1. RSD / CRPS & Long Term Prognosis
2. RSD / CRPS & Legs , Ankles & Feet
3. RSD / CRPS & Needing People For Clinical Studies
4. RSD / CRPS & Carpal Tunnel
This week i decided to search what the long term prognosis for people with rsd /crps . This is something we should all be aware of , What to exspect , How hard will it get for us , Is there anything we can do to slow it down ?
Question's i,m sure we have all asked ourselves from time to time . So i decided to investigate and see what i could find out . wheater it is bad or good . We all need to know what we are up against .
Take Care & Soft Hugs
Recognizing and Treating Reflex Sympathetic Dystrophy
Prognosis and Prevention
RSD itself cannot be prevented, as it is an unintended consequence of trauma, but early intervention and recognition can prevent its devastating effects. The prognosis for RSD depends on the stage during which it is recognized. About 75 percent of patients get better within two years, but the remainder continue to suffer.
A support group, the Reflex Sympathetic Dystrophy Syndrome Association, has been established for patients and their families to help them better understand and cope with the condition. The RSDSA recognized the frustration faced by patients and the many problems and unanswered questions that health care professionals, adjusters, human resource personnel and attorneys may have in dealing with the disorder. To contact the RSDSA, write to PO Box 821, Haddonfield, NJ 08083, or call 609-858-6553.
David J. Fletcher, M.D., M.P.H. is director of MidWest Occupational Health Associates, (Now SafeWorksIllinois of Champaign) Decatur, IL and clinical assistant professor at the University of Illinois, College of Medicine.
where i found this info ... http://www.safeworksillinois.com/articles/article-templatebb33.html?id=47
Prognosis and Treatment for Reflex Sympathetic Dystrophy Patients
Patients may recover from Reflex Sympathetic Dystrophy. Spontaneous recoveries are rare. Best results occur when there is an early diagnosis and aggressive treatment. Sympathetic blocks and sympathectomies are widely used to treat Reflex Sympathetic Dystrophy. (Raja & Hendler, 1990). Additional forms of treatment include physical therapy, psychotherapy, biofeedback training, and use of various drugs including corticosteroids, calcium channel blockers, anti-convulsants, opiods, anti-inflammatories, and antidepressants. (Stanton-Hicks, Baron, Boas, Gordh, Harden, Hendler, Koltzenburg, Raj, & Wilder, 1998). The long-term prognosis is not encouraging. Some studies have indicated that as many as two-thirds of Reflex Sympathetic Dystrophy patients experience the spread of symptoms into more than one limb. (Schaffer, 1997). It is not uncommon for Reflex Sympathetic Dystrophy to progress to a final or fourth stage in which the patient may develop global symptoms including intractable hypertension, generalized edema, skin lesions, and a weakened immune system. (Hooshmand, 1997).
where i found this info... http://www.dallas.net/~nitehawk/RSDstudy.html
Many people with chronic pain do not manufacture enough endorphins, this causes two problems. The first is that your body is sending inappropriate pain messages, and it is not releasing endorphins to protect against the pain. The second is a lack of sufficient endorphins causes hypersensitivity to pain. There are ways we can work to increase our endorphins naturally and with medications.
Naturally occurring endorphins can be obtained by: 1. Exercise 2. Biofeedback, Meditation, Prayer 3. Bodywork, Massage, Hydrotherapy 4. Laughter. Endorphin research suggests that there is a link between our emotional state and the health and well-being of our immune systems. So pleasant memories, exercise, sexual activity, laughter, are all ways we can increase our levels of endorphins and therefore help our body to fight pain through its own natural chemicals.(7)
The body weakens and pain increases when there is a dominance of repressed, bottled up danger emotions such as pain, anger, and fear. It is strengthened as a result of increased expression of such positive emotions as happiness, pleasure and love. Evidence shows that our emotions and thoughts "talk" with the billions of defense cells in our immune system. The "limbic-hypothalamic system" of the brain is known as the major mind-body connector modulating the responses of the endocrine, immune, and autonomic nervous systems ( which includes the sympathetic nervous system ) in response to mental suggestions and beliefs. Sustaining a belief that recovery is possible can mobilize a healing response by activating all these major systems of mind-body communication and healing.(9)
What is the prognosis?
Don't give up hope! Hopelessness and stress can cause a worsening of symptoms. It's important to take care of the mind as well as the body. Look at the things you are able to do and not dwell on what you can't do. The best way to recover is to adapt to the changes this disorder causes to the body. It's OK to morn the way you once were. Everyone with a devastating disease, disorder, or injury goes through a period of grieving. Unless you are one of the lucky RSD/CRPS patients that experience a total remission, the best thing to do is, from now on, learn to work with your body the way it is. You will probably have a limited amount of activities you are able to do in one day. Get to know your limits, but sometimes push a little beyond. Some days will be better than others. Learn to pay attention to what your body is telling you and if it's time to stop an activity, rest, then continue when the pain subsides.
It's important to continue, or to start back slowly to performing everyday normal tasks such as doing dishes (wear gloves if water bothers you), making the bed, doing laundry. These tasks probably will take three times as long as it would before you were afflicted with RSD/CRPS. That's OK, doing laundry is just one of the big hurdles I have to mentally battle with myself to do 2 times a week. Every step of the process causes pain, the mental hurdle is the hardest. Once I get over that ( actually saying to myself " just do it" ) I break up the laundry process into stages, with stretching, and resting included ( sometimes it can take me three days to finish ). Problem solving, planning out how, doing, and eventually accomplishing these tasks starts you mentally feeling better and opens up your world to doing things you never thought possible.
Learn to adapt to and not fearing pain is very important. When you feel severe pain while doing something -stop the activity, take deep breaths ( count to 8 in, hold for 5 then slowly exhale ), try to relax all your muscles and your mind, slowly stretch the area with the pain, let the pain pass through you, while continuing taking deep, slow breaths. Concentrate on relaxing your whole body, try to visualize a beach with waves lapping at the shore, or a field of flowers, stand up and stretch if necessary. If you go back to doing the same thing again and the pain continues, repeat the above. Sometimes your body is just telling you it's time to do something else, get back to the task later, when the nerves have calmed down.
It's important to remember the nerves are sending FALSE signals because of the RSD/CRPS. The pain is not a warning of a serious injury, although it can stop you in your tracks ( your brain thinks there is a serious injury, setting off the sympathetic responses ). Mentally you have to relax and do the breathing technique mentioned above. Breathing and relaxation techniques can calm the sympathetic nervous system and sometimes stop or ease the nerve pain temporarily.
Take time out when you need to rest, 15 minutes resting can work wonders. Get as much support from other RSD/CRPS people, friends, family and therapists as you can. Sometimes those around us don't understand what's going on especially since we look normal, that's OK. It's your responsibility to educate them to this bizarre disorder (give them a copy of this paper).
TREATMENT: Work closely with your treating Physician. Don't ever let anyone tell you that you just have to live with this, or it's all in your head. If your doctor tells you this- it's time to get another doctor. Different people require different prescriptions or combination of drugs and therapies to treat the symptoms. A treatment that works for one RSD/CRPS patient may not work for another. It is necessary to try different combinations until the pain and other symptoms are controlled.
Strong narcotic pain medication is not recommended. The long term effects and complications outweighs their long term effectiveness. Strong narcotic pain medications can lower the pain tolerance levels in patients over time. Although opiates are now used to treat chronic pain, they should be used as last resorts, after all other means are tried. If you are taking strong narcotic medication for the pain, do not let anyone make you feel guilty, or let people treat you like an addict. Just tell them that your endorphins are not normal and the medication aids in keeping the pain controlled, periodically have your doctor review the effectiveness of the medications you are taking and possibly try new combinations.
There are a variety of prescription drugs available to treat the many symptoms of RSD/CRPS. Seratonin in chronic pain patients is depleted very quickly so some form of Seratonin reuptake inhibitor is needed e.g. tricyclic antidepressants.
Drug Therapy: Local or systemic corticosteroids, Muscle relaxants, Alpha-adrenergic and beta blockers, Analgesics, Anti-inflammatories, Anticonvulsants, Tricyclics and related compounds, Calcium channel blockers ( chronic pain causes the cells to become flooded with calcium and are stuck in the open position, which stops communication between nerve cells ).
Blocks: Nerve blocks, Sympathetic blockade, Intravenous regional blocks.
Good alternative treatments that might be effective are: biofeedback, pain management specialists, physical therapists, (HBO) hyperbaric enhanced oxygen chambers, acupuncture, botox, massage, visualization therapy, herbal supplements, nutritional therapy, hypnosis, T.E.N.S. and hydrotherapy.
When diagnosed in the first three months nerve blocks may be effective. It is important to get physical therapy (with a therapist who has knowledge of RSD/CRPS). If nerve blocks or other treatments are not working or making you worse, stop them and try something else. You are responsible for your own health care. Do not let anyone cast, perform surgery with out getting a second opinion from a RSD/CRPS specialist. Don't suffer through ineffective treatments.
Understanding the Nervous System
The Autonomic nervous system (ANS, which regulates individual organ function and homeostasis, and for the most part is not subject to voluntary control) is divided into two parts these parts are the sympathetic nervous system and the parasympathetic nervous system. The parasympathetic system is concerned with conservation and restoration of energy, as it causes a reduction in heart rate and blood pressure, and facilitates digestion and absorption of nutrients, and consequently the excretion of waste products. The parasympathetic nervous system is confined to the head and trunk. The parasympathetic nervous system (PNS) calms, relax’s & slows down the body. When the SNS is activated then for obvious reasons the PNS is inhibited simultaneously. In other words the brain shuts down its primary calming mechanism to force you to remain alert & ready to face the threat.
The sympathetic nervous system is what arouses us in an emergency situation. The sympathetic nerves come from the thoracic vertebrae, or ribs, and the lumbar vertebrae, or small of the back. The preganglionic nerves of both systems release acetylcholine ( a substance that allows messages to travel from one nerve to another ), but the postganglionic nerve of the sympathetic system releases norepinephrine ( a hormone, released by the adrenal glands, that increases blood pressure by narrowing vessels ). The response that the sympathetic nervous system invokes is know as the "fight or flight" response. It allows the body to either, stay and fight the threat or to run away. The sympathetic nervous system (SNS) commands release of various hormones in the body like the adrenaline, noradrenaline, glucocorticoids etc. through our various endocrine glands, like the pituitary & adrenal.
When the sympathetic nervous system is stimulated it can cause such things as dilation of the pupils of the eye, the constriction of blood vessels in the head, stomach, and extremities, increase in blood flow in the heart and muscles, the mouth dries up, adrenaline is pumped into the blood stream, air passages expand, the stomach stops working, the liver works hard to produce available sugar for energy, the kidneys slow down (secretion of urine is reduced), the bladder wall relaxes, the skin is stimulated to sweat and sometimes to contract its muscles. All of this is the body's natural defense mechanism. Stimulus to the sympathetic nervous system can also include environmental factors such as the cold. When damage occurs to the autonomic nervous system it can result in Reflex Sympathetic Dystrophy Syndrome/Chronic Regional Pain Syndrome (RSD/CRPS).
Anyone can get RSD and there is now an estimated seven million people affected in to United States alone. Because the Sympathetic Nervous System effects so many different systems of the body, RSD/CRPS is a complex and little understood disorder. Sympathetic maintained pain is the most common. When pain occurs in the damaged area, the sympathetic nervous system takes the pain impulses and continues to fire off neurons along major nerves continuously, sometimes for days. The pain can be caused by something so simple as just touch, a breeze, certain movement, or temperature change.
Anatomy of Pain: pain signals travel from your peripheral nerves to your spinal cord to your thalamus, a message sorting and switching station in your brain. The thalamus sends two types of messages. One goes to your cerebral cortex, the thinking part of your brain, which assesses the location and severity of damage. The second is a "stop-pain" message back to the injury site to tell local nociceptors to stop sending any more pain messages. Once alerted, your brain doesn't need additional warning. But sometimes, this mechanism fails and pain persists.
Meanwhile, your cerebral cortex relays the pain message it received to your brain's limbic center. Your limbic center produces emotions, such as sadness or anger, in response to pain messages ( this is why relaxation and deep breathing is so important to control the emotional pain response ). Your limbic center can affect the way your cerebral cortex perceives pain messages, and can lessen or intensify your pain. Your cerebral cortex also sends messages to your autonomic nervous system, which controls vital body functions such as breathing, blood flow and pulse rate.
Several types of neurotransmitters (proteins and hormones produced in your brain or nervous system) can increase or decrease pain signals. A hormone--one of the prostaglandins--speeds transmission of pain messages and makes nerve endings more sensitive to pain. A protein called substance P continuously stimulates nerve endings at the injury site and within your spinal cord, increasing pain messages. Seratonin and norepinephrine (nor-ep-i-NEF-rin) seem to decrease pain by causing nociceptors to release natural pain-relievers called endorphins.
People with impaired sympathetic nervous systems can be susceptible to low blood pressure and fainting. When the sympathetic nervous system becomes over aroused it can result in panic attacks, general anxiety disorders and stress. The sympathetic nervous system also integrates brain and immune function.
What research is being done?Investigators are studying new approaches to treat RSDS and intervene more aggressively after traumatic injury to lower the patient's chances of developing the disorder. Scientists are studying how signals of the sympathetic nervous system cause pain in RSDS patients. Using a technique called microneurography, these investigators are able to record and measure neural activity in single nerve fibers of affected patients. By testing various hypotheses, these researchers hope to discover the unique mechanism that causes the spontaneous pain of RSDS, and that discovery may lead to new ways of blocking pain. (2)
Pacing: Make sure you space out activities, breaking them up into smaller sections. Vary your activities and the posture needed for them. Plan your meals for the day, decide which tasks need to be done, and split them up with resting and stretching periods.
Exercise: Plan your exercise. Whether it's walking, swimming, stretching, yoga or some other activity plan it at a time of day you feel your best. Perform a set of exercises that are appropriate for you and your pain. Do them in a relaxed, meditative state. Don't forget to take advice on which exercises are best for you from an expert.
Relaxation: Best taken after your exercise session. Let yourself go into a deep relaxation for about 15-20 minutes at least once a day. Sitting watching TV is not the equivalent of relaxation. You need to lie down and really let go so that you allow the production of endorphins, natural pain relieving agents, to flow. The relaxation will leave you feeling peaceful, centered with less pain.
Social Contact Try to have close contact with at least one person during the day, family or close friend. I know it's not always possible, but - a hug a day helps keep the pain away! If you can't do this physically, contact a friend by phone, write a letter or through your support group.
Unable to exercise?Try to find a Hyperbaric/Oxygen chamber (HBO) near you, and take a session of one hour treatments. This can replace exercise until you are able to exercise on your own. Do not pay more than $65 per treatment. Check around to get the best prices, some chiropractors offer HBO treatments. Make sure that they are using oxygen enhancement, otherwise the treatments are not effective. The extra oxygen given to you in the mask helps the nerves and injured tissues to heal. This treatment over a period of a month helped to stop all of my sympathetic maintained pain, took the swelling and stiffness out of my joints, and had me sleeping at night with energy the next day. The regular pain was less and I just overall felt better. The treatments were so successful I was able to start to exercise on my own, replacing the treatments of the HBO.
Here are some basic guides to follow:
Eat four to five small meals a daythis gives the body the fuel it needs otherwise the body will rob the muscles of essential nutrients.
Topical Remedies:Rosemary oil and lavender oil diluted with water or witch hazel rubbed onto the skin can relieve pain.
Fibromyalgia patients exercise is a must, it will help with insomnia and remove the toxins trapped in the muscles. Symptoms will improve after your body gets used to exercise. (Candida infection click here is common in people with fibbromyalgia). In addition to the above listed supplements you should take Melatonin, sustained release formula is best (promotes a sound sleep) take 1-2 hours before bedtime, use as directed.
Please show this information to your Doctor and get approval before following this advice.
Are you depressed?It is common for RSD/CRPS and Fibromyalgia patients to suffer from depression. Seratonin levels in the body get depleted very quickly with chronic pain, talk to your doctor about this. There are many low dose antidepressants that work well restoring Seratonin levels, and can help ease chronic pain. Anyone with chronic pain should be taking some kind of medication to keep the Seratonin levels normal.
Affecting the hand and feet, this disorder causes hypersensitivity to cold. When the hands/feet are exposed to cold temperatures or to vibrations/tapping the small arteries contract and spasm, as a result the fingers and toes are deprived of oxygenated blood, which causes severe numbness.
Raynaud's many times accompanies RSD/CRPS.
Coenzyme Q10 100-200mg a Day (improves tissue oxygenation)
E 200iu (improves circulation)
Calcium 1500 mg a day
Magnesium 750mg a day
Zinc 50mg daily ( do not exceed over 100mg daily from other supplements you are taking)
where i found this info ... http://www.artzoo.com/health/rsdcrps.htm
The RSD prognosis varies from patient to patient, and the factors that affect this are unknown. Some people experience spontaneous remission from symptoms, while others have unremitting pain and irreversible changes despite treatment. Although the doctor who is most familiar with a patient's situation is the best person to discuss the RSD prognosis, keep in mind that even the doctor cannot predict exactly what toexpect.
What Is the RSD Prognosis?
A prognosis gives an idea of the likely course and outcome of a disease. The prognosis for reflex sympathetic dystrophy (RSD) varies from person to person, and doctors are not sure of the factors that affect a person's RSD prognosis.
Spontaneous remission from symptoms occurs in certain people. Others can have unremitting pain and crippling, irreversible changes in spite oftreatments for RSD. Some doctors believe that early treatment is helpful in limiting the effects of the disease, but this belief has not yet been supported by evidence from RSD research or clinical studies.
More research is needed to understand the causes of RSD, how it progresses, and the role of early treatment.
Final Thoughts on the RSD Prognosis
The doctor who is most familiar with a patient's situation is in the best position to discuss the RSD prognosis and to explain what RSD statistics may mean for that person. At the same time, it is important to understand that even the doctor cannot tell exactly what to expect.
where i found this info... http://nervous-system.emedtv.com/rsd/rsd-prognosis.html
Good progress can be made in treating CRPS if treatment is begun early, ideally within 3 months of the first symptoms. If treatment is delayed, however, the disorder can quickly spread to the entire limb and changes in bone, nerve and muscle may become irreversible. The prognosis is not always good. The limb, or limbs, can experience muscle atrophy, loss of use and functionally useless parameters that require amputation. RSD/CRPS will not "burn itself out" but, if treated early, it is likely to go into remission. http://findarticles.com/p/articles/mi_qa3898/is_200011/ai_n8906623
where i found this info... http://en.wikipedia.org/wiki/Complex_regional_pain_syndrome#Prognosis
Quality of Life Issues and Psychosocial Considerations in Reflex Sympathetic Dystrophy
Reflex sympathetic dystrophy (RSD) can be a lifelong condition that can have a significant impact not only on the patient but on family and friends as well. The condition may affect many aspects of the patient's life in varying degrees including:
Activities of daily living
Some of the adjustments of daily life that the patient may have to make include:
Frequent leave of absence from work or possibly early retirement due to inability or difficulty performing work-related tasks
Giving up or modifying leisure activities such as hiking, kayaking, traveling.
Modification of exercise regimens
Foregoing routine activities such as driving or shopping)
Participating in family activities and outings
Financial difficulties due to frequent visits to health-care providers, other medical-related expenses, or unemployment
A study from the Netherlands evaluating quality of life issues among patients with chronic RSD reported that the greatest interruption in daily life was related to:
Chores around the house
In this study, patients with chronic RSD of the upper extremity reported that chronic pain, difficulty sleeping, and lack of energy were the most distressing aspects of the condition that impacted negatively on their quality of life. Mobility was not a significant issue for these patients. The greatest disruptions in daily life were related to:
The overall quality of life scores for patients with chronic RSD were lower than for patients with diabetics, people with migraine headache, and people with chronic lung disease, all of who traditionally report significant disruption in their quality of life.
Reflex sympathetic dystrophy may create a financial strain on the patient and their family due to reduced income, unemployment, and additional medical expenses required for various treatments. It may be prudent for the patient and their family to meet with a financial planner or an insurance agent and devise a budget so that eventual and unexpected expenses will be accounted for. This may reduce the general stress level for the patient and their loved ones.
Friends and family may find it beneficial to map out a plan of action with the patient's participation so that a daily routine is established. This reduces stress levels and minimizes unexpected changes in plans. Responsibilities that may need to be addressed include:
Lifestyle Modifications in Reflex Sympathetic Dystrophy
In order to remain as independent as possible and to minimize the disruption of daily life, individuals with reflex sympathetic dystrophy (RSD) will need to consider changes and modifications to be made not only in their daily routine but in their surroundings as well. For example, for the person with lower extremity RSD, getting around can cause a significant challenge since doing normal activities (e.g., walking, climbing stairs, squatting, sitting for long periods of time with knees flexed, and getting in and out of cars) can be quite painful. Each individual and family should assess the surroundings, perhaps with the help of professionals, and prioritize the modifications needed to will help the patient maintain their independence and function.
Some of the lifestyle modifications that patients with RSD may wish to consider include:
Velcro or zippers instead of shoelaces
Flat shoes instead of heels for patients with lower extremity RSD
Velcro or zipper closures for shirts or sweaters
Grab bars in the bathtub, shower, and next to the toilet
Tub or shower bench
Long-handle comb or brush so the patient does not have to raise their arm so high
Elevated toilet seat
Large knobs on appliances requiring manipulation (e.g., stove, dishwasher, washing machine)
Easy grab handles for cabinets
Light weight dishes and pots
Lightweight flatware with long handles
Sliding shelves or turntables on kitchen shelves so the patient does not have to reach into cabinets to access items at the back of a shelf
Long handled cleaning appliances, (e.g., brooms, dustpans, sponges)
Lightweight appliances (e.g., vacuum cleaner)
Long-handled "grabbers" for removing items on high shelves or picking up items from the floor
Blanket support frame so that blankets or sheets does not rest directly on the feet of a patient with allodynia
Nightlights in the bedroom and any other rooms where the patient may walk if they awaken during the night
Modified controls to facilitate driving
Car doors that are easy to open and close
Seat positions that are easy to manipulate
Handicapped parking stickers
Voice activated lights, appliances, or computer
Electric wheelchair to avoid upper body strain or injury
Wheelchair-access modifications at home
Nursing or home health care
A note from your doctor recommending special accommodations, such as an aisle seat in airplanes
Use of wheelchairs in airports, train stations, or malls
Medical support professionals and/or accountants to budget medications, special appliances, home-nursing care, and other medical related supplies and expenses
Maintaining a Healthy Lifestyle in Reflex Sympathetic Dystrophy
It is important for the patient with reflex sympathetic dystrophy (RSD) to maintain a healthy lifestyle despite the difficulties they are experiencing, including getting enough sleep, exercising, and eating healthy foods. Patients must be particularly vigilant about the potential long-term health consequences of a changing life style caused by chronic pain. Since patients with RSD may be forced to lead a more sedentary lifestyle, they may be more at risk for developing other medical problems including:
Weight control is crucial for overall good health as well as making sure to eat balanced meals and take vitamins if needed. It is beneficial to find facilities that offer modified exercise programs for physically handicapped individuals. For individuals who have a tendency to shield the affected limb from any stimulation or from being touched or manipulated, it is very important to maintain hygiene of the affected limb even though it it may be perceived as being painful.
Sleep Disturbances in Reflex Sympathetic Dystrophy
Sleep disturbances due to chronic, severe pain of reflex sympathetic dystrophy (RSD) can have a significant detrimental effect on quality of life. Sleep deficit can actually prolong pain for patients with RSD in addition to affecting mood, level of fatigue, and ability to function well in activities of daily living. It has been estimated that approximately 50-70% of people with chronic pain experience sleep disturbances. If sleep is an issue for the RSD patient, it is important to communicate this concern with their health care provider. Some techniques the patient may try include taking a nap early in the day instead of late afternoon and avoiding nicotine, caffeine, and alcohol.
Because currently there is no cure for reflex sympathetic dystrophy (RSD), the disorder may persist for a prolonged period of time and can have a significant psychosocial impact on patients. The chronic, severe nature of pain experienced by many RSD patients, particularly those with established and long-standing RSD, may lead to psychological comorbidity including depression, anxiety, feelings of isolation, and a sense of hopelessness and helplessness. In some cases, the adverse psychological consequences of the RSD may increase the risk of suicide or suicide ideation. It is, therefore, important for patients and their families to recognize and understand the potential psychological effects of RSD and seek a thorough psychological consultation and evaluation as part of the overall strategy for managing RSD.
A variety of different treatment options are available to help RSD patients with concurrent psychological co-morbidity including drug therapy and cognitive behavior therapy. A multidisciplinary approach to treatment involving a pain management specialist, neurologist, physiatrist (specialist in physical medicine and rehabilitation), and/or a psychologist/psychiatrist may be necessary to help RSD patients learn to better cope and adjust to both the physical and psychological consequences of the disorder.
Because RSD is so poorly understood, there are physicians who are not familiar with the condition and its symptoms who perceive their patients' complaints to be psychiatric in nature ("it's all in your head"). Also, since RSD is related to many cases of workmen's compensation for injury occurring on the job, there may be a tendency for some health care providers to view the patient's complaint as malingering. This is a significant source of stress for many patients and may lead to significant delays in diagnosis and treatment. This situation adds to the psychosocial issues the patient already deals with due to chronic pain and interruption in their quality of life.
In addition, the patient may have to deal with a loss of independence as their level of functioning may be significantly compromised. It is hard for many patients to accept their changing condition and they actually go through a grieving process in the course of coming to grips with their new reality.
The medical literature describes four stages, through which people move in relating to chronic pain, including:
Hoping that there is some cure that will make the pain go away
Wondering if the treatment they are receiving is appropriate
Feeling anger, resentment, or depression when they realize the pain is not temporary
Evaluating changes in lifestyle as they accept that permanent pain and varying levels of disability is their new reality.
Family and friends who form the support group around the patient must be educated and made aware of RSD, its treatment and rehabilitation, behaviors of the patient that should be encouraged or discouraged, and the supporting role they can play. It is very important for friends and family to understand what the patient is going through and allow the patient the opportunity to express their grief and frustration without being judgmental. Family and friends also need to be supportive and to encourage the patient to keep their spirits up and to continue functioning to the best of their ability.
RSD / CRPS Dealing with it in your legs , ankles and feet . Mines has spread as it mostly does to people who suffer with rsd / crps . I decided to investigate how & why & what we can do to help ease the pain . My feet get so bad it's so hard to walk on them . I feel like a 100 year old person , Bend over trying not to put to much pressure on them . i do everything i can think of to stop the pain & scared this will put me in a wheel chair . What do you do when it spreads ? what do you do to ease the pain ? I try to stay off them as much as possible when it gets real bad & pray for it to ease up some .
Take Care & Soft Hugs
RSD feet treatment
Reflex sympathetic dystrophy syndrome(RSDS), also called complex regional pain syndrome(CRPS), is a painful disorder generally resulting from an injury to a limb.
It is believed that high numbers of nerve impulses are sent to the injured site, resulting in pain, changes in skin texture and weakening of bones and tissues in that area.
The injury that triggers reflex sympathetic dystrophy syndrome could be anything from frostbite, burn, a simple bruise or cut to a serious impact wound (gun shot, stabbing, shrapnel). Surgery and conditions such as heart attack, stroke or cancer may also cause reflex sympathetic dystrophy syndrome.
Usually reflex sympathetic dystrophy syndrome begins in the hands or feet but it can spread throughout the body, especially when it is not treated early.
Reflex Sympathetic Dystrophy Syndrome is a progressive disease that can be divided into three stages. Each stage has distinct symptoms, though symptoms may blend over from stage to stage.
Stage one symptoms (1 to 3 months)
• Burning pain - usually in the hand or foot but, can occur in other areas.
• Swelling and Tenderness - affected area is swollen and sore to the touch.
• Temperature and Color Change - skin of affected area may feel warmer or colder than normal skin and have a shiny, dry, red or tight look to it.
• Sweating - excessive sweating is often accompanied by a low-grade fever.
• Rapid Hair and Nail Growth
• Loss of Movement in Joints - joints in affected areas become stiff and mobility is restricted.
• Muscle Spasms - spasms can be confined to one area or up and down the arms, legs or back.
Stage two symptoms (3 to 6 months)
• Extreme Sensitivity - light touching, breezes, bed sheets or air conditioning can cause an extreme amount of pain.
• Spreading Pain - pain may spread from feet or hands up to the hips or shoulders.
• Change in Hair and Nails - hair growth decreases and nails become cracked, brittle, grooved and spotty.
• Increased Swelling - the affected area may become pale and waxy looking.
• Bone and Joint Damage - osteoporosis(weakening of the bones) sets in, joints thicken and become less mobile.
• Muscle Atrophy - muscles shrink and weaken from lack of use
Stage three symptoms (6 months and beyond)
• Severe Bone, Muscle and Skin Damage - the changes in affected bone, muscle and skin become irreversible...the skin becomes tight and muscle and other tissue becomes weak and constricted.
• Constant Pain - The pain becomes unyielding but, for some the pain does not remain as severe in stage three.
• Severe Mobility Limitations - there is a muscle atrophy and severely limited mobility of the affected area. Joint movement is greatly impaired and occasionally the limb will be displaced from its normal position.
Reflex Sympathetic Dystrophy Syndrome(RSDS) can strike at any age, but is most common between the ages of 40 and 60. It affects women more often than men.
It is estimated that up to 20 percent of individuals with hemiplegia (paralysis of one side of the body) will suffer from RSDS.
Reflex Sympathetic Dystrophy Syndrome is primarily diagnosed through observation of the symptoms:
1. Presence of initial injury
2. Pain is higher than expected from injury
3. Change in appearance of affected area
4. No other cause of pain or altered appearance can be found
Thermography (measurement of blood flow) to test temperature changes and three-phase bone scanning help detect the presence of RSDS.
It is important to make an early diagnosis. Prompt treatment provides the greatest opportunity for recovery.
Among the modalities that are sometimes used are biofeedback and exercise.
Another common approach to treating Reflex Sympathetic Dystrophy Syndrome in its early stages is injecting an anesthesia into the nerves to block the impulses flowing into the injured area. This provides pain relief and allows for physical therapy which helps maintain flexibility and strength in the muscles.
Physicians use a variety of drugs to treat RSDS, including corticosteroids, vasodilators, and alpha- or beta-adrenergic-blocking compounds. Elevation of the extremity and physical therapy are also used to treat RSDS. Injection of a local anesthetic, such as lidocaine, is usually the first step in treatment. Injections are repeated as needed. TENS (transcutaneous electrical stimulation), a procedure in which brief pulses of electricity are applied to nerve endings under the skin, has helped some patients in relieving chronic pain.
In extreme cases surgical sympathectomy (the cutting of the nerves) may be used to stop the pain but, may cause a loss of sensation in the area.
There is no known cure for Reflex Sympathetic Dystrophy Syndrome. If treatment begins within three months of the first symptoms, the disease often will go into remission. Because RSDS is a progressive disease, it may become an irreversible, crippling disorder. It is important to seek medical attention for any unexplained onset of burning pain, especially if it develops after an injury.
where i found this info ... http://www.arthritis-treatment-and-relief.com/rsd-feet-treatment.html
To understand just how bad the pain is, cancer pain is ranked at 24. Now do you have a better understanding of what it's sufferers have to endure? Why they develop depression and anxiety? Why they don't (or cannot) do many activities that many people take for granted? For me, I used to love concerts. Not anymore... as the music vibrations kill me! Just listening to music causes so much pain you wouldn't believe. Or sleeping. My feet hurt so bad I have to sleep with them draped off the side of the bed so nothing touched them.
Wearing normal shoes? Almost impossible. I wear slippers most of the time. During the summer months when my pain levels were better, I was actually able to wear sandals and occasionally I was able to dance. But those moments are rare and now that the weather is colder it's now impossible.
Things that so many people take for granted. Liked a shower. Yes-- that, too, can be quite painful. I much prefer to take a bath as it's much less painful. My days and what I do are solely dependent upon just how much pain I am in. It sucks but it's something I have to live with the rest of my life. I'm in my early 30's and disabled. Taking care of my children is something I shouldn't have to worry about. But I do, because they now do more to help me than the other way around.
I hope that by learning more about this condition you can gain a better understanding of what more 1.5 to 3 millions sufferers of this disease live with in a day to day basis. Some have it better, others worse. Some don't even know they have it and think the pain is all in their heads. But it's not. And it's about time that people learned what this condition is and how it affects so many people. It's been a real rough road for me both emotionally and physically but if I can help just one person in any way then it will put a smile on my face.
There are excellent resources. Please visit rsdhope dot org, as it's one of the best websites I have been to.
Please feel free to contact me if you have any questions or if you just want someone to talk or vent to. I wish I had people like that in my life that understood first hand what I am going through. It would help.
And remember...... IT'S NOT ALL IN YOUR HEAD! IT'S REAL AND IT'S OUT THERE!
Would you like to learn more about RSD/CRPS or perhaps talk to others who may suffer from it?
I have created a brand new website that offers more detailed information as well as a message
board that acts as an online support group for pain sufferers worldwide. It may be new but one
day it will be (hopefully) a often used asset for pain sufferers worldwide.
What are the symptoms of RSD/CRPS?
1) Constant chronic burning pain (includes allodynia - extreme sensitivity to touch, sound, and vibration)
2) Inflammation (this can affect the appearance of the skin, bruising, mottling, etc.)
3) Spasms-in blood vessels and muscles of the extremities
4) Insomnia/Emotional Disturbance (includes the major changes to the limbic system such as short-term memory problems, concentration difficulties, etc.)
5) Movement disorders- difficulty in moving the affected body part
6) Increased Tone- Muscle and skin brightness
7) Increased reflexes- Muscle and skin tightness
8) General weakness- increased fatigue, swelling, sores, rashes, and fever are all possible
9) Skin color changes- skin may turn shiny, become red and tight. May have a mottled appearance. Can also be blue-ish purple. Increased sweating with either increased temperature or decreased temperature.
10) Nails/ Hair- On affected areas, the hair can grow more rapidly or not at all. Nails can become brittle and cracked.
11) Bone Changes --- Softening of the bones, Osteoarthritis, Osteoporosis, joint stiffness/tenderness.
12) Sleep Patterns --- Insomnia is often seen, also disrupted sleep pattern. Some Medications help this.
13) Miscellaneous --- Dizziness, Tinnitus, Agitation, Irritability, Visual disturbances such as blurriness, dry eyes and others. Also, sounds/vibrations even strong winds can exacerbate the pain as well.
there is more you can read about her story at ... http://reviews.ebay.com/RSD-CRPS-A-Guide-for-Chronic-Pain-Sufferers_W0QQugidZ10000000009400229
Foot PainFoot Pain ReliefTreatment for foot pain varies, depending on the cause. Mild foot pain often can be relieved by wearing shoes with wide toe boxes, by using shoe inserts or pads (available over the counter), and by keeping off the affected foot as much as possible until the pain subsides. RICE therapy—rest, ice, compression, and elevation—can be used to treat some types of foot pain. Rest involves reducing activity as much as possible until the pain subsides. In some cases, crutches, and/or a splint, air cast, or hard cast is necessary. Ice can be applied to the painful area to reduce pain and swelling. Ice should not be applied directly to the skin. Compression involves supporting the foot with a firmly (not tightly) wrapped elastic bandage, compression stocking, or gel wrap. Keeping the foot elevated about 6 inches above the heart with a slightly bent knee can help to minimize bruising and swelling.
( since we cannot use ice try heat instead heating pad , moister heating pads , hot towels I have even use those things hunters use to keep there hands warm and they do work up to 10 hours i bandage them on my feet )
where i got this info ... http://www.podiatrychannel.com/foot-pain/relief.shtml
This is a long but relatively comprehensive definition of RSD. Building on the basis of this comprehensive definition of RSD, one can come to the conclusion that RSD is a syndrome with multiple manifestations which require the following minimal symptoms and signs for the condition to be called RSD (CRPS).
1. Pain: constant, burning pain, and in some forms at times during the course of the disease, stabbing type of pain (causalgic). The pain is relentless and is invariably accompanied by allodynia (even simple touch or breeze aggravating the pain) and hyperpathia (marked painful response to even a simple stimulation).
2. Spasms in the blood vessels of the skin and muscles of the extremities. The spasms in the blood vessels result in a cold extremity. The muscle spasms result in tremor, movement disorders such as dystonia, flexion spasm, weakness and clumsiness of the extremities, and tendency to fall.
3.RSD is accompanied by a certain degree of inflammation in practically all cases. This inflammation may be in the form of swelling (edema), skin rash (neurodermatitis), inflammatory changes of the skin color (mottled or purplish, bluish or reddish or pale discolorations), tendency for bleeding in the skin, skin becoming easily bruised, inflammation and swelling around the joints as well as in the joints (such as wrists, shoulders, knee, etc.) which can be identified on MRI in later stages, and secondary freezing of the joints.
4.The fourth component and pre-requisite of diagnosis of RSD is insomnia and emotional disturbance. The fact that the sympathetic sensory nerve fibers carrying the sympathetic pain and impulse up to the brain terminate in the part of the brain called "limbic system". This limbic (marginal) system which is positioned between the old brain (brainstem) and the new brain (cerebral hemispheres) is mainly located over the temporal and frontal lobes of the brain. The disturbance of function of these parts of the brain results in insomnia, agitation, depression, irritability, and disturbance of judgment. Insomnia is an integral part of an untreated RSD. So are problems of depression, irritability and agitation.
So the clinical diagnosis of RSD is based on the above four principles rather than simply excluding RSD and finding some other cause for the patient's pain.
RSD, as defined above, usually develops after a minor trauma. There are precipitating factors that enhance the development of RSD. These consist of immobilization of the extremity with cast or brace, application of ice, and inactivity due to strong addictive narcotics and tranquilizers.
The application of brace type cast, wheelchair and crutches also reduces the proper sensory input and results in immobilization of the extremity. The extremity that has become immobile loses its surface temperature.
The body considers that extremity inactive and not needing blood on the surface so the body constricts the surface blood vessels to preserve heat and not to waste it on an immobile extremity. This second factor of immobilization aggravates the first factor of burning pain by increasing the degree of constriction of blood vessels to the skin of the extremity.
The combination of the above three factors, use of ice, immobilization and addicting drugs, exaggerates the SMP (sympathetically maintained pain) due to the original minor trauma.
The original injury may involve any part of the body, but the most common areas affected by this type of sympathetic pain (i.e. constant burning pain, accompanied by severe anxiety, depression and muscle spasm) are the hand, elbow, knee, and foot.
As the condition becomes more persistent and chronic, the physician unknowingly perpetuates and aggravates the condition by the good intention of trying surgical procedures in the area affected by RSD.
Stages of RSD
Stage I: A sympathetic dysfunction with thermatomal distribution of the pain. The pain may spread in a mirror fashion to contralateral extremity or to adjacent regions on the same side of the body. In stage one, the pain is usually SMP in nature.Stage II: The dysfunction changes to dystrophy manifested by edema, hyperhidrosis, neurovascular instability with fluctuation of livedo reticularis and cyanosis causing change of temperature and color of the skin in matter of minutes. The dystrophic changes also include bouts of hair loss, ridging, dystrophic, brittle and discolored nails, skin rash, subcutaneous bleeding, neurodermatitis, and ulcerative lesions (Fig. 5). Due to the confusing clinical manifestations, the patient may be accused of self-mutilation and even "Münchausen syndrome." All these dystrophic changes may not be present at the same time nor in the same patient. Careful history taken is important in this regard. Stage III: Inflammation becomes more problematic and release of neuropeptides from c-fiber terminals results in multiple inflammatory and immune dysfunctions. The secondary release of substance P may damage mast cells and destroy muscle cells and fibroblasts. Stage IV: Identifies the final stage of RSD / CRPS manifested by:
1. Failure of the immune system, reduction of helper T-cell lymphocytes and elevation of killer T-cell lymphocytes. This is in contrast to the opposite, up-regulated function of immune system in early stages.
2. The hypertension in early stages due to alpha-1 up-regulation reverses to eventual exhaustion and to the common occurrence of orthostatic hypotension in this late stage. Blood pressure changes in this stage are due to autonomic failure. The failure of the sympathetic system exaggerates the response to drugs that lower or raise the blood pressure.
3. Intractable generalized extremity and visceral edema involving the abdomen, pelvis, lungs, and extremities due to long-standing disturbance of sodium-potassium and calcium magnesium pumps usually left untreated for several years. The same organs may eventually be subject to multiple abscesses due to failure of immune function.
4. Ulcerative skin lesions.
5. High risks of cancer and suicide.
6. Multiple surgical procedures seem to be precipitating factors for development of stage IV.
This late stage is almost the flip side of earlier stages, and points to exhaustion of sympathetic and immune systems. Ganglion blocks in this stage are useless and treatment should be aimed at improving the edema and the failing immune system.
The faster the stages develop, the more severe the RSD and the treatment should be applied in a more aggressive fashion.
Even in the early stages, laboratory tests such as triphasic bone scanning or thermography show a spread of the disease from one side to the other. The headache and facial pain becomes bilateral, the facial pain is complicated by dizziness, tinnitus (buzzing in the ear). In the later stages of the disease, the spread is both horizontal and vertical (e.g., from right arm to left, down the legs). The reason for this spread is the anatomical structure of the sympathetic nervous system. The majority of the Sympathetic nerve fibers do not allow the standard somatic nerve fibers, but follow the wall of the blood vessels and end up in the chain of clumps of the nerve cells, called sympathetic ganglia", which are present on each side of the spine. Input of pain into any part of these chains of nerves causes the impulse to spread both vertically and horizontally.This is the main reason sympathectomy or removal of the ganglia is fraught with an extremely high percentage of failure.
This complex clinical picture of the spread of this disease has played a major role in confusing and delaying the proper diagnosis and treatment of RSD. to begin with, the injury causes such a small scar that may be barely visible. This is followed by a constant burning pain, severe neck pain and headache, spread of pain to the opposite side, followed by dizziness, fatigue, insomnia, agitation and irritability.
On this background, the patient may develop pain in the arm, tremor of the hand, may have trouble walking, spasms in the legs, and may end up in a wheelchair. It is obvious that such a patient may be viewed as a neurotic, depressed, and a hypochondriac.
The condition is further compounded by the fact that the patient has normal MRI, CAT scans, and x-rays. The pain is a physiological phenomenon, due to the disturbance of small sympathetic nerve fibers; CAT scan and MRI will not show such an abnormality. An individual who suffers a heart attack and goes to the emergency room, has a normal CAT scan and MRI in the face of a potentially fatal disease. By the time MRI is abnormal, showing fluid in the involved joints or damage to the bone due to increased circulation in the deep structures, the disease is quite advanced and easy to diagnose.
Eventually, the spasm may spread to the truncal muscles; as a result, an accordion-like jamming effect of the vertebrae evolves, with resultant bulging of the lower lumbar discs noted on MRI. This may result in unnecessary surgical operation. The RSD causes constriction of blood vessels to the hands; in this clinical picture, the patient is often mis-diagnosed as carpal tunnel syndrome, tardy ulnar nerve palsy, or thoracic outlet syndrome.
Not infrequently, such patients undergo multiple operations over the arms and cervical and lumbar spine regions, with rapid acceleration and deterioration of the RSD.
The worst risk factor, and the cardinal sin, is amputation of a limb. If the patient has any sympathetic mediated pain, amputation is going to multiply the disease by several times, due to the fact that the stump of the Amputation causes scar formation at the cut ending of the nerves with marked exacerbation of RSD in the most severe form, called "Causalgia".
Even without application, surgical procedure over the inflamed area of involvement of the RSD (such as ankle, knee or wrist), is a major aggravator of RSD which overnight changes as stage I RSD to stage III or later.
where i found this info... http://www.rsdrx.com/rsdpuz4.0/puz_1.htm
At Pain Medicine Consultants, our goal is to provide safe and effectivepain relief to improve the quality of your life.
Our board certifiedphysicians specialize in the treatment of acute and chronic spinal pain, including pain from pinched nerves , nerve damage and damaged discs. We are also well-qualified to treat other chronic pains, such as back pain, leg pain, neck pain and shoulder pain, as well as, muscle, arm, sciatica and cancer pain.
We are often able to able to avoid high-risk surgical procedures, using our extensive experience in both non-invasive and invasivepain management and control methods, which include the appropriate prescription, use and application of pain medicine.
Many times, when a patient has had a previous injury and is still experiencing pain, our physicians are able to alleviate the pain by 50% or more. They have also been instrumental in helping athletes in the NFL, NBA and MLB return to their pre-injury level of functionality.
If you are suffering from chronic pain, we encourage you tocontact or visit our pain management offices in Tampa or Sarasota . The physicians and entire team at Pain Medicine Consultants are eager to improve your quality of life by providing you with safe, long-term pain relief.
where i found this info... http://www.painmedconsultants.com/
What Is Happening in My Body to Cause CRPS?
Until recently, doctors thought that CRPS always involved a problem in the sympathetic nervous system (a set of nerves that control the size of blood vessels, sweating, and many other bodily functions). They now think that only some patients with CRPS have these sympathetic nervous system problems. Pain that comes from problems in the sympathetic nerves is called sympathetically-maintained pain, or SMP. The only way a doctor can find out if a patient has SMP is to do a sympathetic nerve block. (Sympathetic nerve blocks are injections of a numbing drug, called a local anesthetic, into different sites in the body). A person suffering from CRPS can be said to have SMP only if he or she has good pain relief from a sympathetic block.
If SMP does not explain the pain in most patients with CRPS, what is the cause of the pain? Experts agree that there are problems in the peripheral nervous system (the nerves in the body) and the central nervous system (the brain and spinal cord) of patients with CRPS, but the details are not known. There are other factors that can be involved in the development of CRPS because they directly affect the activity of the nervous system, muscles, and bones. Examples of these factors are emotional issues or stress and not using a painful body part.
I happen to run across this and some people may be interested in trying this out . Also cickable link at the bottom so you can see it for yourself.All you have to do is contact them and speak with someone .....
Take Care & Soft Hugs
(N)(I)(H) Clinical Research Studies / Protocol Number: 00-NR-0200
Title: Neurotropin for Acute Dental Pain and for Chronic Neuropathic Pain Number: 00-NR-0200 Summary: This study will examine the effectiveness of the drug neurotropin in treating chronic pain after injury to a limb or a large nerve.
Two groups of patients will participate in this study: patients with complex regional pain syndrome type 1, or CRPS-I (also called reflex sympathetic dystrophy) and patients with complex regional pain syndrome type 2, or CRPS-II. CRPS-I is pain that develops after relatively minor injury to an arm or leg, but lasts much longer and is much more severe than would normally be expected. CRPS-II is pain resulting from injury to a large nerve. Candidates will have a history and physical examination, blood tests, and electrocardiogram. Participants will undergo the following tests and procedures:
Patients with CRPS I and II will receive an individualized regimen of physical therapy and standard treatment to control their pain. In addition, they will receive neurotropin or placebo tablets for 5 weeks, then no trial medicine for at least 1 week, and then the other trial drug for the next 5 weeks. That is, patients who took placebo the first 5 weeks will take neurotropin the second 5 weeks and vice versa. Neither the patients nor the doctors will know who received which drug during the two intervals until the study is over. Patients will complete questionnaires about their pain, quality of life, and ability to perform daily living activities. They will have various tests to measure pain (such as sensitivity to heat and cold, to an electric current, to a mild pin prick, etc.); to provide information about changes in their condition (such as tests of range of motion of joints and limb size); to measure blood circulation and sweating in the arm or leg (such as measurements of blood flow to the limb, skin temperature, and sweat production), and other procedures. Sponsoring Institute:
National Institute of Nursing Research (NINR)
Type: Participants currently recruited/enrolled
Gender: Male & Female
Referral Letter Required: No Population Exclusion(s): Children Eligibility Criteria:
Dental outpatients undergoing elective removal of impacted third molars based on a preoperative diagnosis of the type and number of teeth to be extracted. The difficulty of extraction will be classified based on clinical exam and a panoramic radiograph as simple extraction (1), soft tissue impaction (2), partial boney impaction (3), or full boney impaction (4). Both lower teeth to be extracted should be similarly boney impacted, and the score for each of the two lower teeth should be 3 to 4. Uppers are usually in soft tissue. The diagnosis for each tooth will be confirmed by the oral surgeon after the procedure based on the surgical procedure actually performed. CRPS patients are referred with a diagnosis of CRPS-I or CRPS-II in one limb only, based on pain (1) that is post-traumatic and spread beyond the region of the injury; (2) has persisted for more than 2 weeks; and (3) is associated with swelling, altered skin color or skin temperature, altered sweating, allodynia or hyperesthesia or limitation of active movement. Atrophic changes in skin, hair loss or nail changes, or disuse atrophy of skeletal muscle may be present.
Both sexes are to be studied.
Children can participate, if they can provide adequate self-ratings.
All ethnic and racial groups can participate.
Patients must be willing to return to NIH for follow-up evaluation under this protocol.
Dental outpatients must not be taking any medications chronically (with the exception of oral contraceptive agents).
Pregnant and lactating women are excluded.
Based on the oral surgeon's postoperative diagnosis, any extraction which is classified as producing unusual surgical trauma will result in exclusion from the remainder of the study.
Dental subjects will also be excluded if they are not adequately sedated by midazolam alone and require intraoperative administration of an opioid drug such as fentanyl, administration of greater than 14.4 ml of local anesthetic (2% lidocaine with 1:100,000 epinephrine), or postoperative administration of a steroid for possible injury to the inferior alveolar nerve.
Patients referred with CRPS-I or CRPS II who have abnormal screening test results or who have non-traumatic disorders to which pain may be attributed (gout, malignancy, arthritis, etc.) will be excluded.
Any patients who have had ablative procedures for treatment of their neuropathic pain disorder will not be eligible for inclusion in this study.
Subjects with impaired mental capacity that precludes informed consent and children who cannot provide adequate self-ratings are excluded.
Patients who have a positive HIV result will be excluded.
Subjects with obviously impaired mental capacity that precludes informed consent and ability to provide adequate self-ratings are to be excluded.
Patients who have a positive HIV result will be excluded.
Currently Not Provided
Reflex Sympathetic Dystrophy
Sympathetic Nervous System
Chronic Regional Pain Syndrome
Reflex Sympathetic Dystrophy
National Institutes of Nursing Research
Patient Recruitment and Public Liaison Office
10 Cloister Court
Bethesda, Maryland 20892-4754
Toll Free: 1-800-411-1222
TTY: 301-594-9774 (local),1-866-411-1010 (toll free)
If you have:
Questions about participating in a study, please contact the
Technical questions regarding the Clinical Center web site, please contact theDepartment of Clinical Research Informatics, CC. Search The Studies | Help | Questions | Clinical Center Home | NIH Home
National Institutes of Health Clinical Center Bethesda, Maryland 20892. Last update: 03/24/2009
Carpal Tunnel & RSD / CRPS
I been hearin alot about people who get rsd / crps after carpal tunnel surgeries . So i decided to investigate what i could find on this subject .
Facts or Myth's . Treatments or what ever else i could find .
Take Care & Soft Hugs
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~United Pain Medicine, P.A., Sherwood, AR 72120, USA. firstname.lastname@example.org
PURPOSE: A complex regional pain syndrome of an extremity that has previously resolved can recur after repeat surgery at the same anatomic site. Complex regional pain syndrome is described as a disease of the autonomic nervous system. The purpose of this study was to evaluate preoperative and postoperative sympathetic function and the recurrence of complex regional pain syndrome type I (CRPS I) in patients after repeat carpal tunnel surgery. METHODS: Thirty-four patients who developed CRPS I after initial carpal tunnel releases and required repeat open carpal tunnel surgeries were studied. Laser Doppler imaging (LDI) was used to assess preoperative sympathetic function 5-7 days prior to surgery and to assess postoperative sympathetic function 19-22 days after surgery or 20-22 days after resolution of the CRPS I. Sympathetic nervous system function was prospectively examined by testing reflex-evoked vasoconstrictor responses to sympathetic stimuli recorded with LDI of both hands. Patients were assigned to 1 of 2 groups based on LDI responses to sympathetic provocation. Group I (11 of 34) patients had abnormal preoperative LDI studies in the hands that had prior surgeries, whereas group II (23 of 34) patients had normal LDI studies. Each patient in this study had open repeat carpal tunnel surgery. RESULTS: In group I, 8 of 11 patients had recurrent CRPS I, whereas in group II, 3 of 23 patients had recurrent CRPS I. All of the recurrent CRPS I patients were successfully treated with sympathetic blockade, occupational therapy, and pharmacologic modalities. Repeat LDI after recurrent CRPS I resolution was abnormal in 8 of 8 group I patients and in 1 of 3 group II patients. CONCLUSIONS: CRPS I can recur after repeat hand surgery. Our study results may, however, identify those individuals who may readily benefit from perioperative therapies. TYPE OF STUDY/LEVEL OF EVIDENCE: Prognostic I.
where i found this info ... http://www.ncbi.nlm.nih.gov/pubmed/18294544
The diagnosis and management ofComplex Regional Pain Syndrome, formerly known as Reflex Sympathetic Dystrophy has always been a controversial issue. However, the Social Security Administration’s ruling in the Federal Register on October 20, 2003 provides helpful diagnostic guidelines. There is, however, still no consensus on how to appropriately treat CRPS.
CRPSis diagnosed by documenting a history of injury in any part of the body, especially the limbs, followed by complaints of severe pain, skin sensitivity, swelling and reddish purple discoloration, sweating, hair loss or growth, atrophy, and warmth in the acute setting but cold in the chronic setting. Contrary to popular belief CRPS can spread to any part of the body, including internal organs and can also affect hormone regulation.
CRPSis classified into Type I and Type II. The clinical features are basically the same in both categories. The only difference is that no specific nerve injury can be identified in Type I, whereas in Type II, nerve injury can be documented. In addition to obtaining a good history and physical examination, some useful diagnostic tools include thermography, bone scan, quantitative sensory testing and sweat output measurement.
Although there is no known cure for this disease, it can be controlled if treated within three months of actual onset, not diagnosis. We have more than seven years of experience in the diagnosis and management ofCRPS using a multi-disciplinary, non surgical approach with the proper combination of medications, nerve blocks, massage, and physical and occupational therapy. Our protocol has been most effective in reducing pain and suffering, thereby improving quality of life and activities of daily living.
We do not recommend surgery for the management ofCRPS unless there is a critical or life threatening problem. The pain of CRPS can mimic symptoms of carpal tunnel syndrome, ulnar neuropathy and disk herniation, and it is wrong to operate in such cases. Ganglion blocks may be helpful if given within three months of disease onset, but not in chronic cases. In our experience, no patient referred to us has ever benefited from the use of a spinal cord stimulator.
Conventional opiates such as Oxycontin, Dilaudid, Lorcet, Lortab, MS Contin are excellent analgesics in the acute setting but have limited value in chronic cases due to their long term side effects. Antagonist opiate analgesics such as Buprenex or Nubain are better alternatives because of their lesser addicting properties. We have found that antidepressants such as Trazodone and Effexor XR, muscle relaxants like Klonopin and Zanaflex, anticonvulsants like Trileptal and Neurontin, and anti-inflammatories like Mobic, when used in the appropriate circumstances, are helpful in reducing the symptoms and signs ofCRPS
where i found this info... http://www.rsdconsultants.com/CRPS%20Info.htm
The third diagnostic principle is neuropathic pain, including CRPS I, is complicated by inflammation in varying degrees. This inflammation was first reported by Mitchell (1864)as "shiny skin" and, later on, by Sudeck (1942). The neurogenic inflammation results in bullbous lesions, sterile abscess, edema and impingement of the nerves at the wrist, elbow, thoracic outlet and ankle areas - resulting in the disease being mistaken for conditions such as carpal tunnel, thoracic outlet (TOS), tarsal tunnel syndromes, and myofascial syndrome. The well-intended surgical procedure to relieve such entrapment neuropathies may in turn aggravate the inflammation by virtue of surgical trauma becoming a new source of neuropathic pain.
The inflammation is another manifestation of dysfunctional sympathetic system. The sympathetic system is responsible for immune system regulation (Arnason, 1993). As a result, the patient may develop bouts of unexplained fever, edema, attacks of subcutaneous bleeding, neurodermatitis, bulbous lesions , pelvic inflammatory disease (PID), or interstitial cystitis. Inflammation may cause development of subcutaneous skin nodules, pulmonary nodules, laryngitis, difficulty with phonation, attacks of hacking cough and hematemesis. In late stages it can cause elephantiasis, subcutaneous bleeding, bullous deep ulcerative lesions involving the skin as a manifestation of disturbance of the immune system. It can be mistaken for infection, osteomyelitis, dermatitis, and cystitis. Treatment with antibiotics provides no relief.
The inflammation is usually intermittent, and is not consistently present. Only a careful history taking can document previous attacks of inflammation.
where i found this info... http://rsdrx.com/CRPSABSTRACT.htm
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