MYOFASCIAL PAIN-UPDATE IN DIAGNOSIS AND TREATMENT 1047-9651/97 $0.00 + .2O THE IMPORTANCE OF MYOFASCIAL PAIN SYNDROME IN REFLEX SYMPATHETIC DYSTROPHY (OR COMPLEX REGIONAL PAIN SYNDROME) Satiko Tomikawa Imamura, MD, PhD, Tchia Yeng Lin, MD, Manoel Jacobsen Teixeira, MD, PhD, Andrew A. Fisher, MD, PhD, Ronaldo Jorge Azze, MD, PhD, Luis Augusto Rogano, MD, and Rames Mattar, Jr, MD, PhD Reflex sympathetic dystrophy (RSD) is a descriptive term meaning a com- plex disorder or a group of disorders that may develop as a consequence of trauma affecting the limbs, without obvious nerve lesion. RSD may also develop after visceral diseases, and central nervous system lesions or, rarely, without an obvious antecedent event. It consists of pain and related sensory disturbance, abnormal blood flow and sweating, abnormalities in the motor system and trophic changes in structures of both superficial and deep tissues. Causalgia presents the picture of RSD, results of partial injury of a nerve or one or more of its major branches. In 1994, the International Association for the Study of Pain (IASP) suggested new terminologies for these painful conditions: complex regional pain syndrome I (CRPS I) for RSD and complex regional pain syndrome I1 (CRPS 11) for causalgia. Myofascial pain syndrome (MPS) may complicate many types of musculo- skeletal syndromes and is associated with nerve and soft-tissue injuries, espe- cially CRPS. From the Physical Medicine and Rehabilitation Division (STI, TYL), Department of Ortho- paedics and Traumatology of Hospital das Clinicas (STI, TYL, RM, RJA), and the Hand (RM) and Pain (LAR, MJT) Clinics, University of SZo Paulo School of Medicine, S%o Paulo, Brazil; and the Physical Medicine and Rehabilitation Service, Veterans Affairs Medical Center (AAF), Bronx; and the Department of Rehabilitation Medicine, Mount Sinai School of Medicine, City University of New York (AAF), New York, New York - - - - - - - - - - --- PHYSICAL MEDICINE AND REHABILITATION CLINICS OF NORTH AMERICA VOLUME 8 NUMBER 1 . FEBRUARY 1997 207