1. Rsd/Crps & Pregnancy
2. Crazy or Brilliant , Extreme home remidies
3. Techniques to cope with pain Q & A's
4. Difference between Neuropathic pain & Nocieption pain
5. Medical conference
6. Tips for winning disability
7. No test to prove rsd/crps
8. Flair-ups & How to handle them
9. Rsd/Crps information center
10. Rsd/Crps often seen in PA workmens comp cases
11. Memantine treatment for rsd/crps
12. Managing chronic pain
~*~*~*~ RSD/CRPS & Pregnancy ~*~*~*~
Some wonder how this affects women when and if they have an pregnancy , I for one would wonder would it make it worst , or toleratable . Some to maybe answer some questions . I thought i would research this subject .... Take Care ... Please remember you should discuss this and any concerns with your doctor , they are able to tell you more about this and the meds you take during your pregnancy ....... Disclaimer
Please note that Fighting RSD accepts no responsibility for the accuracy of the content on this website or the associated support forum. The opinions put forward on this site is that of patients with the condition, who have no medical training.
Spinal Cord Stimulation, Conception, Pregnancy, and Labor: Case Study in a Complex Regional Pain Syndrome Patient
Ricardo Segal, MD
Neurological Surgery, University of Pittsburgh School of Medicine Pittsburgh, Pennsylvania, USA
Copyright Copyright © 1999 Blackwell Science, Inc.
Brachial plexus injury • causalgia • complex regional pain syndrome • labor • pregnancy • reflex sympathetic dystrophy • spinal cord stimulation
Introduction. Interventional modalities for pain treatment are reserved for patients failing multidisciplinary pain management, including psychological, physical, pharmacological, and anesthetic techniques.
Objective. Medications for intractable pain may be unacceptable because the risk of teratogenic effects. The purpose of this study is to find out whether spinal cord stimulation may be safe during conception, pregnancy, and delivery.
Materials and Methods. We report a 30-year old, female, neonatal nurse who developed left hand burning pain, swelling, coldness, and weakness following a mild brachial plexus injury in a motor vehicle accident. The patient responded well to a combination of Neurontin, Trazadone, Ultram, and Vicodin. A year later, the patient married and wanted to become pregnant but was afraid of possible teratogenic effects of the medications. Therefore, she requested an interventional modality for control of her symptoms. We recommended spinal cord stimulation (SCS) based on our excellent experience with this modality in the management of complex regional pain syndromes (CRPS). However, we did inform the patient that no data had been published regarding the safety of this modality in pregnancy and labor.
Results. Cervical SCS resulted in excellent pain control and discontinuation of the medications. Thirteen months later, she delivered a healthy five pound baby girl. Mother and baby were discharged home in two days. The SCS was not turned off at any time during the labor and delivery.
Conclusion. SCS was safe for implantation in our case study of a pregnant woman. This may constitute a new indication for SCS in patients otherwise successfully managed with non-interventional modalities for pain control.
Pregnancy and RSD/CRPS
For some women with RSD/CRPS during pregnancy, their RSD/CRPS may become more tolerable, for others it may become less tolerable or stay the same. Women with RSD/CRPS who are wishing to become pregnant should discuss this with their doctor, especially as some medications used in the treatment of RSD/CRPS are not advised during pregnancy
Most of the things i found were blogs of women who went through pregnancy , due to most doctors have not done any studies of rsd/crps and pregnancies .. My recommendation is still the same speak with your doctor or doctors about your pregnancy , they can better advise you and what to do in a case like this , i,m sorry i wasnt much help in this subject .
More Causes and Risk Factors of having rsd/crps
RSD/CRPS appears to involve the complex interaction of the sensory, motor, and autonomic nervous systems, and the immune system. It is thought that brain and spinal cord (central nervous system) control over these various processes is somehow changed as a result of an injury.
Causes associated with the onset of RSD/CRPS include the following:
Paralysis on one side of the body (hemiplegia)
Repetitive motion disorder (e.g., carpal tunnel syndrome)
Spinal cord disorders
Trauma (e.g., bone fracture, gunshot and shrapnel wounds)
In 10% to 20% of cases, no direct cause can be found. Injury that precedes the onset of RSD/CRPS may or may not be significant.
Home Remedies for chronic pain Crazy or Brilliant
Sometimes the weirest thng can be a life saver , or even just to help ease to pain we all go through everyday . so i decided to search around and see what i could find and even give some of them a try to see what happens . I will let you knon later what i find that works or if you try something and find that it works please feel free to share it with us ( please dont try hitting yourself in the head with a hammer or using a hot poker to get rid of pain this is just plain crazy , Not to , mention you would go through even more pain ) ............ Take Care .............
Crazy or Brilliant? Extreme Home Remedies for Pain
Doctors Share Real-World Bad Ideas to Treat Pain
By LAUREN COX
ABC News Medical Unit
Right now — in bathrooms, bedrooms or at the kitchen sink — people across the world are trying rather unusual home remedies to cure their pain. In Mexico, some people rub potato halves on their foreheads for headaches. In Central America, blowing cigar smoke on a sufferer's back is believed to bring them pain relief. And in the United States, rubbing cobwebs into cuts is believed to stop bleeding and pain.
The following is a list, compiled by pain management doctors, of the most extreme measures people have taken to cure pain — sometimes hitting the jackpot and sometimes just hitting their heads.
The primal instinct to get rid of pain can lead to desperate actions, including fighting fire with fire.
"I've personally taken care of patients that hit their head with objects — hammers, boards et cetera — or literally pounded their head on the wall," said Dr. Tim Collins, assistant professor of neurology at Duke University Medical Center in Durham, N.C.
One patient had her brother tap her on the head with a hammer, because she felt it made her headache better," said Collins. "Fortunately, he didn't hit her very hard."
Perhaps the hammers and boards stunned people into temporarily forgetting their pain, but Collins said it didn't cure their headaches.
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Another case of fighting fire with fire — quite literally — is the people who take a hot poker to the sensitive areas, said Dr. Alan Brewer, director of the pain management program at the University of Colorado in Denver.
"They take these hot iron rods, and just poke it into the skin," said Brewer, of the approach, which, he said, he saw firsthand in Kuwait. But he added that this strategy is also practiced among some groups of Native Americans.
"Obviously, their pain goes away while it's burning, so they forget it for a while and pay attention to the new pain," he said.
Yet, more commonly, people in pain are likely to seek out soothing objects instead of construction tools. Doctors in Pittsburgh had a patient who swore by Irish Spring brand soap. Except he didn't wash with it, he slept with it."[He put] Irish Spring brand soap under the sheet and over the mattress cover to treat arthritis pain of the knee," said Dr. Doris Cope, vice president of the anesthesiology department at the University of Pittsburgh Medical Center.
"The patient swore that the Irish Spring -- and no other brand -- helped his arthritic knee pain a lot," said Cope. Good Logic, Bad Logic
When people try out home remedies concocted by others, they tend to look for more logical treatments than sleeping with soap. But a bit of reasoning in the wrong direction can lead to many more problems.
Ear candling is one so-called logical treatment that is making a comeback in holistic medicine circles.
Ear candles are exactly what they sound like -- candles you stick in your ear. Light the far end, and supposedly the smoke or burning wick creates a weak vacuum in the ear, drawing out earwax and other impurities that cause pain.
But while a burning explosion in a tunnel will suck out the available oxygen, hot air on the end of a cone-shaped candle doesn't suck out anything, according to the popular medical myth debunking site Quackwatch.com, run by Dr. Stephen Barrett.
And it might be a good thing that it doesn't work; according to the Quackwatch site, a vacuum strong enough to pull out ear wax would also rupture the eardrum.
So if hot candle wax doesn't work, what about olive oil?
Dr. William Zempsky, an associate professor at the Connecticut Children's Medical Center, said he has seen patients who try to treat earaches with the coating properties of olive oil -- just squeeze a few drops of olive oil at room temperature to ease the pain.
But this actually works, said Zempsky. In fact, studies have shown olive oil is more effective than some anesthetizing ear drops.
"It's a pretty good way of decreasing ear pain," said Zempsky.
Products for Sale
Natural remedies -- like the olive oil trick -- are all the rage now.
"One out of three people are seeking alternative care -- including some physicians," said Dr. Joseph Shurman, chairman of pain management at Scripps Memorial Hospital in La Jolla, Cali.
"There are all kinds of herbs, homeopathic remedies being used in the home," said Shurman.
Along with the natural plants, is a growing side business of selling cures from natural metals. One big business to treat arthritis pain involves magnets, which supposedly draw blood to the inflamed site to heal the joint. But while magnets are not likely the key to pain relief, they do have natural properties that may be more pain than they are worth.
Magnets for arthritis and bone pain placed under beds or in hip pockets resulted in one patient demagnetizing all his credit cards," said Cope.
More serious damage can be done when patients try to drink metals.
"I have had one patient taking a known toxin for his complaints -- a silver compound that has been repeatedly outlawed by the FDA," said Collins.
Side effects from using colloidal silver products may include seizures, kidney damage, stomach distress, headaches, fatigue and skin irritation, according to the U.S. National Institutes for Health. And some consuming the concoction have even been known to turn themselves blue -- the result of a buildup of the substance in the skin.
Emotions at Stake
"Very often the scenario is that they're looking for a magic wand," said Dave Patterson, a psychologist who treats chronic pain patients at the University of Washington's Department of Rehabilitation Medicine in Seattle. "They tend to seek medical solutions when there are no medical solutions."
While emotions and thoughts can drive some people into harmful scams, the same feelings can help heal them.
Clinical studies have shown that people's belief about a treatment can actually improve their condition. It's called the placebo effect -- when a person's pain symptoms get better even on a sugar pill.
"It can be higher than 35 percent," said Shurman, who notes that PET imaging of the brain have shown similar effects in the brain whether a patient takes a narcotic or a sugar pill.
"Even though ethically we cannot prescribe placebos -- we'd have to tell the patient -- placebos are very effective," said Shurman.
Techniques to cope with pain
Q and A,s ON the subject
Paul Chelminski, M.D., M.P.H., Assistant Professor of Medicine, University of North Carolina at Chapel Hill ( where i found this http://abcnews.go.com/Health/LivingWithPain/ )
Question: Is Alcohol Good For Pain Relief?
Answer: When I was a teenager, I was watching the movie, Papillon, and unfortunately this idea that alcohol could relieve pain was perpetuated by this movie because I remember there was this somewhat gruesome scene where a leg was amputated from one of the movie actors with the assistance of a bottle of brandy.
Alcohol has no direct pain-relieving properties. There is a strong relationship between chronic pain and anxiety and depression. And alcohol does have some transient benefits on mood that can help indirectly alleviate the patient's suffering from pain, but no direct effect on the pain itself.
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~Question: Is Marijuana Good For Pain Relief?
Answer: Marijuana's been advocated for the treatment of a variety of serious medical problems including AIDS, cancer, and chronic pain. However, several well-designed clinical trials have failed to show any direct benefit of marijuana in relieving pain. It's important to remember, though, that chronic pain is complicated by mental health issues such as depression and anxiety, and I suspect that many patients with chronic pain are trying to self-treat and alleviate the depression and anxiety that accompany their pain.
Question:If I Take Too Much Pain Medicine, Will It Stop Being Effective?
Answer: This is a complex question, and generally refers to a phenomenon we call tolerance. Usually we're talking about the opioids or narcotic medications, in this case. The idea is that the body becomes resistant to this medication over time, thus requiring larger and larger doses. Although scientists talk about this, we know that this can happen pharmacologically, clinically we don't see this that often. Often times, patients remain on the same dose of opioids for long periods of time without requiring increasing doses.
Question:Do Magnets And Copper Bracelets Relieve Pain?
Answer: In today's kind of media-intense environment, people are inundated with all kinds of claims about the effectiveness of a variety of interventions for medical conditions including pain, cancer, HIV, AIDS. Many of these are unsubstantiated.
This is some of the things i try when i,m in a bad flair up
1. Heating Pads
2. tropical creams
3. menthol patches
4. hot baths
5. menatation / self hypnosis
6. water theraphy ( my pool in summer or local hospital pool )
7. pet theraphy
8. pray alot
9. music theraphy
10. lay in silence and think about old times or when i was able to do things i cant do now
The Difference between Neuropathic pain and nociceptive pain
I dont know how many of you understand what the difference is between the two , so here i am putting it out there so those who dont know will know what it means . ( i myself never heard of it before )
Take Care And Soft Hugs
Common Types of chronic pain
Chronic pain usually falls into one of two categories:
Nociceptive pain is caused by damage to body tissue and usually described as a sharp, aching, or throbbing pain. This kind of pain can be due to benign pathology; or by tumors or cancer cells that are growing larger and crowding other body parts near the cancer site. Nociceptive pain may also be caused by cancer spreading to the bones, muscles, or joints, or that causes the blockage of an organ or blood vessels.
Neuropathic pain occurs when there is actual nerve damage. Nerves connect the spinal cord to the rest of the body and allow the brain to communicate with the skin, muscles and internal organs. Nutritional imbalance, alcoholism, toxins, infections or auto-immunity can all damage this pathway and cause pain. Neuropathic pain can also be caused by a cancer tumor pressing on a nerve or a group of nerves. People often describe this pain as a burning or heavy sensation, or numbness along the path of the affected nerve.
Cancer Pain can be nociceptive or neuropathic.
Chronic pain is generally associated with one of the following areas:
Chronic back or leg pain
Chronic back or leg pain may be the result of spinal diseases such as arachnoiditis, degenerative disc disease, epidural fibrosis, failed back surgery syndrome, lumbar disc herniation, osteoporosis and spinal stenosis. Back pain is often located in the lower back, but may extend to the thighs, calves, and even feet. Affected areas may feel tender or sore to the touch, and the pain may increase with movement. This type of pain can be felt as a sharp pain, a burning sensation, or a dull muscular ache - and can range from mildly uncomfortable to completely disabling.
Complex Regional Pain Syndrome (CRPS)
CRPS usually develops in the foot or hand after surgery, injury such as a broken bone, or as a result of nerve damage. The term actually describes two painful syndromes - Reflex Sympathetic Dystrophy (RSD) (CRPS type I) and Causalgia (CRPS Type II). The overriding symptom is extreme pain, frequently described as burning. Other symptoms can include sensitivity to touch, skin changes, swelling, weakness, and decreased function of the affected hand or foot.
This term covers a variety of neurological disorders resulting from damage to the nerves. The common symptoms include pain, burning, weakness and numbness, and these most often appear in the hands or feet. Painful neuropathies may originally be caused by nutritional imbalances, alcoholism, toxins, infections, or autoimmunity, or may be the result of illnesses such as kidney failure or cancer. Treatment will usually focus on the underlying disease or condition if it is known.
If you are suffering from chronic pain, discusstreatment options with your doctor and ask to be referred to a Pain Specialist near you.
where i got this from .... http://www.medtronicneuro.com.au/chronic_pain_commontypes.html
You would think that with all these doctors getting together from all over the world . To discuss rsd/crps , Someone might have thought to bring a couple rsd/crps people with them to help in there discussions , To give some kind of input or even go through possible testing so all doctors can see for themselves in case someone had found relief or saw with there own eyes what a real rsd/crps person goes through ,They might have brought along a couple of patients , To help with there so called discussions . Anyone can talk about it and i guess this was a good step but why not use a real patient to try tests they are talking about . Sometimes you run across a cure by stumbling over it . I for one would try anything if in hopes that maybe something they may happen to run across , would help me , Lord know's , I been through every test know to man . And i would be happy to be a guinea pig in a test or trial if it would help me or someone else . I guess this is my little way of venting i,m sick of being like this as i know the rest of you are also . BUT when will they understand what it is what we go through ? when will they get it , If it were one of them they will be all over this thing doing everything possible . Thats for sure . But instead of doctors discussing this , Why not let the people who suffer join in on the conversation , Those who have first hand knowledge of what its like to live like this everyday of there life . Sometimes to learn you have to listen . Thanks for letting me vent ........ Take Care And Soft Hugs ...........
Scientific Presentations Experts from a wide variety of clinical and basic research areas, including neuro-imaging, pain, neural plasticity, the sympathetic nervous system and the immune system were invited to bring their knowledge and research approaches to bear on the difficult clinical problem of RSD/CRPS. The participants considered the current knowledge about RSD/CRPS in the context of the state-of-the-art research tools used in their laboratories and proposed ways to apply these approaches to RSD/CRPS. It is hoped that new opportunities for innovative research into the mechanism(s), epidemiology and treatment of RSD/CRPS will be fostered by their cross-disciplinary discussions.
During their presentations, the participants suggested that the mechanism(s) that cause RSD/CRPS are elusive, primarily because of the number of complex systems affected. It became obvious that a single mechanism can barely account for all of the changes seen in patients with RSD/CRPS. Several innovative hypotheses were presented at the workshop and it was agreed on the notion that several mechanisms interact to produce the symptoms of RSD/CRPS.
Drs. Ralf Baron and Wilfrid Jänig presented clear evidence of sympathetic nervous system dysfunction in their experimental studies of human patients with RSD/CRPS. Activating the sympathetic nervous system by lowering body temperature results in increased pain in the affected area in a subgroup of RSD/CRPS patients, whose pain is relieved by sympathetic nerve block or sympathectomy (destruction of the sympathetic innervation to the affected area). However, this sympathetically maintained pain (SMP) mainly involves the deep somatic tissues. While it is not known how autonomic dysfunction relates to the myriad tissue pathologies in RSD/CRPS, this evidence led the participants to generally agree on the following key issues: 1) RSD/CRPS is a neurological (rather than psychological) disorder, and 2) RSD/CRPS is likely to be a disorder of the central (in addition to the peripheral) nervous system.
Dr. Clifford Woolf provided evidence that some types of neuropathic pain are related to changes in pain signaling pathways, including in the neurons of the spinal cord. Such modifications could distort the signaling process so that normally painless stimuli begin to produce pain, and stimuli that should be slightly discomforting actually produce severe, long-lasting pain. New technologies in gene and protein expression profiling should permit researchers to explore these issues further. However, it must be kept in mind that RSD/CRPS in most patients is triggered by traumas without nerve lesions. Thus the pain in these RSD/CRPS patients is not neuropathic pain in the strict sense.
Dr. Linda Watkins suggested that the immune system might play a role in the disorder since signs of inflammation (redness, swelling, increased blood flow and tissue accumulation of immune cells) in the painful region are common in RSD/CRPS patients. The release of pro-inflammatory cytokines in response to neural and glial activation may be one connection between the abnormal regulation of the sympathetic nervous system and the characteristics of inflammatory immune reactions seen in the disorder. These thoughts connect to the idea that peripheral inflammatory processes are involved in the pathogenesis of early RSD/CRPS. However, the exact mechanisms of the initiation and maintenance of these inflammatory reactions, their connection to the sympathetic and afferent (peptidergic) innervation of the affected tissues and their relation to the central changes (e.g., the spinal cord, as addressed by Dr. Watkins) are far from clear. Dr. Levine, who presented several similarities between RSD/CRPS and autoimmune inflammatory diseases such as rheumatoid arthritis, provided support for this idea.
Dr. Wilfrid Jänig approached the problem from a systems level and proposed that the inappropriate integration of sensory, autonomic and motor components at several levels in the central nervous system could be a cause of RSD/CRPS. The initial insult mostly occurs in the periphery and triggers changes in the central representations of the sensory, motor and sympathetic systems which are reflected in the changes of the respective output systems observed in the RSD/CRPS patients. Subsequent interactions with the immune, endocrine and vascular systems could lead to changes in the long-term responsiveness of the central nervous system that finally determines the disease symptomatology in the chronic state.
Dr. Catherine Bushnell applied her expertise in neuroimaging to the question of nervous system activation in RSD/CRPS. She presented comparative imaging of pain in the brain after cutaneous or visceral stimuli to identify brain regions that are uniquely responsive to a particular type of painful stimulus. Similar comparisons between "normal" pain and pain in RSD/CRPS patients should help to clarify which regions of the nervous system are abnormally activated in this disease state. This is a very attractive and promising idea in view of the finding that many chronic RSD/CRPS patients have generalized sensory deficits (cold, warm, pain, touch perception) that can be quantified. If this is a CNS abnormality, functional imaging could suggest CNS sites that should be explored.
Dr. Stephen Bruehl presented clear evidence that psychological distress in patients with CRPS is not a causative factor but might evolve secondary to the chronic pain syndrome. Furthermore, statistical factor analysis of multiple signs and symptoms in CRPS shows that the diagnostic criteria that have been defined so far should be extended by particular signs (e.g. by motor symptoms) in order to increase diagnostic sensitivity and specificity.
In summary, based on evidence from clinical observations, experimentation on humans, and experimentation on animals the general hypothesis has been put forward that RSD/CRPS is a disease of the central nervous system. RSD/CRPS patients exhibit changes which occur in somatosensory systems processing noxious, tactile and thermal information, in sympathetic systems innervating blood vessels, sweat glands and possibly other targets, and in the somatomotor system, indicating that the central representations of these systems are changed. The way these central changes are triggered by the peripheral trauma, which is often minor compared to the dramatic expression of the clinical phenomena, remains an enigma. Furthermore, the way these central changes connect to the peripheral inflammatory/immune changes is entirely unclear. Finally, we cannot explain why pain and the other changes associated with the sympathetic nervous system (including swelling), the motor system and the somatosensory system may disappear, in RSD/CRPS patients with sympathetically maintained pain (SMP), after sympathetic blockade (e.g., with a local anesthetic or with guanethidine). It was agreed that, based on the clinical changes observed in the RSD/CRPS patients which can be measured quantitatively, it should be possible to formulate hypotheses about the underlying mechanisms. These hypotheses should be tested by using a multidisciplinary approach, which includes clinical experimentation and human models. Such an approach is imperative to reach to a mechanism-based diagnostic classification of the RSD/CRPS patients and ultimately to the development of a mechanism-based therapeutic strategy.
New Research Directions The workshop participants identified several critical needs in our basic understanding of RSD/CRPS, as well as potential directions for basic and clinical research on new treatment strategies. These needs were in the areas of 1) diagnostic criteria, 2) epidemiology, 3) RSD/CRPS model systems, 4) disease mechanisms, 5) integration between basic research and clinical research, and 6) therapy:
A consensus definition of RSD/CRPS with standardized diagnostic criteria. There is practical agreement among neurologists, anesthesiologists and others about the minimal clinical criteria (signs and symptoms) that define RSD/CRPS. However, without a universally accepted definition and diagnostic criteria and a further validation and extension of the present clinical criteria, it is difficult to accurately identify RSD/CRPS patients, select patients for clinical trials, validate experimental human and animal model systems for research, and last-but-not-least to formulate testable hypotheses. The participants suggested that an expert meeting to specifically define the clinical and diagnostic criteria, based on what is known, should be a high priority for the field. Once determined, these consensus criteria should be disseminated to the medical, research and advocacy communities, in particular to those groups involved in the epidemiological studies, design of appropriate models for symptoms in RSD/CRPS, research on underlying mechanisms and the design of RSD/CRPS therapies tested in prospective clinical trials.
Epidemiological studies of RSD/CRPS using well-defined diagnostic criteria. Epidemiological studies to identify characteristics of patients at high risk for developing RSD/CRPS, to better define the relationship between certain clinical signs and disease onset, progression and distribution on the body, and to find out the incidence of patients with RSD/CRPS were considered a high priority. Patients with RSD/CRPS exhibit different combinations of symptoms. Does the individual RSD/CRPS patient progress through the three stages of the disorder as described in the literature. Most patients do not seem to go through different stages, although this has not been thoroughly investigated. Currently the symptomatic variability among RSD/CRPS patients makes it difficult to draw firm conclusions about mechanisms of the disorder based on clinical profiles, and could contribute to unclear findings in clinical trials. Strict patient selection based on defined clinical criteria could help to resolve this problem. Epidemiological studies may also help to clarify the anecdotal evidence regarding different incidence rates between women and men and the differences in the disease state between children and adults with RSD/CRPS. Finally, epidemiological studies may serve to work out prospective studies in order to find predictors for the development of RSD/CRPS.
Validate the existing models of CRPS and generate new models that recapitulate the unique features of RSD/CRPS. Appropriate experimental systems in which to study RSD/CRPS are required to advance the field; current model systems do not accurately reflect all of the symptoms experienced by patients, such as the potential gender disparity. We have models to study mechanisms operating in CRPS II (which may develop after trauma with nerve lesion); however, as noted by Dr. Gary Bennett, we almost totally lack animal models to study mechanisms operating in RSD/CRPS. Further, there are few simple in vivo or in vitro experimental model systems available to study potential RSD/CRPS disease mechanisms or to predict the efficacy of potential therapeutics.
Define disease mechanisms that give rise to RSD/CRPS in susceptible individuals. Several theories about disease mechanisms were presented at the workshop, but most questions addressing mechanisms clearly remain open. The participants felt that further research efforts focused on determining underlying mechanisms that cause RSD/CRPS are absolutely necessary to make progress in the design of a more appropriate (mechanism-based) diagnostic classification of RSD/CRPS patients and in the design of better therapeutic strategies. In the past, research efforts relevant to RSD/CRPS have generally focused on one component of the syndrome, such as pain, or blood flow, or bone/joint changes, but very little or not at all on central nervous system components related to the sensory, motor and sympathetic systems. Because RSD/CRPS affects multiple body systems, it is important to investigate the interactions between these peripheral and central components.
Integrate research on animal and human models with clinical research on patients. The workshop participants found it essential (and attractive) that research on animal and human models and clinical investigations of RSD/CRPS should be closely aligned. Thus research on mechanisms performed on different models must be interactive with clinical research. Any model, even the human one, is only an approximation to the clinical situation. Research on mechanisms in the models should concentrate on symptoms but not on syndromes.
New RSD/CRPS therapies tested in prospective clinical trials. To date, there are no clinical trials on the efficacy of various treatments of RSD/CRPS available that used evidence-based-medicine criteria (Dr. David Borsook). The participants presented preliminary anecdotal evidence for therapeutic approaches, such as long-term sympathetic and/or spinal cord blockade and physical therapy that could be tested in controlled, prospective clinical trials. Trials designed to treat patients at risk for developing RSD/CRPS (e.g., those undergoing knee-replacement surgery) would help to standardize the patient populations and may contribute to more reliable clinical results. As suggested by Dr. Howard Fields, a collaborative, multi-disciplinary, multi-site translational research program on RSD/CRPS may help to facilitate the development and testing of new therapies for this disorder.
In summary, there was a consensus amongst the participants of the workshop that future research on the mechanisms of RSD/CRPS must be much better integrated with the observation on the human patients, i.e. with the clinic. Design of both animal and human models must be more closely integrated with each other and with the clinic in order to focus the scientific questions, the formulation of hypotheses and the experimental approaches. Only such an interdisciplinary and multidisciplinary approach has a realistic chance of uncovering the pathophysiology and improving treatment of RSD/CRPS. Such an approach should be optimal to use and focus the different methodological techniques that are available to reach these aims. The best way to achieve this overall aim is to create research programs in association with the clinic in which the RSD/CRPS patients are diagnosed and treated.
Dr. Ralf Baron (Germany)
Dr. Gary Bennett (McGill)
Dr. David Borsook (Harvard)
Dr. Stephen Bruehl (Vanderbilt)
Dr. Cathy Bushnell (McGill)
Dr. Howard Fields (UCSF)
Dr. Wilfrid Jänig (Germany)
Dr. Cheryl Kitt (NINDS)
Dr. Jon Levine (UCSF)
Dr. Audrey Penn (NINDS)
Dr. Linda Watkins (University of Colorado)
Dr. Clifford Woolf (Harvard)
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Jänig W. Pain and the sympathetic nervous system: pathophysiological mechanisms. In: Autonomic Failure. Mathias CJ, Bannister R, eds. Oxford: Oxford University Press, 4th edition, 1999; pp. 99-108.
Jänig W, Baron R. The role of the sympathetic nervous system in neuropathic pain: clinical observations and animal models. In: Neuropathic Pain: Pathophysiology and Treatment. Hansson PT, Fields HL, Hill RG, Marchettini P; eds. Seattle: IASP Press, 2001; pp. 125-149.
Jänig, W., Baron, R. The values of animal models in research on CRPS. In Harden, R.N., Baron, R. Jänig, W. (eds.) Complex regional pain syndrome. Progress in Pain Research and Management, Vol. 22. IASP Press, Seattle, pp. 75-85 (2001).
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Jänig W, Häbler H-J. Sympathetic nervous system: contribution to chronic pain. In: Nervous system plasticity and chronic pain. SandkÜhler J, Bromm B, Gebhart GF, eds. Progr Brain Res 2000; 129:453-470.
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Rommel O, Gehling M, Dertwinkel R, Witscher K, Zenz M, Malin JP, Jänig W. Hemisensory impairment in patients with complex regional pain syndrome. Pain 1999; 80:95-111.
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Published meeting report from December 2002 issue of Anesthesia & Analgesia (subscription required):(http://www.anesthesia-analgesia.org/cgi/content/full/95/6/1812)
Last updated February 09, 2005
This is where i found this ........
Tips for Winning Disability Benefits for RSD
1. Acceptable Documentation: RSD / CRPS is a difficult to diagnose disorder and you may see many different doctors before getting a proper diagnosis. The SSA considers medically acceptable diagnosis and documentation for RSD from a rheumatologist as the strongest evidence.
Records and reports from hospitals, clinics, nurses and other treatment providers are also considered in the SSA evaluation but are typically not enough to establish a claimant’s disability for RSD without proper medical documentation and a diagnosis from an RSD specialist.
It is also very important to have documentation over an extended period of time. What Social Security refers to as "longitudinal evidence". Because a person’s functional limitations from RSD can vary over time it is vital to have documentation over a sufficiently long period of time. In addition, since the symptoms of RSD can change and individuals can respond differently to treatment, it is important to have a sufficiently long enough period of treatment records to show your impairment.
2. RSDS/CRPS Testing: Even though there is no definitive test for RSD, objective testing is available that can help document your symptoms and also exclude other causes of your symptoms associated with RSD. This provides further evidence of your disability for RSD. It is important to remember that not all people will have findings on every test and results can be helpful in excluding other disorders.
• thermography (measures skin temperature)
• sympathetic nerve blocks (determine if it is sympathetically mediated pain)
• bone scans (identify changes in the bone and blood circulation)
• nerve conduction studies (find damage to the peripheral nervous system)
3. Non-medical Documentation: Documentation from family members, co-workers and others who have knowledge of your functional limitations due to RSD can also be helpful in providing information regarding activities of daily living and work limitations.
4. Social Security (SSA) Diagnostic Criteria: It is very important to have documentation from a doctor familiar with RSD / CRPS who can make a diagnosis based on criteria set out by the 2003 SSA ruling Evaluating Cases Involving Reflex Sympathetic Dystrophy Syndrome / Complex Regional Pain Syndrome. Since RSD/CRPS is not a listed SSA impairment you need to either equal an impairment listing or prove limited functional capacity.
When Social Security evaluates RSDS/CRPS they look for persistent pain complaints that are out of proportion to the severity of the injury and one of more of the following documented signs in the affected area:
• changes in skin color or texture, changes in sweating, changes in skin temperature, and abnormal pilomotor erection (goose bumps)
• abnormal hair or nail growth
• involuntary movements of the affected region of the initial injury
5. Loss of Function Evidence: This is probably the most important factor Social Security uses to determine your disability benefits for RSD. Regardless of the cause of your RSD impairment, functional loss refers to an inability to walk effectively on a sustained basis, or inability to perform fine and gross movements effectively on a sustained basis. The SSA is more concerned with how your RSD affects and limits your ability to work rather than the fact you were diagnosed with RSD. The key is documentation describing your pain over an extended period of time with specific examples of how your pain limits your ability to function.
Detailed information about your activities of daily living and functional limitations is very helpful in documenting your disability for RSD. This is an area that many claimants neglect and leads to denials for their case. Claimants should complete what are referred to as residual functional capacity (RFC) forms.
Residual Functional Capacity Forms (RFC): Residual functional capacity forms can also provide strong evidence for Social Security when they are evaluating your claim of disability benefits for RSD. At the initial, reconsideration or CDR level, the SSA will do an RFC assessment.
However, you can have your own treating doctor (preferably an RSD specialist) fill out a residual functional capacity form. This form can then be used to show the functional limitations caused by your RSD. A lawyer at Fields Law Firm can help you create RFC forms for your RSD doctor to fill out.
6. Medication Side-Effects: This is another overlooked factor that can provide additional evidence of your disability for RSD / CRPS. Many people who suffer from reflex sympathetic dystrophy have to take very strong pain medication to manage their symptoms. Side-effects of pain medication can interfere with a claimant’s daily activities. Documentation of any adverse effects (with specific examples) is important because it provides additional evidence of the severity of your RSD and will be included in Social Security’s assessment of your residual functional capacity.
7. Combination of Impairments: RSD can affect almost every area of the body, especially in later stages of the disorder. It is important to have documentation and present evidence of your combination of impairments caused by RSD. An example would be a claimant diagnosed with RSD who also suffers from chronic fatigue syndrome and depression that affects their ability to do normal everyday activities because of chronic pain and fatigue.
You need to provide documentation of multiple complications from your RSD along with other disorders and disease such as diabetes or depression. If you then argue that the combination of impairments prevents you from normal activities of daily living you will have a much stronger argument that you are disabled.
Fields Law disability for RSD lawyers will assist you in getting the medical tests you need to document your disability for RSD. We can also help you find a doctor that is familiar with treating RSD / CRPS patients. If you are unable to work because of RSD we can help you apply for social security disability benefits for RSD. If you have been denied disability benefits we can appeal your case.
We offer a Free case review. Any disability lawyers understand how frustrating it is to have reflex sympathetic dystrophy syndrome and be denied disability benefits for RSD / CRPS when you are unable to work. There are never any fees unless we win your disability case.
I could go on and on about no test out there to prove rsd / crps these are just a few with links to show where i got my information . With all of todays technology you would think they could come up with something to prove rsd/crps instead of making us go through test after test . They dont understand how much some of these hurt just to come up with sometimes nothing . We endure so much its not funny .Its not just the test , But the daily pain we live with every single day . Plus they dont understand the stress , how tired we get , the anger we feel , The tears we cry , the driving ( if some can still drive , i can no longer drive ) But when i went to court i brought in all this information . It did no good for me and i had to settle out of court or risk getting nothing , because i didnt keep a video daily log of my up's and down's . Because i over searched which made the other sides lawyer think i put this in my head and made it real . even after showing them the deformity of my left arm . they didnt even belive an MRI on 2 bluging disc's i got from wear a sling for 3 years . What i got really was a boot up my butt and sent out of court with a small check . All of you who are going to court my advise to you is keep a daily journal , video tape your bad flair up days , video tape when you limbs turn different colors , bring a small tape recorder to all dr appointments , so you have voice records when they have you see another dr . I got stupid and didnt do this and if i would have i wouldnt have been dismissed like some 3 year old who got in trouble for not doing something right . I live in a very small town , things down south is much different then if i lived in a big city . but if i knew all this before hand , i would have done things differently . Good Luck to those who are in court battles . And i hope you take some of my advice and you wont have to walk away with a small check , ( but i look on the bright side it could have always been worst , i could have got nothing ... Take Care ...
No specific test is available for CRPS, which is diagnosed primarily through observation of the symptoms. However, thermography, sweat testing, x-rays, electrodiagnostics, and sympathetic blocks can be used to build up a picture of the disorder. Diagnosis is complicated by the fact that some patients improve without treatment. A delay in diagnosis and/or treatment for this syndrome can result in severe physical and psychological problems. Early recognition and prompt treatment provide the greatest opportunity for recovery. It is not usual for the course of this syndrome to change suddenly.
where i found this ... http://www.painreliefcenters.net/conditions.html
Q ... Is there a test to prove or disprove that I have RSD/CRPS?
A....No, there is no single diagnostic test. The diagnosis of this condition is based upon your symptoms, history of injury/surgery, and clinical evaluation.
where i found this ... http://www.reddinganesthesia.com/RSD%20FAQs.htm
IS THERE A TEST FOR RSDS?
THERE IS NO ONE SINGLE TEST THAT CAN PROVE/DISPROVE THE PRESENCE OF RSDS.
A DIAGNOSIS SHOULD NOT, THEREFORE, BE BASED ON THE OUTCOME OF JUST ONE BUT RATHER, A COMBINATION OF TESTS, AND MOST IMPORTANTLY, A CLINICAL DIAGNOSIS BY AN RSD-INFORMED DOCTOR.
THIS SOMETIMES MAKES IT DIFFICULT WHEN DEALING WITH INSURANCE COMPANIES, SOCIAL SECURITY DISABILITY OR WORKMEN’S COMPENSATION BECAUSE THEY ARE USED TO DEALING WITH DISEASES THAT CAN BE RULED IN OR OUT BASED ON A SINGLE TEST.
where i found this .... http://www.rsdsmn.org/39.html
No, unfortunately there is not. There is no one single test to [yes/no] diagnose RSD/CRPS.
RSD/CRPS remains first and foremost a clinical diagnosis. In this respect, patient history is important, as is any previous surgery or injury (helpful to determine onset and possibly stage).
There is no tool or test that can *diagnose* RSD. A doctor diagnoses RSD/CRPS, based on signs, symptoms, patient history and a number of tests that can aid in making a diagnosis, such as x-rays, bone scans, etc. ...
where i found this .......... http://users.skynet.be/d.lineate/rsd/info/rsdfaq.html#20
RSDS/CRPS Testing:Even though there is no definitive test for RSD, objective testing is available that can help document your symptoms and also exclude other causes of your symptoms associated with RSD. This provides further evidence of your disability for RSD. It is important to remember that not all people will have findings on every test and results can be helpful in excluding other disorders.
• thermography (measures skin temperature)
• sympathetic nerve blocks (determine if it is sympathetically mediated pain)
• bone scans (identify changes in the bone and blood circulation)
• nerve conduction studies (find damage to the peripheral nervous system)
where i found this ........ http://www.minnesotasocialsecuritydisability.com/winning-rsd-benefits
CRPS is a clinical diagnosis. There is no laboratory test for CRPS although certain laboratory testing may be helpful as diagnostic aid. In 1994 IASP established the diagnostic criteria for CRPS. Following are the diagnostic criteria (20 )
The presence of an initiating event.
A cause of immobilization
Continuous pain, allodynia and/or hyperalgesia
Skin temperature changes more than 1.1o C difference from the homologous body part.
Evidence at some time of edema, skin color changes and abnormal pseudomotor activity in the area of pain.
No existence of other condition that would otherwise account for the degree of pain and dysfunction.
Some clinician criticizes on the CRPS criteria. They object that current criteria do not adequately define the minimum requirement for diagnosis while others find high false positive percentage using the current criteria. (21 ) Based on multi-center clinical study the following recommendations are proposed to change the current criteria
no specific test is available for crps and no pathognomonic clinical feature identifies this condition. Rather , indentifying a constellation of history , clinical examination and supporting laboratory findings make the dignosis. complex regional pain syndrome can occur in children and adults
where i found this ....... http://www.mayoclinicproceedings.com/pdf%2F7702%2F7702crc.pdf
The specialists who may be qualified to treat RSD are anesthesiologists and neurologists. There is no one test to identify RSD, although there are some tests that are helpful in ruling it out. A thorough medical history and a careful physical examination are essential. The presence of objective signs and consistency of symptoms are also important. Doctors may observe differences in skin temperature between the affected and unaffected limbs.
where i found this ....... http://www.imei.com/connections/complexregionalpain.html
Dr. Brown testified that CRPS is a poorly understood disease, for which no test can be performed to confirm a diagnosis of the syndrome.
( from a real court document )
this is where i found this ....... http://caselaw.lp.findlaw.com/scripts/getcase.pl?court=nc&vol=appeals2006/&invol=050612-1~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
Flair up's and how to handle them , I know somethings that work for me but if you have something that helps you i would love to hear from you so i can add it to the list , We need to help each other , " Who else do we have to turn to who really understands what we go through ? " But us and if we stick together even if its one hint it helps belive me it really does .. I thank you for your help .. Take Care & Soft Hugs
1. I use all kinds of different creams and lotions , roll on's etc
2. Long deep breathing and slowly letting it out
3. heating pads ( i would be lost with out them i keep 1 on the couch & 1 in my bed which i sleep with nightly )
4. Involve myself in a game show ( try to take my mind off the pain )
5. Call my family or a friend ( again to take my mind off the pain )
6. CRY ! ( sometimes alot , just to let it out )
7. try to get comfy in bed with alot of pillows
8. prop my feet up while in bed before i go to sleep ( it does help )
9. take an extra pain pill or valuim to calm me down ( my dr trusts me to know i wouldnt ever take more then i need ) which i count in front of him so he will belive me
10. Think about a vacation ( tho i dont go i can still imagine what it would be like )
11. i even try to do something weather it be house work or a craft project to help move my muscles so it dont hurt so bad , i try to involve myself with things to keep pushing on .
12. Try to relax if i do to much i will pay for it the following day with pain and flair up's
13. i pray alot , not for a miracle cause there are other more deserving them me , but just to help ease the pain
14. Work alot on this site it helps me to help others and also keeps my mind off my pain .
15. If its past 8pm i take a sleeping pill to knock me out so i dont feel the pain as bad altho i wake up alot , i try anything i can think of .
16. Try to distract myself anyway i can weather it be TV , Music , Reading , talking etc what ecer i can think of
17. epson salt bath and candles , find peacefulness in the hot soaking water
18. heat packs when i cant wait for the heatong pad to get hot i toss one on the floor and stomp on it so it breaks and i get some kind of relief fast .
19. groom my horses ( this is one of my bext therapies ) altho i can only use one arm , they seem to understand when i,m in pain and work with me . my dog comes next just petting her with my good arm gives her attention and keeps my mind off my pain .
20. Hot wash cloths even help when i,m hurting and relax on the couch .
21. Rest as much as possible , this relives stress , pain , take a nap .
22. Aqua theraphy now since it is getting colder this is now done for the season
23. Playing games on the net , helps to keep your mind off things .
24. I have a neck pillow i,ll call it filled with buck wheat and rice ,you can buy gel filled neck pillows at most any store and well worth the money . you place it in the microwave for 2 to 3 mins. and place it where you hurt and it helps ease the pain , if you do not have one you can make your own simply by using rice in a sewn cloth or a sock tied at the end . and this works great too i also use those too for different spots of pain and relax in bed or on the couch . ( just another use for rice go figure LOL )
25. also just a FYI old socks can be used to place then inside each other till you get a nice size pad and wet it and place it into your microwave ( moist heat ) and another use for old socks .
26. I also work in my rose garden ( a little at a time ) i never try to over do it cause i will pay a high price in pain later or the next day .
But it helps to keep my mind off things and i love watching those roses bloom .
Thats all i can think of at this time , i hope it helps someone , but please feel free to send me what you do so i can add it to the list !
Take Care & Soft Hugs
RSD/CRPS INFORMATION CENTER
when looking for a lawyer this place can help you get in touch with the right people who knows what rsd is and how to fight it in the court of law ......... click on the link and it will take you to the web site .......
RSD Reflex Sympathetic Dystrophy
Throughout these pages you will find helpful clinical and legal information on Reflex Sympathetic Dystrophy.
Information on the clinical features, progression of RSD as well as RSD diagnosis and treatment options and questions to ask your doctor about RSD.
RSD: The Legal Perspective
Find answers to questions commonly asked by those suffering from the pain and loss of RSD / CRPS: As an RSD patient what are my legal rights? Do you have a case? How much will legal representation cost?
We all know about rsd/crps and what it does . But now a dr is given small dosages of ketomine as a pain med to help ease the pain we live in . Can we afford this med ? Can we even travel to this place to even get this med , or how many times do we have to travel to get there to get this done ? If you live in PA. then you have a better chance of trying this out but for someone like me who lives in the south i am unable to travel that far on a regular bases .....
Reflex Sympathetic Dystrophy (RSD) and Complex Regional Pain Syndrome (CRPS) Often Seen in PA Workers' Comp
Reflex Sympathetic Dystrophy (RSD), also known as Complex Regional Pain Syndrome (CRPS) is a horrible condition we see all too often resulting from work injuries. This condition can develop from a traumatic work injury, even what previously seemed to be a relatively minor one. Scientists still do not seem to know why RSD or CRPS develops.
The hallmark symptom of RSD or CRPS is unrelenting, often burning, pain. This character of pain, called "neuropathic" pain, is caused by irritation of the nerves in the affected area. Frequently, there are also changes in the skin or fingernails of the area as well (known as "trophic" changes). Sadly, there is no cure for RSD or CRPS, and doctors simply try to manage the symptoms of the patient as best they can.
Research is continuing in this area, and there are some promising things on the horizon. A recent study, led by local RSD/CRPS specialist Dr. Robert Schwartzman, found that the drug ketamine, given in an anesthetic dosage, may relieve pain in RSD/CRPS patients who have failed with other treatments. Administration of ketamine while the patient is placed in a five-day coma has been successfully performed in other countries, but has not been approved as yet in the United States. Obviously, in the workers’ comp setting, treatment not approved by the FDA probably does not need to be paid for by the PA workers’ compensation insurance carrier.
An incurable, debilitating, condition like RSD/CRPS raises many issues in Pennsylvania Workers’ Compensation. Unfortunately, the Pennsylvania Workers’ Compensation Act was designed for injuries which will eventually heal. The system is not properly prepared to deal with a lifelong debilitating condition like RSD/CRPS, which makes the selection of lawyers experienced in PA workers’ compensation particularly important.
Posted by Glenn Neiman
you may click on some of the links and see what else they have to say about this
where i found this .... http://thematrix-dreammaker.blogspot.com/2008/07/rsd-and-crps-often-seen-in-pa-workers.html
Memantine Treatment of Complex Regional Pain Syndrome: A Preliminary Report of Six Cases.
Clinical Journal of Pain. 23(3):237-243, March/April 2007.
Sinis, Nektarios MD *; Birbaumer, Niels PhD + ++; Gustin, Sylvia PhD +; Schwarz, Anja PhD +; Bredanger, Sabine MD [S]; Becker, Stephan Thomas MD [//]; Unertl, Klaus MD [S]; Schaller, Hans-Eberhard MD *; Haerle, Max MD *
Objectives: Recent studies have confirmed the contribution of the central nervous system (CNS) to the pathogenesis of Complex Regional Pain Syndrome (CRPS), because animal models of neuropathic pain syndromes demonstrate an overexpression of N-methyl-D-aspartate-receptors in the CNS. The aim of this work was to study the influence of a central acting drug-the N-methyl-D-aspartate receptor antagonist Memantine-in patients with CRPS of one upper extremity. Here we present the results of 6 patients treated with Memantine for 8 weeks.
Methods: All patients developed CRPS after traumatic injury to one upper extremity. To document changes during the study, levels of pain were measured after clenching the hand using a numeric pain intensity scale ranging from 0 (no pain) to 10 (maximum pain). Motor symptoms were documented for the fingers (fingertips to palm and fingernails to table) and the wrist (flexion/extension). Furthermore, the force was analyzed using a JAMAR-Dynamometer and a Pinchmeter. For assessment of central changes, functional magnetic resonance imaging and magnetoencephalography were used to further document the results of other experiments in 1 patient. Autonomic changes were photographed and pictures were compared before and after treatment with Memantine.
Results: Six months after treatment with Memantine, all patients showed a significant decrease in their levels of pain which coincided with an improvement in motor symptoms and autonomic changes. The functional magnetic resonance imaging and magnetoencephalography results provided evidence of cortical reorganization [changes in somatotopic maps in the primary somatosensory cortex (S1)]. These changes returned to a cortical pattern comparable to the unaffected side after treatment with Memantine.
Discussion: Based on these first results, the use of Memantine for treatment of CRPS seems promising and supports the hypothesis of a CNS contribution to the pathogenesis and maintenance of neuropathic pain syndromes.
(C) 2007 Lippincott Williams & Wilkins, Inc.
where i found this .....http://rsds-crps-news.blogspot.com/2007_03_01_archive.html
Managing Chronic Pain
By Rachel Stern
Signal Staff Writer
Sharp, burning, stinging, throbbing. Whatever you call it, it's pain. We've all had it, and it all calls out for relief. Whether it's migraine headache, arthritis, or low-back pain, there is generally an over-the-counter analgesic to take care of it, and, failing that, a prescription. But what happens when your pain simply won't go away?
Nicolas Weider, D.O. (Doctor of Osteopathy), board-certified anesthesiologist and Physician-in-Charge at the Kaiser Permanente Panorama City Pain Management Clinic, explains that this is known as chronic pain, which comprises several different disorders.
"Chronic pain in general is pain that lasts more than three months," said Weider. "there are many different types of pain disorders: for instance those due to congenital factors or to trauma. There are also specific pain disorders, like complex regional pain syndrome, when there is an activation of multiple parts of the nervous system."
The ABC's of Chronic Pain
More than 50 million Americans experience chronic pain, according to the American Pain Foundation, with back pain, headache and joint pain caused by arthritis being the most common conditions. Chronic pain costs the United States billions of dollars annually. According to Shahin Sadik, M.D., Board Certified in Anesthesiology, Pain Management and Pain Medicine, the U.S. is behind other major Western countries such as Canada, Great Britain, and the European Union in terms of palliative (pain-relieving) care. For a long time, pain per se received little attention or government funding, the situation is changing. Sadik, who has practices in Valencia and Palmdale, said part of the problem is the anti-drug message the government so assiduously dispenses.
"There is a stigma about opiate use," said Sadik. "But prescribed and controlled, they are wonderful drugs. People are happier when their pain is down."
Part of the stigma is among doctors themselves they are worried, said Sadik, that if their patients get addicted and want to stay on the medications longer than is necessary, they themselves will have trouble from the Drug Enforcement Agency, which oversees the dispensing of all controlled substances. But in his 14-year experience as a pain doctor, only approximately one to two percent of his patients have used their medications inappropriately.
"And these patients should be treated differently from street-drug addicts," said Sadik. "Though they shouldn't get narcotics anymore, we help them get into detoxification programs."
Congress designated the years 2001-2010 as the "Decade of Pain Control and Research." Among the goals of this initiative are the requirement that U.S. hospitals and nursing homes meet new standards of pain management, and that health-care professionals be more informed about the nature of chronic pain.
Physicians have learned that pain is much more complicated than had been previously thought, said Weider, involving many different mechanisms depending on the source of the underlying problem. In some cases, pain receptors begin to act on their own, with concomitant physical changes in the behavior of the nerves, making chronic pain very difficult to treat.
Sadik decided on pain management as a sub-specialty because he himself was a chronic pain patient, due to an automobile injury.
A Stuck Switch
Simple pain involves the transfer of basic information from the site of the injury to the brain. For instance when you get a sunburn, the initial injury is at the level of the skin, whose nerves send a signal to the spinal cord and from there to the brain. With chronic pain, however, there is an over-sensitization of the nerves so that they feel pain all the time. "In fact, the nerves create their own circuit that persists, even when there is no longer an 'original' injury," said Weider. "This is caused by chemicals shuttled on the spinal cord, which effectively reset the suffering person's pain 'thermostat.' The goal of treatment for chronic pain is to try to set that thermostat back.'"
This is how antidepressants and anti-seizure medications can alleviate chronic pain, said Sadik. They work directly on the nerves to stop them from "firing," which is what causes the pain.
Treatment of chronic pain differs from most other medical techniques in that practitioners might essentially "throw the book" at the pain, whereas in general medical approaches are more fine-tuned mechanisms. Because the theory is that pain-inducing chemical signals are "wound up," and the practitioner wants to break that cycle, he or she will often use whatever works, whether that involves neurochemical stimulation, medication, removal of disks for back pain, or exercise, for instance if the issue is that the patient lacks core strength.
"Or we might use all of them," said Weider. "The traditional thinking in medicine is to try things systematically, whereas for chronic pain we might try remedies in parallel to see what works."
What has changed in the past decade or so, is that pain is now being taken seriously as a chronic disease, said Weider, like diabetes, or any other chronic condition. The key insight is to see all pain as urgent, whether it is acute or chronic.
The Emotional Connection
It has long been understood by traditional cultures and by the psychotherapeutic community that emotions have a relation to pain. This is not the same thing as saying to sufferers of chronic pain that "it's all in their head" - on the contrary, neurology is helping to explain the specific pathways whereby emotions exacerbate or mitigate pain.
"Your mind does not create the pain," said Weider, "but it can create a tendency to focus on it."
For instance, many pain patients find that their pain increases at night. Weider said that this is sometimes due to the fact that there are fewer distractions at night, and actually presents a therapeutic opportunity to use techniques like guided imagery to take their mind off their pain. This is especially helpful since using imagery is a skill that patients can develop on their own, and since part of the experience of pain is feeling out of control, the sense of control itself can alleviate some of the pain. In addition, there is abundant evidence, said Sadik, that chronic pain can cause other symptoms, like depression.
"Pain is both emotional and sensory," he said. "Depressed people often have a lower pain threshold, which sets them up for more pain. It's a vicious cycle and when we address the emotional component of dealing with chronic pain, the patient's demeanor improves; they don't feel so hopeless, whereas before they couldn't see a future out of tunnel of pain. That's part of our job too."
Pain researchers are confident that future studies will further illuminate the relationship between emotions and chronic pain.
An Eclectic Approach
Because chronic pain has many causes, practitioners avail themselves of many remedies. These can be medications, like anti-inflammatories, anti-seizure medications, muscle relaxants and opiates like codeine, methadone and morphine. Other, non-pharmaceutical modalities like heat, chiropractic and massage are also used.
"We figure out what works, and whatever it is, we use that," said Weider. Non-medicinal modalities are especially helpful for elderly patients, since they can be particularly bothered by the side-effects of muscle relaxants and pain medications, which can promote loss of balance and falls. This sets up a situation where the elderly become afraid to move, and their resulting inactivity, or even fear of movement itself, can make their pain worse. Though the kinds of conditions Weider and Sadik may see, e.g.: low back pain, muscle pain and arthritis, are common, the difference is in how they approach the problem and the patient.
"We see (patients) after they have been evaluated by a primary doctor or even by a specialist, when the outcome has not been satisfactory," said Weider. "And they ask us to help them. It can be the most frustrating thing to handle, to have a pain that won't go away but which doesn't have a specific cause."
Whether there is an objectively obvious cause, or whether the pain is subjectively perceived doesn't matter, said Weider. The issue is that the patient has an unpleasant sensation regardless of whether there is an indirect or direct trauma. The proof is in the perception.
"In the past, we would say to a patient, in effect, 'I don't understand why you're still in pain,' or worse, 'You really shouldn't still be in pain now,'" said Weider. "Now we ask 'What can we do to stop the pain?'"
What changed, he said, is the education doctors have received in pain management.
"Pain medicine has grown quite a bit," said Sadik. In the future, he hopes, doctors will be able not only to understand their patients' chronic pain, but to reliably alleviate it as well.
Annemarie Donkin contributed to the story.
where i found this ....... http://rsds-crps-news.blogspot.com/2007_03_01_archive.html
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