards the symptoms: persistent pain in the affected area, redness, swelling, mobility difficulties, etc. In terms of solutions, the vast majority of patients diagnosed have surgical treatment. distrofia simpatica riflessa

This is because the real source of their problems is, in a good number of cases, in wrist fractures, crush injuries, subclinical carpal tunnel syndrome (ie, with negative test results), among others.

Any group or profile with higher incidence level ?.

Yes, undoubtedly, people with fractures badly treated or operated incorrectly, and that have been aligned poorly, for example. Within these cases, those associated with wrist fractures stand out.

We are dealing with a transversal problem, but which, being linked to other pathologies, has a greater incidence in the groups that suffer from them. Therefore, diagnoses of RSD are more common after the age of sixty, which sadly increases the clinical ‘disinterest’ in their suffering. ‘Grandmother is already complaining’, ‘with that age what’s what she expects’, etc. etc. (…)

At what point is the medical research on RSD?

There lies one of the key problems. Reflex sympathetic dystrophy, as a concept, is a brake on medical research. We find a general response, ‘comfortable’ and we do not go further. Therefore, we face a problem for the patient, but also for the science itself.

Let’s talk openly. Reflex sympathetic dystrophy does not exist, it is a ‘scam’, a catch-all in which to hide what goes beyond our knowledge.

*1 Reflex Sympathetic Distrophy,  Chronic Regional Pain Syndrome or Complex Regional Pain Syndrome .