Objective: To evaluate the benefits of cold and warm stress Digital Infrared Thermographic Imaging (DITI) for detecting Reflex Sympathetic Dystrophy (RSD) in stroke patients compared with conventional non-stress DITI. Method: Twenty-three stroke subjects with clinical RSD and fifteen stroke subjects without RSD underwent stress and non-stress DITI. Stress DITI study was performed by continuously imaging both hand dorsum for 30 minutes while immersing an sound side lower limb in cold and warm water bath. The cold and warm water bath were kept at 12.0⁑1.4oC and at 37.0⁑1.4oC respectively. Results: The sensitivity and specificity of conventional non- stress DITI were 82.6% and 80.0% when side to side temperature difference was more than 1oC. The sensitivity and specificity of cold stress DITI test were improved to 95.7% and 93.3%, those of warm stress DITI test to 86.9% and 86.7%. Conclusion: This study indicates that cold stress DITI study may be helpful method in identifying the RSD, which is not detected by conventional non-stress DITI test.