1. Rsd/Crps & foot pain
2. Rsd/Crps Poorly understood
3. Home remedies
4. Foot & Heel pain
7. Shoulder Pain
8. General Information on rsd/crps
9. Rsd/Crps & your teeth
10. Long term use of meds for rsd/crps
11. Rsd/Crps & Muscle spasm's
12. Movement disorders
14. Hyperacusis in patients with rsd/crps related to dystonia
15. Charactistic signs & symptomsof sympathetic nervous system
16. Drug theraphies for rsd/crps
17. History of rsd / crps
18. Problems with rsd / crps
19. Laboratory model for clinical pain
20. Relief of pain & suffering
21. Disorders affecting breathing nerve's & Muscles
22. Medical issues
23. This is some of what i endure due to rsd/crps
24. There are contradictions in regards to the use of narcotics
25. Clinical trials: Neurotropin to treat pain
26. Partners or Caregivers understanding our pain
27. Coping with servere pain
28. Tips for coping with rsd/crps
29. Home remedies for foot pain& dry skin
30. Where your loved one can find support
31. The 2 faces of pain
My feet get pretty bad most everyday , i try alot of different things to help ease the pain from soaking to muscle rubs . I,m sure most of you go thru the same thing . So i tryed to find anything i could on this subject.
Take Care & Soft Hugs
Complex Regional Pain Syndrome (CRPS), commonly referred to as reflex sympathetic dystrophy or RSD, is a syndrome in which pain, usually burning type, is out of proportion to the injury (either nerve or no nerve involvement). The pain may spread through the entire limb and/or to other parts of the body. Examples of precipitating events that may cause CRPS include the following: fractures, surgery, frostbite, soft tissue trauma, burns, MS, tight cast, strokes, heart attack and amputations. The symptoms are characterized by autonomic dysregulation such as swelling, vasomotor instability (skin becoming pale/cool/cyanotic or red/warm/dry), abnormal sweating, trophic changes (course hair, thick rigid or brittle nails, skin may become coarse or thin, smooth, and tight), hypersensitivity, abnormal motor activity, and decreased bone density.
Medically, CRPS is managed by a variety of medications aimed lowering the rate of nerve firing, reducing inflammation, reducing anxiety, and reducing pain. More invasive measures include sympathetic nerve blocks in the spinal column or ganglion blocks, implanted dorsal column stimulation or decompression, all of which carry the same risks of any invasive procedure.
The main reason for this entry is to share a positive treatment outcome for CRPS using IMT. In general, the physical therapy treatment for CRPS includes reduction of pain to allow the pt. to maintain function. Traditional forms of exercise such as aerobic, pool therapy, ROM, joint mobilization/soft tissue mobilization, exercise emphasizing compression and distraction, functional ex. and exercise that increases blood flow to the extremity or increase proprioception to the spinal cord may be beneficial All exercise must be extremely gentle and nonaggressive especially if not initiated during times of sympathetic blocks.
My past experience with CRPS includes most patients unable to tolerate any manual techniques and very minimal exercise resulting in extremely slow progress. It has been shown in research that early intervention with physical therapy is extremely important to minimize loss of function. The earlier the intervention the more likely to reverse the dysfunction.
Recently I evaluated a pt. with CRPS onset following a bunionectomy. The pt. presented 3 months post op with extremely antalgic gait, inability to bear more than 30% weight on the affected foot, and requiring a walking cast boot to tolerate being on her feet. The patient’s foot was swollen, reddened, and there was no active mov’t in the big toe. Within 5 treatments of IMT including light touch on areas of the body specific to affecting the autonomic nervous system and indirect myofascial release (vs. more aggressive direct techniques) the patient is able to bear 50-50% body weight, ambulate w/o the walking boot with more normality. Gait quality still consisted of slight antalgia, decreased push off and mild trunk shift but the patient is able to walk further and have more energy throughout the day to function. The skin has returned to a more normal color and edema has decreased resulting in less smooth/shiny appearance. The slough and calluses which persisted on her incision long after surgery fell off naturally within 1 week and active ROM has returned in the big toe. Range of motion home exercises are being performed in a warm bath and also passively to isolate different joints of the toe. Ankle ROM exercises are also completed in the bath. In no way is this patient healed or pain free but the quality of the toe/foot appearance, gait quality and tolerance have progressed more rapidly than I have ever seen in the past.
I know I’m more than a little biased towards IMT but I want people out there to know that there is gentle, effective treatment out there that can make life a lot easier and functional if you have CRPS. Please spread the word!!
where i found this information ... http://missionhillspt.wordpress.com/2008/08/04/complex-regional-pain-syndrome-or-crps-treatment/
Complex Regional Pain Syndromeis a poorly understood neurological phenomenon that is even more confusing because it goes by so many different names. It is also known as Reflex Sympathetic Dystrophy (RSD), Sudecks Atrophy and causalgia. The condition is basically a short circuit of the nervous system where nerves misfire thus sending constant pain signals to the brain even though there is no real or limited pain going on. In other words, it is a completely abnormal response by the nervous system to external stimuli.
This condition can occur anywhere on the body but is fairly common in the foot and leg. Pain is out of proportion to an injury; the pain may be severe, constant or burning. There are three stages in the condition.
Stage 1 the traumatic stage, starts immediately or several weeks after injury. The skin becomes dry, and red which then becomes cool and moist within several weeks. The foot and lower leg will begin to swell. There will be limitation of joint movement and constant pain only alleviated by sleep and
Look at the picture of the hands and arms. Note the swollen left hand and arm. You can also see that it is more red and shiny in appearance than the right hand and arm.
The following x-ray reveals the severeosteoporosis that can occur. Look how demineralized the middle of the foot appears.
There are two types of CRPS, Type I and Type II. Type I is also referred to RSD and these involve cases in which the nerve injury cannot immediately be identified. Type II also referred to as Causalgia involves cases where there has been a majortrauma to a distinct nerve.
There really is nolaboratory test to diagnose Complex Regional Pain Syndrome. It is diagnosed on clinical grounds particularly to a nerve or soft tissue injury’ which does not respond in a normal healing path. A thorough medical history and physical examination are necessary. It should be noted that in this instance surgery can be considered as an injury. CRPS has been seen quite frequently following elective foot surgery where the foot and lower leg required immobilization for a period of time due to the type of surgery performed.
It is estimated that people go to as many as five doctors before the proper diagnosis is made. The problem with this is that valuable time is wasted in beginning treatment. The earlier treatment is instituted , the better the prognosis.
There are basically three types of specialists that should be consulted for treatment. One is aneurologist the others include a physiatrist, and a pain management specialist which is generally an anesthesiologist. Even going to one of these specialists does not guarantee proper diagnosis and treatment. You should ask your physician if he or she is experienced in treating this condition.
Treatment, of course, is based on the severity of the presenting symptoms. Peripheral nerve blocks may be performed in an effort to break up the ongoing pain sensation being transmitted to the brain. A TENS unit is sometimes of value in an effort to break the pain cycle.Physical therapy such as massage, compression with range of motion exercises to the affected areas. nonsteroidal anti-inflammatory medication may be used for pain and inflammation. Systemic therapy with oral steroids, propranolol, nifedipine or other mood altering drugs may be helpful.
In severe cases surgical lumbar sympathectomy may be performed as a means to break the pain cycle.
The points to take away from this discussion of Complex Regional Pain Syndrome is that it is a diagnosis that is often overlooked and because of the delay in treatment, permanent pain anddisability may arise. Additionally there are only a few types of specialists that are properly experienced to adequately treat this
where i found this information .... http://www.foot-pain-explained.com/CRPS.html
Complex regional pain syndrome is a chronic pain condition that most often affects the arms, legs, hands, or feet. Complex regional pain syndrome is also known as reflex sympathetic dystrophy or causalgia.
Complex regional pain syndrome usually develops in a limb after an injury (such as a broken bone) or surgery that may have involved nerve damage.
The overriding symptom is extreme pain, frequently described as burning. Other symptoms can include:
Sensitivity to touch
Decreased function of the hand/foot
Your doctor may base a diagnosis of complex regional pain syndrome on:
Nervous system tests
Magnetic resonance imaging (MRI)
Medtronic data on file.
Talk to your doctor about the right pain treatment for your complex regional pain syndrome (CRPS). Not all treatments may be applicable to your type of pain. Treatments include:
Doctors often try medication first. Because each person responds differently to medication, your doctor may try a variety of doses and drugs. Medications range from over-the-counter pain relievers, such as aspirin, acetaminophen, anti-inflammatory steroids, and stronger pain medicines.
Physical therapy attempts to build or recondition muscles – allowing you to move more normally and with less pain. Your doctor may recommend passive physical therapy, such as massage and applying heat/cold, or active therapies, such as exercise.
Chronic pain can bring stress that affects you, your relationships, and your body. Psychologists are available to work with you on relaxation techniques and coping and self-monitoring skills.
Your doctor may do tests, such as MRI or CT scans, to look for the cause of your pain. If the test reveals a problem that is known to be corrected by surgery, your doctor may recommend this treatment.
Therapeutic Nerve Blocks
Therapeutic nerve blocks are local anesthetic and/or steroid injections given at the origin of pain. Nerve blocks usually provide temporary pain relief. If your pain is not managed after multiple injections, your doctor may consider other treatments.
Medical devices, such as Medtronic neurostimulators or drug pumps (intrathecal drug delivery systems), are surgically placed devices that modulate pain signals before they reach the brain.
Medical devices for the treatment of pain include:
Neurostimulators – send mild electrical impulses to the epidural space near the spine, masking the perception of pain messages to the brain and replacing pain with a tingling sensation
Drug pumps – deliver pain medication directly to the fluid around the spinal cord (called "the intrathecal space"), requiring only a fraction of the medication that would be needed if taken orally.
Unlike some surgeries, these treatments are reversible. Your doctor can turn off or remove the system. In addition, you can try these therapies temporarily before you receive a permanent implant.
With neuroablation, doctors destroy (usually with heat) the nerves that serve as pathways to the brain. Neuroblation is often a last resort when other treatments have failed.
Information on this site should not be used as a substitute for talking with your doctor. Always talk with your doctor about diagnosis and treatment information.
Last updated: 3 Aug 2008
where i found this information .... http://www.medtronic.com/your-health/crps/
Soaking your feet in epson salts helps too , or even one of those massagers with the different settings . I use this most everyday ..... Take Care & Soft Hugs .....
Sometimes some of the weirdest stuff help to releive aches , pains and etc. Here are just a few , In our case sometime we need to give it a try to see what else we can do to help ourselves. And give ourselves a little bit of calmness. Anything is worth a try . You can find all this stuff in any health food store ......... Take Care & Soft Hugs ........
Sore Muscle Aches/Pains :Natural Pain Relief with Herbs
Before you reach for over-the counter pain relievers, which have been shown to have negative side effects, try some of these natural solutions for general muscular aches and pains, arthritis, sore muscles, sciatica, strains, and sprains.
Homeopathic:Arnica is one of the best known herbal sports medicines, arnica has dramatic results if used immediately after an injury. The most common application is in ointments and creams. In a homeopathic capacity, arnica can be taken internally with good results and with a great margin of safety. The tiny while pellets are a great addition to any first aid kit.
Herbal Oils:Rosemary oil relieves the pain of aching muscles and joints. It is a warming and stimulating circulatory tonic. Use rosemary infused oil, or dilute rosemary essential oil with a carrier oil for external use. Fresh rosemary brewed as a tea can lift a headache and energize your spirits.
Natural Anti-Inflammatory Herbs:Boswellia gum resin extract has anti-inflammatory and analgesic properties. Boswellia or Indian frankincense is one of the Ayurvedic gum resins which are referred to collectively as guggals. 3 Formulas containing boswellic acid combined with glucosamine are often used to relieve the joint pain of arthritis. Devils claw herb has an extensive history of use as an anti-inflammatory, and pain reliever. Devil's claw offers slow but sure relief of joint pain caused by both osteoarthritis and rheumatoid arthritis, the tubers contain a group of chemicals called iridoids that have anti-inflammatory activity. The most convient forms to use are tinctures and herbal capsules.3
Natures Aspirin: Salicylic acid (from the Latin word for theWhite Willow tree, Salix, from whose bark it can be obtained)6 is the compound used to make aspirin. Salicylate deters the body's production of certain prostaglandins that are linked to inflammation, pain, and fever among other things. The body converts the salicin in white willow into salicylic acid,.. for all practical purposes willow and aspirin are the same.1 Wintergreen oil contains methyl salicylate, It may be used externally for arthritis, backache, gout, tendinitis, muscular, joint, arthritic and rheumatic pain. Use sparingly,as the active phytochemical, methyl salicylate is toxic in large doses. Birch is the name of any tree of the genus Betula. The American species Betula lenta, (Sweet Birch, Cherry Birch) oil is almost identical with wintergreen oil, but is not as toxic.
Pepper Power: Applied topically,Cayenne works partly as a counter irritant, but it also blocks a body chemical integral to the transmission of pain impulses. Salicylates (like those in aspirin) add to its pain-preventing power. Creams and ointments containing capsaicin, one of cayenne's active ingredients, are widely available, and work well on tough arthritis joint pain, but can be very irritating to the skin. Cayenne infused oil is a better choice for muscle and sciatic pain, and can be applied more frequently over a wider area of the body with much less of the burning sensation of capsaicin extracts.
Old world pain remedies:Vervain can be taken as a tea, extract, or used as a poultice. It is good in headache, earache, neuralgia, rheumatism, etc. In this form it colors the skin a fine red, giving rise to the idea that it had the power of drawing the blood outside. Vervain is also a traditional antirheumatic used to relive joint pain. Protective of the liver, calming and lifts depression that can occur with chronic illness like arthritis. 5
Using Essential Oils for pain: Aromatherapy massage oils combine the healing touch of massage with the pain relieving qualities of natural plant oils. Make your own custom blends for sore achy muscles, sciatica, arthritis pain, headaches and more. Dilute the essential oils in a 1 to 2 percent solution with a carrier oil like almond or olive.Black pepper oil is hot, warming, very yang. Externally it is rubefacient and gently analgesic. 2
Applied externallyCamphor oil numbs the peripheral nerve endings. It also stimulates circulation and acts as a rubefacient. 2 Eucalyptus oil reduces pain in sore muscles, sprains, and sports injuries. 4 This oil is very cooling to the body, and eases the breath. Oil of fennel relieves muscular or rheumatic pains. 4. Fennel is also good for abdominal pains and cramping. Peppermint essential oil reduces pain, inflammation, and spasms, and stimulates local blood circulation. It is used to treat muscular aches and pains, strains, and sprains. The natural menthol in peppermint is responsible for its cooling, refreshing pain relief. A few drops of peppermint goes a long way.
allergies and hay fever - Herbal Remedies
Herbal teas made from stinging nettle, ephedra, ginkgo and reishi contain natural antihistamines and anti-inflammatories that open up constricted bronchial and nasal passages and eases hay fever and allergies.
sleep - dreams and insomnia - Herbal Remedies
Calming herbal sleep blends and essential oil of lavender to inspire restful sleep. Gentle, relaxing teas to drink in cases of insomnia, and induce quiet, restful sleep. Create a dream restful herbal sachet to slip into your pillow at night to inspire dreams.
Aches and pains, we all have them. Recipes for aromatherapy massage oils, herbal oils and natural herbal pain releif for abdominal pain, headaches, sore muscles, and arthritic pain. Learn how to treat traumatic injuries such as bruises, sprains and torn ligaments yourself at home.
With all the meds we take i,m sure our liver and kidneys take a beating . So maybe some of these will help to releive some of this problem ........
Liver Tonics - Herbal Remedies
Your liver is a vital key to good health. In holistic medicine liver tonics help to detoxify the body and are used to treat the underlying causes of conditions such as chronic fatigue, stress, and inflammatory conditions like arthritis, and psorisis, just to name a few.
where i found this information ....... http://www.anniesremedy.com/remedy_use115.php
Foot and Heel Pain
Feel-Good Strategies for Aching Feet
With every step that she takes, the average woman, going about her daily business, puts 500 pounds of pressure on her feet. Multiply that times 10,000 steps a day--more or less--and it's no wonder that feet hurt sometimes. As a matter of fact, it's a wonder that your feet don't hurt all the time.
What Women Doctors Do
Running Shoes Save Her Feet
Kathleen Stone, D.P.M.
Hairdressers, waitresses, nurses and yes, even women podiatrists have benefited from relaxed dress codes that make cushy running shoes acceptable attire in many workplaces, says Kathleen Stone, D.P.M., a podiatrist in private practice in Glendale, Arizona.
"I always wear running shoes, not dress shoes, on days when I am going to be on my feet a lot," she says.
The doctors's take-home lesson: Think comfort and save the pumps for all-day sit-down meetings.
When shopping for running shoes, your best bet is an athletic shoe store. A skilled salesperson can size up your feet and help you select the right shoe.
Look for a fixed heel counter at the back of the shoe and flexibility at the ball of the foot.
Women podiatrists report that women tend to have more foot pain than men, or at least they tend to consult doctors for the problem more than men do, says Kathleen Stone, D.P.M., a podiatrist in private practice in Glendale, Arizona. "That's because traditionally, women's shoes have been designed for fashion, not comfort," she says. "Once women switch to better-designed footwear--which many have done--they have fewer foot problems."
AT-HOME FOOT THERAPY
Here's what women podiatrists and other "foot therapists" tell women bothered by sore heels, aching arches, cramped toes and other everyday foot and heel complaints.
By performing these simple exercise, you may minimize or prevent continued progression of stiffness, says Phyllis Ragley, D.P.M., vice president of the American Academy of Podiatric Sports Medicine who practices in Lawrence, Kansas.
Play footsie with an orange juice can. If the arch of your foot hurts, you may have a touch of plantar fasciitis, or inflammation in the plantar fascia--the tough, gristly sheet of connective tissue that stretches from your heel to your toes. To soothe it, take a seat and--barefooted--roll your arch over a can of frozen juice concentrate for five to ten minutes, suggests Marika Molnar, P.T., director of West Side Dance Physical Therapy in New York City. "The cold helps reduce inflammation, while the massage helps loosen the tense tissues." Mark the juice can, keep it separate from juice that you plan to drink and reuse it as needed.
Stretch like a dancer. For a super-duper stretch, give this dancer's technique a try, suggests Helen Drusine, a massage therapist who works with professional ballet and Broadway dancers in New York City. Kneel on the floor or on a rug, with the balls of your feet on the floor, tucking your spread-out toes under to stretch the arches of your feet. Sit back on your heels so that most of your body weight presses your toes against the floor. Do this for a few seconds, slowly increasing your time as it becomes more comfortable.
"Tucking the toes this way helps people who use their feet a lot, because it keeps the plantar fascia and the tendons stretched," says Drusine.
Do not do this stretch, however, if you have sore tendons, says Dr. Ragley. Try a light massage of your feet and toes instead.
Do the follow-up stretch. Next, says Drusine, perform the same exercise with the tops of your feet flat on the floor. Again, do not do this exercise if you have sore tendons.
Loosen up your calf muscles. Tight calf muscles can hobble your feet, interfering with their ability to properly strike the ground and roll forward, says Dr. Ragley. That, in turn, can cause heel or arch pain as tissues in your feet are unduly stretched to make up for tight calves.
To stretch your calf muscles, stand barefoot facing a wall, with your arms straight out in front of you and your palms flat against the wall. (Hint: To maximize the stretch, says Dr. Ragley, point your feet inward slightly.) Keep your heels on the ground, tuck your buttocks so that your body remains straight (do not bend forward at your waist), bend your elbows and lean into the wall until your cheek touches the wall.
"You should feel the stretch in your calves," she says. "If you don't, you are either standing too far from the wall and bending at the waist to lean into it, or too close." How far you need to be from the wall depends on your height and how flexible your calf muscles already are. "I'm about five feet six inches. For a good stretch, I stand about 1½ feet from the wall when I do this."
Hold the stretch for as long as you feel comfortable. Then repeat (five times to start), this time with your knees slightly bent. "This helps stretch the soleus--the small muscle that leads directly into the Achilles tendon," Dr. Ragley explains.
It's best to stretch after you've warmed up a bit from easy walking or after a warm shower or bath.
EXERCISE YOUR "FOOT FINGERS"
"Normal walking does not do much to strengthen or stretch the small muscles in the feet," says Carol Frey, M.D., of the Orthopedic Hospital in Los Angeles.
To keep your toes loose and flexible and to isolate and strengthen the small muscles in your feet, Dr. Frey suggests the following exercises.
Play pickup. Use your toes to pick up marbles from the floor and drop them into a bowl. Or place small corks or pencils between your toes and squeeze them for five seconds.
Stretch and release. Wrap a thick, taut rubber band around all the toes on one foot, then spread your toes and hold the stretch for five seconds. Repeat ten times.
Try a golf-ball massage. Roll a golf ball under the ball and arch of your foot for two minutes.
MORE HELP FOR THE HURTING
It should be no big surprise that changing the kind of shoes you wear--or how you wear them--is a big part of foot comfort. Here's some additional advice from experts who counsel women with foot pain.
Buy running shoes, even if you don't run. If your feet hurt, they need all the support they can get, says Dr. Ragley. So forget flimsy canvas shoes, flip-flops, moccasins and slippers. Instead, wear running shoes whenever you can, everywhere but in the bed and bath. "These provide the cushioning, arch support and proper heel that reduce stretch on the plantar fascia."
Cup your heel. If your plantar fascia is tight, you can develop heel spurs--bony deposits where the tissue connects to the heel bones. "That area can become inflamed, causing acute pain in the middle and inside rear of the heel first thing in the morning and after prolonged sitting," says Pamela Colman, D.P.M., a podiatrist in private practice in Bethesda, Maryland.
A heel cup, available at most drugstores, will stabilize your heel and slightly control the rolling-in of the foot (pronation) that can contribute to the pain.
where i found this information .... http://www.mothernature.com/Library/bookshelf/Books/19/96.cfm
With all the meds we take this hopefully will be a good one to try
Toilet Training for Adults
These days, there are no hard-and-fast rules on how often you need to move your bowels to be considered "regular."
Though most people average a bowel movement somewhere between once a day and three times a week, doctors say that you are not necessarily constipated if you move your stools less frequently. Constipation is defined as a decrease in your usual number of bowel movements.
So, let's say that you normally go once a day, and you suddenly only need to defecate once a week. That's constipation.
Doctors blame diets high in processed foods and low in fruits, vegetables, beans, grains and other sources of fiber. Fiber moves the bowels. Yet most Americans eat considerably less than the amount needed for a healthy colon. We should get 20 to 35 grams of fiber a day. Instead, we get as little as 5 grams a day.
Though opinions differ on whether women get more constipated than men, they definitely make more doctor visits. It is also known that hormonal changes during pregnancy and the pressure on the abdomen caused by childbirth often lead to constipation.
Women also often get constipated in the week or so before menstruation. This is because fluids that normally flow to the colon, softening and moving stools, are retained in other parts of the body, says Nicolette Francey, M.D., professor of medicine at New York Medical College in Valhalla and a medical consultant for primary care at the Doctor's Consultants, a physicians' organization in New York City.
If you experience constipation, take heart. Women doctors say that retraining toilet habits, adding fiber to your diet and exercising regularly can get those sluggish stools on the go again.
GET MOVING NOW
"Except in rare cases, the last thing that you should take is a chemically based laxative like Ex-lax or Correctol," says Dr. Francey. That's because excessive laxative use is likely to make your bowel lazy, which means that you won't be able to go without help. Worse, laxatives often set up a vicious cycle, in which you are constantly alternating between constipation and diarrhea, and never have regular bowel movements.
But sometimes you just need something. Now.
Try hot broth (or other natural laxatives). "If you have mild discomfort from constipation because you're traveling and can't get to the gym or eat your fruits and vegetables, try a glycerine suppository, milk of magnesia or prune juice," says Joanne A. P. Wilson, M.D., a gastroenterologist and professor of medicine at Duke University Medical Center in Durham, North Carolina. "Sometimes even a warm cup of broth will help your bowels move more quickly."
Use a footstool. "If you're constipated, propping your feet up on a stool with your knees bent while you sit on the toilet will straighten the angle of your bowel and help you pass stool more quickly," says Jacqueline Wolf, M.D., a gastroenterologist, assistant professor of medicine at Harvard Medical School and co-director of the Inflammatory Bowel Disease Center at Brigham and Women's Hospital in Boston.
THE DIETARY FACTOR
What you eat and when has a significant bearing on regularity. Here's what women doctors advise.
Don't skip meals. Often women--especially dieting women--get constipated because they eat only one large meal a day, says Dr. Wilson. "Eating stimulates the reflex that causes stuff to move forward in the gut. Women who diet often eat fewer meals to cut calories. That decreases movement through the gut."
When nothing moves, you can't pass stool. Breakfast is particularly important, because that's what starts your digestive juices flowing every day.
Fill your meals with fruit. Fiber creates soft, mobile stools, says Elaine Feldman, M.D., professor emeritus of medicine at the Medical College of Georgia School of Medicine in Augusta. "You don't have to eat a pound of bran a day; just treat yourself to three servings of vegetables and two fruits a day and some whole-wheat bread."
Introduce fiber slowly. "Too much fiber too fast may solve your constipation, but replace it with gassiness, bloating and diarrhea," Dr. Feldman says.
Meanwhile, try a supplement. Some women complain that they can't digest that much fiber. If that describes you--or if you're working fiber into your diet--try a fiber supplement such as Metamucil, Citrucel or Fibercon, says Linda Lee, M.D., assistant professor of medicine in the Division of Gastroenterology at Johns Hopkins University School of Medicine in Baltimore.
Available in supermarkets and drugstores, supplements can be taken in granular form (mixed in water or juice) or wafer form, washed down with at least eight ounces of fluid. Fiber supplements soften and bulk up stool and nix constipation.
Drink a lot. Drink six to eight 8-ounce glasses of water daily to soften the stool, says Robyn Karlstadt, M.D., a gastroenterologist at Graduate Hospital in Philadelphia. Fill an empty 64-ounce soda bottle with water and keep it at your desk, then help yourself until it's gone.
Apples Do the Trick
Joanne A. P. Wilson, M.D.
Like many of her women patients, Joanne A. P. Wilson, M.D., a gastroenterologist and professor of medicine at Duke University Medical Center in Durham, North Carolina, has experienced the frustration and discomfort of constipation.
But what she recommends is apples.
"I tease my patients about an apple a day," she says. "I tell them that statement probably refers to constipation."
No surprise. Medically, eating apples makes sense--they're a good source of fiber.
Apples and other high-fiber fruits and vegetables are best for constipation, because the sugars in apples are harder for the body to digest. And what the body can't break down, it pushes out. So apples are a natural laxative.
Which is why you shouldn't go overboard. "Eat one apple a day, not four or five," says Dr. Wilson, so you don't get diarrhea.
Help for Frozen or Stiff Shoulders
Shoulder pain is one of those mysterious hurts that sneaks up on your body after doing something that you haven't done for months (if ever), like washing and waxing the car or cutting the grass with a push mower for the first time all season.
In women, shoulder pain is most often a symptom of either tendinitis, muscle strain or something called adhesive capsulitis, commonly known as frozen shoulder, where the shoulder gets so stiff that you can't move it freely, says Stacie Grossfeld, M.D., an orthopedic surgeon at the University of Minnesota in Minneapolis.
Unfortunately, when you don't use your shoulder, it loses its flexibility and stiffens. "One day, after not using your shoulder muscles for months, you'll find that you literally can't reach back to grab your seat belt or unhook your bra," says Dr. Grossfeld.
Or your shoulder muscles can get pinched between the bones and ligaments in your back, a disorder called impingement that results from intense overhead activity, like throwing a softball or swinging a tennis racket, says Dr. Grossfeld.
STEER YOURSELF TOWARD RELIEF
Women doctors and physical therapists say that luckily, most shoulder pains can be eased by following these simple suggestions.
Give it a rest. "If your shoulder hurts, the first thing that you need to do is stop the activity that's causing the pain," says Dr. Grossfeld.
Reach for the ice. "Ice is the cheapest form of pain medicine there is with almost no side effects," Dr. Grossfeld says. Ice decreases inflam mation. Wrap an ice pack or ice from the freezer in a towel and apply it to the site of pain for no more than 15 to 20 minutes every hour.
Allow yourself a painkiller. No need to be a martyr: An anti-inflammatory such as aspirin, ibuprofen or ketoprofen (Orudis) taken several times a day according to package directions will ease the pain and swelling, says Dr. Grossfeld.
Move it gently. Women doctors say that shoulder pain is a classic catch-22: Your shoulder hurts, so you don't want to use it, but if you don't use it, it's likely to get so stiff that you'll end up with a frozen shoulder, and then you won't be able to use it.
The solution? "Once your pain subsides, try gentle range-of-motion exercises," says Dr. Grossfeld.
Lynn Van Ost, P.T., a clinical specialist at the Sports Medicine Center in Philadelphia, suggests this exercise routine: Begin each exercise with your arm hanging down at your side. First, raise your arm straight in front of you until it is over your head (or go as far as you can without feeling any pain) and lower it back to the starting point. Then raise your arm out to the side and lower it. For the third exercise, keep your upper arm tucked against your body, but bend your elbow so that your forearm is in front of you. Rotate your forearm in toward your stomach and return to the starting position. Repeat the exercise again, rotating your arm away from you. Repeat each motion ten times before moving on to the next, and do the entire routine once or twice a day as long as you don't feel pain.
Treat an Illness, Not a Weakness
If you're depressed to the point that you can't sleep, can't concentrate and don't want to get out of bed, you're not alone. More than twice as many women as men have severe depression that can linger for several months, even years, if not treated. Sometimes depression can lift only for symptoms to recur, says Ellen McGrath, Ph.D., a clinical psychologist in Laguna Beach, California, and New York City, chairperson of the American Psychological Association's National Task Force on Women and Depression and author of When Feeling Bad is Good.
Women are also more likely than men to experience mild depression--to feel overwhelmed, powerless, discouraged, ineffective or sorrowful and possibly angry or guilty. These feelings last longer than the blues but typically lift after several hours or days, says Dr. McGrath.
WHY SO SAD?
Research suggests that our genes and biochemistry, our circumstances and our personal history can all--independently or in combination--contribute to depression. It's an illness, not a character flaw, and experts say that it runs in families. People with severe depression seem to have a brain chemistry that predisposes them to bouts. Hormonal changes that precede menstruation and follow pregnancy also appear to play some role. Losses, disappointments, difficult relationships, stress and past trauma can all contribute. So can other illnesses or certain prescription drugs, including oral contraceptives.
"We don't know why depression is more common in women, but a number of theories exist," says Leah J. Dickstein, M.D., professor and associate chair for academic affairs in the Department of Psychiatry and Behavioral Sciences and associate dean for faculty and student advocacy at the University of Louisville School of Medicine and past president of the American Medical Women's Association. "In addition to hormonal and biochemical differences, it may be caused by the added stress in a society where women don't get the same opportunities and respect that men do. Differences in the ways that boys and girls are socialized may also leave women more vulnerable."
Then there are relationships: Unhappily married women run 25 times the risk of depression that happily married ones do, says Carol Landau, Ph.D., clinical professor of psychiatry and human behavior at Brown University School of Medicine in Providence, Rhode Island. No big surprise. But it doesn't end there: Dissatisfaction with other roles--as mother or as employee--can have a similar effect. A study comparing stay-at-home moms and working mothers found that the mothers who were most depressed were those who were unhappy with their roles--whatever they were.
WHAT YOU CAN DO FOR MILD DEPRESSION
Studies suggest that depression takes a toll on the immune system, leaving us more susceptible to illness, and may increase our risk of heart disease. If severe, it can lead to thoughts of suicide, so severe depression warrants professional treatment. Mild depression can respond to some tender self-care, says Dr. McGrath. Here's what she and other experts suggest.
Get some exercise. Studies show that exercise alleviates depression by reducing stress and raising levels of feel-good substances in the brain, notes June Pimm, Ph.D., a clinical psychologist and associate professor of pediatrics and psychology at the University of Miami School of Medicine.
So get up and walk, even if it's the last thing that you feel like doing, says Dr. McGrath. "Remind yourself, 'I can do this. It'll be worth it; I only have to take a few steps,'" she says. Set a goal of exercising 20 minutes a day, three times a week.
( There are so many more remedies on this site have a good look around )
where i found this information ..... http://www.mothernature.com/Library/Bookshelf/Books/19/203.cfm
General Reflex Sympathetic Dystrophy Syndrome / Complex Regional Pain Syndrome Information
Reflex Sympathetic Dystrophy (RSD), also known as Complex Regional Pain Syndrome (CRPS) is a syndrome that occurs as a result of an injury to a nerve or soft tissue that does not follow a typical healing path. The damaged nerves misfire and send constant pain signals to the brain. RSD/CRPS results in extreme pain, tissue swelling, pathological changes in bones and skin, excessive sweating and sensitivity to touch. The development of RSD/CPRS is not dependent on the magnitude of the injury; it simply occurs as a result of ineffective healing following an injury.
There are two types of CRPS:
CRPS Type I, also known as RSD, refers to cases where an injury cannot be immediately identified.
CRPS Type II, also known as causalgia, occurs when a specific, major nerve injury has occurred.
An estimated 8 million Americans suffer from RSD/CRPS. Diagnosis can be difficult because the symptoms are similar to those of other more common ailments, such as chronic pain, rheumatic disease and fibromyalgia. The syndrome is chronic and incurable, but pain can be managed effectively when diagnosed and treated before the progression of the disease is irreversible.
In accordance with FDA regulation, we do not make any therapeutic claims for any Dietary Supplements in accordance with the Dietary Supplement Health and Education Act.
Beneficial Dietary Supplements
Boswellia is a natural anti-inflammatory agent.
Astragalus Root stimulates the immune system and enhances adrenal function.
White Willow Bark is an effective pain killer and fever reducer.
Turmeric is an effective anti-inflammatory.
Stevia is effective in treating RSD.
MSM rejuvinates joints and lessens joint pain.
REFERENCES: Prescription for Nutritional Healing, 3rd Edition, Phyllis Balch, CNC; James F. Balch, M.D.
Where i found this information ..... http://www.herbalremedies.com/rsd.html~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
RSD/CRPS And Your Teeth
Have you had problem with your teeth since you were diagniosed with rsd/crps ? many people have no one is sure if it's the meds or dealing rsd/crps . So i decided to search and see what i could fine on this subject .........As Always Take Care & Soft Hugs ..................
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ARE DENTAL PROBLEMS PART OF THIS DISEASE? - The short answer is yes. The long answer is that many CRPS patients report problems such as; dry mouth (sometimes related to Sjogren's disease) which can lead to receding gums, cavities, and other dental issues; extreme sensitivity to cold/hot temperatures in food/drink; difficulties with dental procedures such as having cavities filled or teeth cleaned, etc. Most CRPS patients report having to have teeth pulled rather than have root canals performed due to issues with the nerves in the mouth/jaw.
where i found this information ..... http://www.rsdhope.org/Showpage.asp?PAGE_ID=162&PGCT_ID=4680
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
where i found this information ....... http://www.crpsadvisory.com/crpsa_clinical_trial_neurotropin.html
Reflex Sympathetic Dystrophy Patients and Dentistry:
A Dentist's View of CRPS
Dental decay, although not as rampant as it once was in the American population, still affects many people. Even though it has declined from historic levels, the incidence of tooth decay is unfortunately again on the rise due to poor eating habits and an increase in sugar consumption. Gum disease is estimated to affect over 90% of our population in one form or another. These problems can often be seen in people with chronic conditions.
Often dental health can be neglected because of pain. The bad news is that ignored dental disease will sooner or later raise its ugly head: A toothache or pain from gum disease can not only afflict those of you who have CRPS dentally, but complicate the entire painful syndrome.
People with CRPS are at especially high risk for several reasons. Depending upon the region affected, physical dysfunction and the lack of manual dexterity can affect your ability to properly clean your teeth. In addition, if a chronic pain syndrome affects your head and neck, there may be times that brushing and flossing just hurts too much. One missed day of dental hygiene can turn into long periods of time where hygiene is severally lacking.
Many medications reduce saliva flow, causing a completely dry mouth (xerostoma) or they can radically alter saliva thickness, causing it to be thick and ropey. Either condition allows bacterial plaque to grow even faster and more tenaciously than normal. Combining this with a soft, sugary diet can wreak havoc on dental health. Many people who live with pain may rely upon "comfort" foods, which are often high in fats and sugars, causing overall health concerns and an increase in dental disease.
Smoking or smokeless tobacco can also alter the bacterial level of your mouth, resulting in an increase of tooth decay and gum disease. Smokeless tobacco has the most direct effect of the two, because of its sugar content and the fact that it lays against the teeth and soft tissues of the mouth for an extended period of time, releasing toxins and tissue-destroying chemicals. Smoking and smokeless tobacco are unhealthy even under the best of situations and can rapidly deteriorate the health of people with CRPS.
Financial issues are also important. Even those who have insurance bear an economic burden of medical expenses, and dentistry is often expensive. Dental problems don't go away on their own. As in any situation, prevention is the best "cure" for emotional, physical, and financial health. Brushing and flossing is a must. If you have particular areas that are constantly painful, using topical anesthetic rinsing gels may help. Even using your finger in a washcloth to act as a toothbrush is better than ignoring an area. Not removing plaque will only cause more pain in the future. Mouthwashes may be helpful, but they will not take the place of brushing and flossing. Also, your dentist may prescribe prescription rinses. Few dentists are trained in the field of head, neck, and facial pain beyond that of dental or periodontal work.
Choose a dentist who is educated about CRPS or who cares enough to allow you to direct his or her education as to your personal situation. This may involve asking for a pre-treatment meeting with the dentist to discuss your health needs. Most dentists, if they are not aware of CRPS, will be glad to familiarize themselves so they can be a good provider and can customize their healthcare delivery for your specific needs. If they do not choose to do so, then find another dentist who will.
Once a good relationship is established, have your dentist outline a treatment plan that is both economically and physically reasonable. You should discuss your pain patterns, history of reactions to local anesthetics, how long you can hold your mouth open, triggers that initiate painful episodes, and any other nuances that are particular to your situation. Pay careful attention to gum treatment as well. Modern techniques can often avoid the painful scraping and cutting of the gums often associated with professional dental prophylaxis. Ultrasonic instruments have allowed hygienists to be thorough and gentle at the same time. "No pain, no gain," should no longer be a hygienist's mantra. More than likely, a reasonable treatment plan can be arranged to help keep you in good dental health.
Dental health begins at home. Suffering from CRPS does not really change your dental needs, but may dictate customized hone care and professional service delivery. Many recent studies have linked chronic gum inflammation and infections to heart disease, stroke, and low birth weights. You must take great efforts not to let your teeth and gums get into such disrepair that drastic measures are needed. Talking to a local caring dentist will help provide optimal dental health and keep your financial investment reasonable as well. Prevention of dental disease may very well pay off in good overall health, allowing your immune system to perform at its optimal level. Remember, good dental health is good health.
Christopher R. Brown, DDS, MMPS, has a practice in Versailles, Indiana, dedicated to the diagnosis and treatment of head, neck, and facial pain. He is also a former president of the American Academy of Pain Management.
where i found this information .... http://www.rsds.org/3/treatment/rsd_dentistry_brown.htm
Q... I am wondering if anyone has had this same problem...I have RSD/CRPS body wide. Started in my arm in 1998 after an auto accident and heriniated disc. Have taken numerous meds and had numerous blocks. Currently, and over the last 3 years I have only been on high dose Methadone. Two years ago I began having problems with my teeth, root canals, cavaties. It is at the point that every tooth in my mouth has had or still needs a root canal. I never had such problems before and until recently I barely had 4-5 filings and 1 root canal. I have talked with the dentist and he says it is not the Methadone, although it is hard to believe... Anyone out there have a similar complaint?
A...I would love to help you solve your mystery. I am a dental hygienist who, bad for me but good for you, is having a hell of a time with RSD too. I have had it now for 1.5 years now. So let me ask you a couple of questions and then we'll go on from there. Nothing is meant to insult you by any means. It's just that without you in front of me, with your mouth to look in....well? you get the picture.
First off: What are you able to do? How limiting is your RSD?
2nd: Are you able to provide yourself with home care? ie; brushing/flossing, etc..?
3rd: Where was your point of injury?
4th: What other meds are you taking?
5th: Silly, I know...but are you "otherwise healthy"? ( I too laugh at this...just looking for clues, OK?)
6th Do you clench or grind your teeth? Or have any other oral habits in conjunction with..perhaps when you are in pain?
Let's start there and I will do a little research from my end on Methadone. OK?
We are friends in hell together.
this is someone else asking the same questions
Long Term Use Of Meds For RSD/CRPS
This is such a hard thing to discuss , because without pain meds , How do we deal with life and our lives . rsd/crps is mostly a forever thing since there is no cure. Its a good idea for your dr. to change up every now and then so your brain receptors dont get use to it and then the meds no longer work . Its really sad when you have to depend on pain meds just to be normal or close to normal as possible . Most of us will always be on pain meds for the rest of our lives and its a sad thing but also a reality check . This is apart of dealing and living with rsd/crps . Its sad but true . I heard once someone tell me i was addicted , I spoke with my dr. about it and he told me " addicted yes maybe so but to function as a normal as possible , Not to get so called high . " It made alot of sense to me . He also told me i know when there someone coming into my office to try to get pain meds and i know the differences from someone who isnt what he called a drug seeker ... Take Care & Soft Hugs
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~Myth: CRPS is a newly discovered disorder.
where i found this information ..... http://www.nationalpainfoundation.org/MyTreatment/articles/CRPS_Myths.asp
Should You Rely On Prescription Drugs?
The problem with relying on the principal of prescription drugs is that just because a doctor prescribes them it does not make it right and kosher. First of all there is no such thing as small doses of MS Contin. Even the smallest dose of MS Contin will block the formation of endorphines.
Secondly, the studies that you have referred to are the studies of a mixture of acute pain which absolutely needs narcotics for treatment on a temporary basis, Cancer pain which needs narcotic treatment on long term basis, but not complex chronic pain of RSD which needs non addicting narcotics (morphine antagonists) but also needs natural endorphines and other brain hormones to heal itself. I always emphasize that there is no way RSD can be controlled unless the pain is controlled. The pain control should be with the help of analgesic antidepressants, non addicting narcotics, and morphine pump which provides such a minute continuous dose of morphine to the brain that does not suppress cerebral endorphines.
MS Contin application introduces morphine to be processed through the liver and blood-brain barrier so the amount of morphine in it is at least 30 times stronger than the morphine in the pump. Finally every human being is born an addict. I am a workaholic, foodaholic, etc... Making the brain dependent on strong addicting narcotics is the best set up for addiction. I am just quoting the study of a mixed bag of pain patients with narcotics does not deny the strong potential of addiction of such drugs.
I agree with you wholeheartedly that in medical profession when the doctor suffers from the guilt of not being able to fix the patients condition, he transfers it by calling the patient an "addict" or a "fake". It is an unfortunate fact that the doctor start s the patient on large doses of Methadone or MS Contin, forces the development of rebound and tolerance, messes up the entire function of the brain, and at the end tells you the patient "you don't have a RSD, you are just an addict". The patient is then sent to a pain clinic to "learn to live with it". The care provider then bows out of the picture and the patient is left with no coverage and no treatment of the damages due to the "Miracles of Modern Medicine".
H. Hooshmand, M.D.
Where i found this information ... http://www.rsdrx.com/rsdpuz4.0/puz_52.htm
Pain is universal. Everyone with RSD/CRPS experiences pain. How we perceive pain, measure it, understand and deal with it, determines our response topain. This page is an effort to help us understand the mechanisms of pain in the body. Narcotics combat pain; differences between addiction and physical dependence, how opioids work in the body and how they can improve function are all explored.
THE PATHWAYS OF PAIN
Pain, as unpleasant as it is, serves a useful purpose. It warns of possible tissue damage and guards against further injury. It is a complex phenomenon, though, and a pain signal relayed from a peripheral nerve to the spinal cord to the brain is modified and interpreted significantly along the way. New understanding about how this signal is transmitted, and how it is boosted or blocked, demystifies some types of chronic pain and opens the door to more aggressive pain treatment.
Special nerve endings in skin and muscle--in the fingertips or toes, for instance-- respond to chemicals released by damaged cells. The nerve fires and a pain signal is sent.
SPINAL CORD: THE PAIN GATE
The pain signal travels along the nerve. A single nerve, like those in the leg, may be up to a metre long. The nerve carries the signal to the spine, branching and forking where it meets the spinal cord. Sensory signals are carried to the dorsal horn, the back part of the cord, whereas nerves at the front part of the spinal cord carry motor signals from the brain to the muscles. The spinal cord relays the message up to the brain. It's a two way network, however, messages travel down the spinal cord from the brain at the same time, dictating how the pain signal is to be interpreted. The dorsal horn of the spinal cord becomes, in effect, a gate that either allows the signal to pass through unadjusted, dampens the signal or boosts it.
Nerves don't connect directly to one another, instead, the signal must leap a gap called a synapse. This happens when the transmitting nerve releases a chemical--a neurotransmitter-- that prompts the next neuron to fire.
Conscious awareness of pain happens when the signal reaches the brain. New imaging techniques have mapped out at least 200 areas of the brain that respond to different types of pain.
PAIN SENSITIZATION AND ITS TREATMENT
A heightened sensitivity to pain can occur when the nervous system adapts to chronic, long term pain in several ways.
Additional nerve connections can develop in the spine in response to chronic pain, boosting the number of channels carrying the signal.
The neurotransmitters associated with pain can also increase in number. A more powerful pain signal manages to bridge the synapses between the nerves.
Narcotics can mimic specific neurotransmitters and effectively block the transmission of pain signals. New research suggests aggressive pain management may eventually reverse physiological effects of heightened pain sensitivity.
Where i got this information .... http://www.rsdcanada.org/parc/english/RSD-CRPS/pain.html
Long term use of narcotic medications, including codeine, hydrocodone, oxycodone, morphine, hydromorphone are all associated narcotics are associated with possible hearing loss. These are the most common narcotics used in pain medication, with codeine also found in heavy duty cough syrup as well (by prescription only in the US). Among the medications with these ingredients are: Tylenol 3 (codeine), Percocet/Percodan (oxycocdone), oxycodone itself (immediate release version and OxyContin), Lortab (hydrocodone), vicodin (hydrocodone) and morphine. I don't know if the same possible long-term side effects are found with darvocet/darvon (propoxphene napsylate), but I believe Darvon/Darvocet have been removed from the UK market for other possible problems.
The key is knowing what "long-term" use is. Taking one tablet every few days for 10 years is very different from taking the same medication every 4 hours for 3 years, even if the overall dose is the same. Also, hearing decreases for many reasons other than long-term pain management, so it's not always so easy as to pin the cause on the pain medication bottle.
I'd say your best bet is if you're concerned or feel you have experienced this side effect, talk with your doctor. Just remember, we're each individuals and respond to medications in our own way. Just because something may be a possible side effect doesn't mean it will happen to you!
where i found this information ..... http://butyoudontlooksick.com/boards/viewtopic.php?f=22&t=20597
RSD/CRPS And Muscle Spasm's
All of us who endure rsd/crps have muscle spasms . Sometimes it looks like ( what i call a parkinson's patient ) They have meds to help keep this under control . If your not on any of these meds. Talk to your dr about it and he/she will give you some to help keep them under control .
Take Care & Soft Hugs
Reflex Sympathetic Dystrophy Syndrome or RSDS is characterized by severe burning pain, pathological changes in bone and skin, excessive sweating, and extreme sensetivity touch
RSDS Symptoms:(Keep in mind that this varies from patient to patient)
Severe burning pain
Pathological changes in the bone (typically in late stages, visible on x-ray or bone scan)
Pathological changes in the skin
Tissue swelling (edema)
Extreme sensitivity to touch
Pathological muscle weakness
Nerve damage (visible on skin or nerve biopsy and/or Electromyogram)
"Typical features include dramatic changes in the color and temperature of the skin over the affected limb or body part, accompanied by intense burning pain, skin sensitivity, sweating, and swelling. Doctors aren’t sure what causes CRPS. In some cases the sympathetic nervous system plays an important role in sustaining the pain. Another theory is that CRPS is caused by a triggering of the immune response, which leads to the characteristic inflammatory symptoms of redness, warmth, and swelling in the affected."Muscle spasms: spasms can be confined to one area or up and down the arms, legs, or back.
Changes in muscle
Movement Disorder- Patients with RSD/CRPS have difficulty moving because they hurt when they move. In addition, there seems to be a direct inhibitory effect of RSD/CRPS on muscle contraction. Patients describe difficulty in initiating movement, as though they have "stiff" joints. This phenomena of stiffness is most noticeable to some patients after a sympathetic nerve block when the stiffness may disappear. Decreased mobilization of extremities can lead to wasting of muscles (disuse atrophy). Some patients have little pain due to RSD/CRPS but instead they have a great deal of stiffness and difficulty initiating movement.7 Tremors and involuntary severe jerking of extremities may be present. Psychological stress may exacerbate these symptoms. Sudden onset of muscle cramps (spasms) can be severe and completely incapacitating. Some patients describe a slow "drawing up of muscles" in the extremity due to increased muscle tone leaving the hand-fingers or foot-toes in a fixed position (dystonia). Patients with such seemly bizarre movements might be inaccurately diagnosed with a psychogenic movement disorder. Additionally, the fact that quite extreme behavioral changes often follow rather trivial injuries in patients with RSD/CRPS, this observation might contribute to the perception that the patient suffers from a psychogenic disorder as well.
Where i found this information .... http://www.rsdfoundation.org/zh/ct_clinical_practice_guidelines.html
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~muscle aches, muscle atrophy, loss of muscle control, muscle stiffness, stiff muscles or other types.
Muscle symptoms: Symptoms affecting the muscles of the body. See free access online books about Muscle symptoms below. See detailed information below for a list of 2574 causes of Muscle symptoms, including diseases and drug side effect causes.
The following medical conditions are some of the possible causes of Muscle spasms. There are likely to be other possible causes, so ask your doctor about your symptoms.
Some possible causes of local muscle spasms:
Over-extending the muscle
Disc disorders - may cause back spasms
where i found this information ... http://wrongdiagnosis.com/symptoms/muscle_spasms/causes.htm
Dystonia is a movement disorder. Weakness, stiffness, and clumsiness are the main features for some patients. In other cases, tremors, jerks, or twisting of the body part occur.Not allpatients with CRPS develop dystonia but many do. And the timing can be anywhere from a week to five years before the dystonia starts to show up. There are a few cases where dystonia occurs first, and then CRPS develops, but it's usually the other way around.
The symptoms of CRPS may even get better as the dystonia comes on. This suggests that separate mechanisms are at play. Scientists generally agree that both problems stem from a dysregulation of the central nervous system. But exactly what happens in each condition is still a mystery.
Doctors are looking for predisposing factors for the onset of dystonia. Does it only occur when there's a bone fracture? Or is it more likely to develop when the limb has been in a cast? Does surgery trigger it? Perhaps there are genetic or environmental factors.
Right now there are more questions than answers. The complex interaction of the nervous system with the immune system and the motor system are part of the picture. What are the biologic and mechanical pathways? This remains unknown and is still the focus of many studies.
where i found this information ..... http://www.eorthopod.com/public/patient_education/7517/crps_and_dystonia_unusual_coexisting_disorders.html
Hyperacusis in patients with complex regional pain syndrome related dystonia.
Introduction: In complex regional pain syndrome type 1 (CRPS-1), patients may have manifestations of central involvement, including allodynia, hyperalgesia or dystonia. We noted that more severely affected patients may experience hyperacusis, which may also reflect central involvement. The aim of this study was to evaluate the occurrence and characteristics of hyperacusis in patients with CRPS related dystonia.
Methods: The presence of hyperacusis, speech reception thresholds (SRT), pure-tone thresholds (PTT) and uncomfortable loudness (UCL) was evaluated in 40 patients with CRPS related dystonia.
Results: PTT and SRT were normal for all patients. 15 patients (38%) reported hyperacusis and this was associated with allodynia/hyperalgesia and with more affected extremities. UCLs of patients with hyperacusis were significantly lower than UCLs of patients without hyperacusis.
Conclusion: Hyperacusis is common among severely affected patients with CRPS related dystonia and may indicate that the disease spreads beyond those circuits related to sensory-motor processing of extremities
where i found this information ... http://pt.wkhealth.com/pt/re/jnnp/abstract.00005069-200712000-00006.htm;jsessionid=JYXX4QzfbkH6ZsVx6GqJxKKN2nNJ7TczMDtSlptLSLnxyGnynyJG!-1327505820!181195628!8091!-1
Characteristic signs and symptoms of sympathetic nervous system involvement are
Extreme sensitivity to touch
Skin color changes (red or bluish)
Skin temperature changes (heat or cold)
Pain is usually disproportionate to the degree of injury and can be triggered by using the affected limb or by stress and can be spontaneous or constant.
Symptoms associated with an immune reaction include:
Accumulated immune cells in the site
Signs of motor system dysfunction include
Difficulty starting movement
Increased muscle tone
Other symptoms include
Patients with any chronic illness, including RSD/CRPS, often suffer from depression and anxiety. Skin, muscle, and bone atrophy (wasting) are possible complications of the syndrome. Atrophy may occur because of reduced function of the limb.
The goal of treatment is pain control and as much mobilization of the affected limb as possible. An individualized treatment plan is designed, which often combines physical therapy, medications, nerve blocks, and psychosocial support.
Medication Medications are prescribed to control pain. The type of pain experienced by the patient determines the type of medication prescribed.
Constant pain caused by inflammation is treated with nonsteroidal anti-inflammatory drugs (e.g., aspirin, ibuprofen, naproxen, indomethacin).
Constant pain not caused by inflammation is treated with central acting agents such as tramadol (Ultram®).
Stabbing pain and pain that disrupts sleep are treated with antidepressants such as amytriptyline, doxepin, nortriptyline, and trazodone. Oral lidocaine, a somewhat experimental treatment for RSD/CRPS, also may be prescribed.
Sudden sharp pain may be treated with anticonvulsants (e.g., carbamazapine, gabapentin).
Generalized, severe pain that does not respond to other medications may be treated with opioids (e.g., propoxyphine, codeine, morphine).
Muscle cramps (spasms and dystonia) can be treated with clonazepam and baclofen.
Localized pain related to nerve injury may be treated with Capsaicin® cream, but its effectiveness has not been proven.
Medications that block selected actions of the sympathetic nervous system, such as clonidine (Catapres®, available in oral and patch formulations), can be useful in some cases.
Muscles stiffness may be treated with muscle relaxants such as
Physical therapy should include daily range of motion exercises. Patients should be advised to avoid activities that could accelerate osteoporosis or joint injury.
Sympathetic nerve block interrupts the transmission of pain signals from a group of nerve cell bodies (called a ganglion). When treating an upper extremity, it is called a stellate ganglion block. A small needle is used to inject an alpha adrenergic antagonist alongside the windpipe. When treating a lower extremity the nerve block is performed in the lower (lumbar).
The procedure, usually performed by an anesthesiologist familiar with the technique, involves the insertion of a needle into the appropriate location and the injection of anesthesia into the ganglion. The effect is monitored over time.
Sympathectomy Patients who have a good but temporary response to nerve block may be candidates for sympathectomy. The goal of surgery is suppression of sympathetic nervous system activity in the affected area.
A transcutaneous electrical nerve stimulation (TENS) unit may be used to treat the affected area. In some cases, spinal cord stimulators are implanted permanently to supply a low intensity impulse to a location in the spinal cord in an attempt to interrupt the pain signals that are being transmitted to the brain.
RSD/CRPS patients often become depressed and anxious because of chronic pain and loss of physical ability. Counseling, support groups, and chronic pain center programs help patients learn coping strategies and provide emotional and psychological support.
where i found this information ... http://www.healiohealth.com/rsd-reflex-sympathetic-dystrophy-syndrome.html
DRUG THERAPIES FOR RSD / CRPS
- DRUG THERAPIES ARE NOT A CURE BUT THEY CAN OPTIMIZE PAIN CONTROL AND PROVIDE THE RELIEF NECESSARY TO REGAIN FUNCTION AND ALLOW THE PATIENT TO PARTICIPATE IN PHYSICAL THERAPY.
FOR CHRONIC PAIN PATIENTS, DRUG THERAPIES ALLOW PATIENTS TO REGAIN A BALANCE IN THEIR LIVES AND RESUME MANY ACTIVITIES THEY HAD PREVIOUSLY STOPPED. HERE WE WILL SIMPLY GIVE THE BASIC MEDICATION TYPES, AN EXAMPLE, AND WHAT THEY ARE FOR.
- OPIATE AGONISTS – THESE MEDICATIONS TRY AND REDUCE CENTRAL NERVOUS SYSTEM ACTIVITY AND THEREBY REDUCE PAIN. OPIATE AGONISTS ACT ON OPIOD RECEPTORS TO INITIATE ANALGESIA, SEDATION, AND EUPHORIA. COMMONLY USED OPIATE AGONISTS ARE MS CONTIN, MORPHINE, OXYCONTIN, OPANA, & HYDROCODONE.
- OPIATE ANTAGONISTS - OPIATE ANTAGONISTS BLOCK AND REVERSE THE EFFECTS OF OPIOID AGONISTS BY COMPETITIVELY ADHERING TO OPIOID RECEPTORS. AN EXAMPLE OF AN OPIATE ANTAGONIST IS NALTREXONE.
NARCOTICS – USED TO MASK PAIN BY BLOCKING PAIN RECEPTORS FROM SENDING PAIN MESSAGES TO THE BRAIN. NARCOTICS ARE ALSO KNOWN AS OPIOIDS. THESE ARE BROKEN DOWN INTO THREE TYPES; CODEINE-BASED MEDICATIONS, THE OXYCODONE BRANCH (OXYCONTIN CR and IR, PERCOCET, PERCODAN, for example), AND THE HYDROCODONE BRANCH OF OPIODS (MS CONTIN, VICODIN, LORTAB, LORCET, METHADONE, AND KADIAN, for example).
Most Drs will prescribe the ER (extended release) or CR (controlled release) versions of these narcotics for a more evenly distributed release of medicine during the day.
So what is the difference then between the OXYCODONE Branch and the HYDROCODONE Branch If you search the Internet here is what most of the double-blind studies show: OXYCODONE and HYDROCODONE are similar in analgesic effect, but OXYCODONE is generally as effective at 66% of the dosage of HYDROCODONE. Individual medications may vary and each patient will vary slightly as well but it gives you an overall idea.
ALSO INCLUDED IN THE NARCOTICS FAMILY IS FENTANYL, EITHER IN THE MORE COMMON PATCH OR THE LESS COMMON LOLLIPOP FORM, ACTIQ. (for more information on what the FENTANYL PATCH is click on the link FENTANYL PATCH INFORMATION
ANTIDEPRESSANTS – ORIGINALLY ONLY USED TO TREAT DEPRESSION, STUDIES HAVE SHOWN THAT THESE MEDICATIONS, BOTH THE NEWER ANTIDEPRESSANTS AND THE OLDER TRICYCLIC VERSIONS, CAN ALLEVIATE PAIN IN CERTAIN SITUATIONS. FURTHERMORE, THEY MAY HAVE THE ADDED BENEFITS OF NOT ONLY HELPING THE PATIENT SLEEP BETTER AT NIGHT BUT ALSO REDUCING SOME OF THE HEADACHES ASSOCIATED WITH RSD/CRPS; ALTHOUGH SOME HAVE A TENDENCY TO CAUSE WEIGHT GAIN AND DROWSINESS. PAXIL, ZOLOFT, ELAVIL, PAMELOR, AND TRAZADONE ARE GOOD EXAMPLES.
TEENS NEED TO BE CAREFUL ON THE DOSING AS SOME STUDIES HAVE LINKED THE USE OF ANTIDEPRESSANTS TO INCREASED SUICIDE RATES. ALWAYS TALK THESE ISSUES OVER WITH YOUR PHYSICIAN.
WORRIED ABOUT ADDICTION WITH OPIATES? IS THERE A DIFFERENCE BETWEEN ADDICTION AND TOLERANCE?
For more information go to ADDICTION AND OPIODS
ANTICONVULSANTS – THESE MEDICATIONS ARE USED TO TRY AND DECREASE THE RANDOM NEURONS FIRING, THEREBY DECREASING THE BURNING PAIN AND SENSITIVITY ASSOCIATED WITH RSD/CRPS. THIS CAN SOMETIMES ALSO DECREASE THE PAIN. EXAMPLES INCLUDE; TEGRETOL, TOPOMAX, AND NEURONTIN. RECENTLY LYRICA HAS ALSO BEEN USED BY SOME DOCTORS IN THIS REGARD.
ANTISPASMODICS / MUSCLE RELAXANTS – MUSCLE SPASMS ARE VERY COMMON WITH RSD, TYPICALLY ROLLING IN NATURE. THE MEDICATIONS USED TO TREAT THIS CAN INCLUDE BACLOFEN, CLONAZEPAM, FLEXERIL, SOMA, AND ZANAFLEX. SOMETIMES A DOCTOR MAY PRESCRIBE A BENZODIAZEPINE FOR THIS. THESE CAN INCLUDE KLONOPIN, VALIUM, AND XANAX. ANTISPASMODICS SUCH AS NEURONTIN CAN BE PRESCRIBED FOR SPASMS BUT THIS IS NOT CONSIDERED A PAIN-RELIEVING DRUG ANYMORE, NOT SINCE THE LATEST REPORTS WERE RELEASED (see other articles on this website for more information).
NSAIDS – USED TO TREAT SWELLING AND INFLAMMATION. THESE CAN INCLUDE CELEBREX AND FELDENE. THEY FORMERLY INCLUDED VIOXX AND BEXTRA BUT THEY HAVE BEEN TAKEN OFF OF THE MARKET. ACCORDING TO DOCTOR TIM SAMS, "MOST RESEARCH HAS DEMONSTRATED THE EFFICACY OF THE COX-2 INHIBITORS, (CELEBREX/FELDENE) BUT HAS CLEARLY NOT FOUND THEM TO BE BETTER PAIN RELIEVERS THAN THE OLDER OR EVEN NONPRESCRIPTION NSAIDS".
NMDA RECEPTOR BLOCKERS - THIS WOULD INCLUDE THE DRUG KETAMINE. I WOULD REFER YOU TO THE FOLLOWING SECTION FOR INFORMATION, ARTICLES, AND STUDIES REGARDING THE USE OF KETAMINE IN THE TREATMENT OF RSD / CRPS;
KETAMINE AND RSD AND/OR LOOK FOR THE BIG BLUE BUTTONS REGARDING KETAMINE ON THE MAIN PAGE OF THE WEBSITE.
TRANSDERMAL MEDICATIONS – PAIN PATCHES, LIDOCAINE AND DURAGESIC/FENTANYL. MOST IMPORTANT WITH THESE ARE THEIR PLACEMENT. CHECK WITH YOUR PHYSICIAN, BUT TYPICALLY THEY ARE NOT PLACED DIRECTLY OVER THE RSD-AFFECTED AREA.
TO READ ABOUT THE SCHEDULES OR CLASSES OF PRESCRIPTION DRUGS SEE THE LINK BELOW;
For additional articles regarding Pharmacological Treatment of RSD / CRPS, see;
where i found this information ... http://www.rsdhope.org/Showpage.asp?PAGE_ID=155&PGCT_ID=3822
History of RSD/CRPS"It would be a great thing to understand pain in all its meanings."
Reflex sympathetic dystrophy (RSD) is the most unpleasant and uncomfortable form of chronic pain. It is the extreme prototype of disabling chronic pain.
Chronic pain is the type of pain that persists long after the original injury. Obviously, recurrent attacks of acute pain due to new and repetitive damages from cancer or recurrent heart attack cannot be considered chronic pain even though they may be of longstanding duration.
It is estimated that approximately 30% of the general population suffers from chronic pain. One third of these patients suffers from RSD.
The chronic pain of RSD is typified by a marked emotional connotation. It is invariably accompanied by anxiety, phobia, and neuropsychological disturbances in the form of irritability, agitation, and depression.
Historically, chronic pain has been the subject of clinical debate among physicians for a few centuries. Greek philosophers considered the brain as the site of pain perception. The first references to hyperpathic sympathetic type of pain appeared in the literature in the late 1700s by the famous British surgeon Potts. He first mentioned that trauma can be the source of burning pain and atrophy of the extremity.
The first report of amputation for treatment of this type of pain was by Denmark in 1813. Even though amputation seems to be a drastic and extreme form of treatment for RSD, even at the present time surgeons are performing amputation for RSD accompanied by osteoporotic fractures.
Needless to say, no RSD patient should undergo amputation. Even multiple fractures in small bones of the foot can be corrected without surgery. Proper physiotherapy, weight-bearing, sympathetic blocks, etc., will always save the extremity from being amputated. However, amputation is done because of lack of understanding regarding the nature of RSD. It is done when all other measures have failed and especially because of the fact that only a small percentage of RSD patients are diagnosed in the early stages of the disease. By the time the disease becomes advance, the pathology takes a rapidly accelerating downhill course that may culminate in the disastrous procedure of amputation. Amputation not only does not cure RSD, but it can be the cause.
In 1851 the French Father of Physiology, Claude Bernard,described the role of the sympathetic nervous system in preservation of milieu interne. He was the first to describe the sympathetic nervous system as being responsible for temperature regulation of the internal balance in the body.
The first report of clear-cut pathologic sympathetic dystrophy was made by the American neurologist, S. Weir Mitchell,who reported for the first time the victims of sympathetic dystrophy on the wounded soldiers of the Civil War. He colorfully called this condition erythromelalgia, implying reddish sick pain. In 1867 he described the condition in more detailed and called it causalgia.......
where i found this imformation .... http://rsdrx.com/rsdtext_book.htm
Reflex Sympathetic Dystrophy (RSD)/Complex Regional Pain Syndrome (CRPS) is a condition which causes chronic pain. While there are many sufferers, it is a 'hidden condition' as those who have it are often housebound, or even bed bound. There are over six millions sufferers in the USA alone.
Diagnosis in the past has been very slow for many patients, as it is only in recent years that the medical profession has started to see pain as a condition in itself, rather than a symptom or side effect. As diagnosis can be difficult, sufferers are often treated as though they have a psychological condition rather than a physical one, adding more stress, and often increasing the pain experienced.
RSD/CRPS is also known by many other names, including Sudeck's Syndrome, Shoulder Hand Syndrome and Causalgiais - none of which are new conditions. There are records of Causalgia being diagnosed as early as the American Civil War.
RSD/CRPS can affect anyone, male and female (with a ratio of about 1:4), young and old, healthy and diagnosed with another condition. The cause may be as simple as a paper cut or a minor fall. In around 30% of cases there is no cause found.
While the symptom of RSD/CRPS vary greatly between individual patients, the most common symptoms are:
Localised swelling of the affected limb
Swelling long after the injury has healed
Discolouration of the affected area - this may vary from deep purple/red to red and blotch
Temperature changes in the affected area, varying from intensely cold to the touch to intensely hot
Patient is unable to have anything at all touching the affected area, even the softest material or gentlest breeze may cause a violent pain reaction
Depression, mood swings, frustration, becoming anti-social, withdrawn
The symptom all sufferers of RSD/CRPS have in common is: CHRONIC PAIN
This is often described as a burning pain, or a combination of different types of pain. The pain remains long after an injury has healed and can even be worse than the pain felt at the time of the original injury. This is pain like nothing else ever experienced by the sufferer.
RSD/CRPS can be treated - although successful cure has been rare to date. For the best possible outcome, treatment must be started as soon as diagnosis is made, within 3-6 months of onset of symptoms and should involve more than one medical professional. Treatments may include nerve blocks, pain relief infusions, anti-inflammatory, anti-depressant and anti-epileptic medications. Some of the 'at home treatments' you can do yourself include hot packs (such as wheat bags), anti-inflammatory creams, warm baths and gentle exercise.
Always remember though, no matter how long you've had the condition or the effect it's had on your life and the lives of those around you,there is hope.
If these symptoms sound familiar to you, or you have been diagnosed with RSD/CRPS, then please contact us for more information and support. We have a monthly newsletter which allows sufferers and their carers, families and friends, to keep in touch with each other and any relevant information. You don't have to go through this alone.
Reflex sympathetic dystrophy is the feeling ofpain associated with evidence of minor nerve injury.
Historically, reflex sympathetic dystrophy (RSD) was noticed during the civil war in patients who suffered pain following gunshotwounds that affected the median nerve (a major nerve in the arm). In 1867 the condition was called causalgia form the Greek term meaning "burning pain." Causalgia refers to pain associated with major nerve injury. The exact causes of RSD are still unclear. Patients usually develop a triad of phases. In the first phase, pain and sympathetic activity is increased. Patients will typically present with swelling (edema), stiffness, pain, increased vascularity (increasing warmth), hyperhydrosis, and x-ray changes demonstrating loss of minerals in bone (demineralization). The second phase develops three to nine months later, It is characterized by increased stiffness and changes in the extremity that include a decrease in warmth and atrophy of the skin and muscles. The late phase commencing several months to years later presents with a pale, cold, painful, and atrophic extremity. Patients at this stage will also have osteoporosis.
It has been thought that each phase relates to a specific nerve defect that involves nerve tracts from the periphery spinal cord to the brain. Both sexes are affected, but the number of new cases is higher in women, adolescents, and young adults. RDS has been associated with other terms such as Sudeck's atrophy, post-traumatic osteoporosis, causalgia, shoulder-hand syndrome, and reflex neuromuscular dystrophy.
— Laith Farid Gulli, M.D.; Robert Ramirez, B.S.
where i found this information ... http://www.answers.com/topic/reflex-sympathetic-dystrophy
Problems with RSD
RSD was first diagnosed over 100 years ago during the American Civil War. While it continues to be a major catastrophic disease resulting from injury, some physicians continue to question its existence, especially during the early stages when the disease presents no definitive physical evidence. Unfortunately, the physician who fails to diagnose and initiate early treatment of RSD may foreclose a possible cure. No laboratory test presently exists to diagnose RSD in its early stages. The early diagnosis depends on the ability of the physician to identify and piece together the many signs of RSD, which do not always follow the textbook description.
Furthermore, many health care centers lack a standardized approach to the diagnosis and treatment of RSD. Many patients find themselves going nowhere or going in circles their care. This can create problems for patients who are receiving Workers' Compensation benefits or pursuing personal injury claims.
If you think you have RSD from an accident related injurycontact us online or call us at 800-404-5400 to set up a FREE consultation to discuss your legal options.
where i found this information ...... http://www.autoaccident.com/lawyer-attorney-1156249.html
A Laboratory Model For Clinical Pain
Mitchell Max's clinical trials with diabetic neuropathy and postherpetic neuralgia patients addressed the major enigma of the pain field: the mechanism involved in chronic neuropathic pain. The classic neuropathic pain disorders are the agonizing conditions known as causalgia -- "the most terrible of all tortures", in the words of S. Weir Mitchell , the Civil War physician who first described it -- and reflex sympathetic dystrophy (RSD) (more recently termed chronic regional pain syndrome).
Usually occurring after nerve injury to a hand, foot, arm or leg, causalgia and RSD may be triggered by any minor injury, by a surgical procedure, or a serious trauma. They are characterized by pain which persists after the original injury has healed; by hyperalgesia , intensified perception of a mild painful stimulus, and allodynia , perception of pain in response to the lightest of touches; even by spontaneous pain, where the patient reports pain although no stimulus is present! The pain often proves resistant to all treatment, including medication, counter- stimulation, anesthetic blocks, psychotherapy, and even neurosurgery. The unhappy victim of such a syndrome becomes withdrawn and depressed, resists all physical contact, and guards the affected limb constantly.
Researchers had tried to reproduce the symptoms of neuropathic pain in animals, but without success. At NIDR, they injected the hind paws of rats with solutions causing brief inflammation, such as Freund's adjuvant or capsaicin , then tested them for hyperalgesia and allodynia by placing them on warmed surfaces and timing the "withdrawal latency" - the time before the rat lifted the affected paw. An improved method, developed by Kenneth Hargreaves of the NAB, was to place the rat in a glass box and direct a pinpoint radiant heat stimulus at the inflamed paw. An attached photoelectric cell measured the withdrawal latency in fractions of seconds. The rats showed increased withdrawal times, moving the affected paws more quickly when exposed to warm and mild heat stimuli. But the symptoms were short lived and there was no evidence of spontaneous pain.
In 1988, Gary Bennett , a physiological psychologist working in the NAB, and Yi -Kuan Xie, a visiting scientist from Beijing, decided to try tying loose ligatures around the sciatic nerve of the rat's left hind leg, to observe any changes in the firing rates of the affected nerves. (These changes would reverse as soon as the sutures were absorbed.) They left the rat overnight and came back the next day to find it guarding the affected paw in a very unusual way, refusing to let it touch the ground. This was the first observation of the chronic constriction injury model: the rat with symptoms similar to causalgia or RSD.
Bennett and Xie recognized the characteristic guarding action of a causalgia or RSD patient. Excitedly, they tested various non-painful and mildly painful stimuli on the rat's paw and found hyperalgesia and allodynia responses similar to those observed in patients. And, although the rat continued to eat, sleep and groom normally, the continued guarding behavior was evidence of some spontaneous pain.
Looking for human subjects to compare observations, Bennett consulted with Max and his colleagues at the Clinical Center , who were interested, but were not working with these disorders. He found the patients he needed at a clinic in Philadelphia, and, with their cooperation, began a series of comparison tests. As Bennett describes these studies, "It got to the point where we were doing so many things so rapidly to these patients that we started videotaping it, because things were happening very quickly....And some of these wonderful patients would come back two, three, four times for us; these people demonstrated courage, real courage." 12
This was the beginning of a close and exciting collaboration between Bennett in the lab and Max and Gracely in the clinic, comparing and discussing their observations.
where i found this information ... http://history.nih.gov/exhibits/pain/docs/page_09.html
Relief of Pain and Suffering
Phantom limb pain and causalgia were two clinical pain syndromes that could not be explained in terms of specific nerve pathways. Amputees experienced phantom limbs: the distinct sensation that the missing arm or leg was still attached, often held in a distorted, intensely painful, position. Causalgia, first described by the American physician, Silas Weir Mitchell, was even more puzzling. After an injury had healed, the patient experienced intense, burning pain and sensitivity to the slightest vibration or touch, usually in the hand or foot, but at a site some distance removed from the original wound. Both disorders sometimes persisted for years. Anesthesiologists used localized nerve blocks to relieve the pain and neurosurgeons developed techniques for severing the nerve pathways involved; but neither treatment was consistently successful.
In the great wars, these relatively rare conditions afflicted many soldiers and baffled and disturbed their doctors: Mitchell in the American Civil War, the French surgeon René Leriche in World War I, William Livingston in World War II. How could phantom limb and causalgia be explained in terms of the specific neural pathways that conducted pain sensation directly from the site of tissue damage?
Silas Weir Mitchell (1829-1914)
In 1872, American neurologist S. Weir Mitchell described a bizarre symptom complex resulting from wounds to peripheral nerves in his book, Injuries of Nerves and Their Consequences (Philadelphia: J.B. Lippincott): "Perhaps few persons who are not physicians can realize the influence which long-continued and unendurable pain may have on both body and mind. . . Under such torments the temper changes, the most amiable grow irritable, the bravest soldier becomes a coward, and the strongest man is scarcely less nervous than the most hysterical girl. Nothing can better illustrate the extent to which these statements may be true than the cases of burning pain, or, as I prefer to term it, Causalgia, the most terrible of all tortures which a nerve wound may inflict."
Mitchell saw a large number of patients who had been wounded in the Civil War and suffered from a chronic affliction he called causalgia. He wrote: "We have some doubt as to whether this form of pain ever originates at the moment of the wounding. . . Of the special cause which provokes it, we know nothing, except that it has sometimes followed the transfer of pathological changes from a wounded nerve to unwounded nerves, and has then been felt in their distribution, so that we do not need a direct wound to bring it about. The seat of the burning pain is very various; but it never attacks the trunk, rarely the arm or thigh, and not often the forearm or leg. Its favorite site is the foot or hand. . . Its intensity varies from the most trivial burning to a state of torture, which can hardly be credited, but reacts on the whole economy, until the general health is seriously affected....The part itself is not alone subject to an intense burning sensation, but becomes exquisitely hyperanesthetic, so that a touch or tap of the finger increases the pain."
The common treatment for causalgia associated with peripheral nerve injury was amputation. Mitchell noted the all too common sequelae:
"Sensory hallucination. --- No history of the physiology of stumps would be complete without some account of the sensorial delusions to which persons are subject in connection with their lost limbs. . . Nearly every man who loses a limb carries about with him a constant or inconstant phantom of the missing member, a sensory ghost of that much of himself, and sometimes a most inconvenient presence, faintly felt at time, but ready to be called up to his perception by a blow, a touch, or a change of wind."
Mitchell performed a number of experiments. He wrote: "I recently faradised a case of disarticulated shoulder without warning my patient of the possible result. For two years he had altogether ceased to feel the limb. As the current affected the brachial plexus of nerves, he suddenly cried aloud, 'Oh, the hand, the hand!' The limb is rarely felt as a whole; nearly always the foot or the hand is the part more distinctly recognized. . . In nearly all there is some feeling, such as pain, itching, or other sensation."
René Leriche (1879-1955)
In 1937 Leriche wrote his classic work on the "surgery of pain," La Chirurgie de la Douleur (Paris: Masson), in which he detailed his work on causalgia and phantom limbs. He acknowledged Mitchell's contribution and looked for ways to solve the problem of pain. As with Mitchell in the Civil War, Leriche's opportunity to study these phenomena came during World War I, when he saw many soldiers with peripheral nerve damage. He observed vasomotor changes which suggested to him an abnormality of vascular stimulation; in 1916, he attempted to alleviate the pain through periarterial sympathectomy.
In 1916 Leriche wrote:
"A few months previously I had unexpectedly encountered one of these cases. I was struck by the resemblance which the condition had to that of a sympathetic disorder: the cyanosis, the sweating, the paroxysmal nature of the pains, the effect on the general mental state, the reference of painful phenomena to a distance--all pointed in that direction. And, remembering that the sympathetic, in its distribution to the limbs, follows the course of the arteries, I asked myself whether, in those case of nerve injury complicated by arterial wounds, it was not the injury to the sheath of the vessel that determined their painful and trophic features--the wound of the sympathetic. . . Starting from this point, I asked myself whether, by acting upon the perivascular sympathetic, I might be able to succeed in modifying the causalgia.
"I saw the patient on the 20th June: the upper limb was completely paralyzed--arm, forearm, hand and fingers. . . dominating everything, was an intense burning pain, concentrated particularly in the palm of the hand and on the pulp of the finger-tips. . . On the 27th August I exposed the brachial artery, which I found small and contracted. I removed its adventitia for a distance of 12 cm. . . By the next day it was obvious that the patient had less pain."
Leriche also saw patients with painful stumps and phantom limb pain. His experience showed clearly that "re-amputation should be avoided. . . and there should be no resection of the neuroma. I have had under my care more than thirty cases of amputation in which neurectomies had been done: none of them had been cured." Leriche found that "novocain infiltrations of the para-vertebral sympathetic chain" provided a new and very effective method for giving relief.
William K. Livingston (1892-1966)
W. K. Livingston had learned at Harvard that pain was a specific response to an unpleasant stimulus, a warning of tissue damage. One of the problems that puzzled him early in his career was visceral pain: patients might experience no apparent pain from tissue damage to certain internal organs but would report "referred pain" in another part of the body. He studied other pain phenomena, such as causalgia and phantom limb pain, which presented similar enigmas. Livingston's research in these areas is described in his books, The Clinical Aspects of Visceral Neurology (London: Baillére, Tindall & Cox, 1935) and Pain Mechanisms (New York: Macmillan, 1943), in which he proposed that pain, far from being a simple reaction to a single stimulus, could involve a complex and diffuse, but interactive, set of neural responses, which Livingston called "the vicious circle."
Livingston wrote in his Pain Mechanisms (1943): "I believe that the concept of 'specificity' in the narrow sense in which it is sometimes used. . . has led away from a true perspective. . . Pain is a sensory experience that is subjective and individual; it frequently exceeds its protective function and becomes destructive. The impulses which subserve it are not pain, but merely a part of its underlying and alterable physical mechanisms. . . The specificity of function of neuron units cannot be safely transposed into terms of sensory experience.
"A chronic irritation of sensory nerves may initiate clinical states that are characterized by pain and a spreading disturbance of function in both somatic and visceral structures. If such disturbances are permitted to continue, profound and perhaps unalterable organic changes may result in the affected part. . . A vicious circle is thus created."During World War II, Livingston was assigned to the Oakland Naval Hospital, where he assumed responsibility for peripheral nerve injury patients and other difficult pain problems, including causalgia cases which he later described as "every bit as striking as [S. Weir] Mitchell's." He maintained extensive case histories on these patients, including notes, drawings, and follow-up correspondence and kept 1279 of these records, filed by number in three-ring binders, until his death. Livingston used periarterial sympathectomies, ganglionectomies, and novocaine blocks to treat his patients, but he recorded several cases where the relief was only temporary and the pain returned.
Relief of Pain and Suffering
The twentieth century saw physicians and pharmacologists seeking better drugs to alleviate pain. In 1929, the National Research Council launched a forty-year drive to develop an analgesic stronger than aspirin but without the addiction potential of narcotics. More than 500 compounds were developed, several of which appeared to induce analgesia in animals. How could these be tested in humans?
Measuring Pain in Experimental Subjects
At Cornell University, physiologist James Hardy, neurologist Herbert Wolff, and researcher Helen Goodell used very precisely calibrated radiant heat stimuli directed to the foreheads or hands of trained experimental subjects. They asked the subjects to report each "just noticeable difference" in the intensity of pain experienced, and graphed their responses on the "dol" scale, in which one dol equals two just noticeable differences, or "jnds". Their method produced very elegant graphs showing the comparative effectiveness of various analgesics, and the physiologic responses associated with different intensities of pain.
Hardy, Wolff and Goodell emphasized the functioning of the sensory systems:
"[Our concept] holds a pain experience to be composed not only of pain sensation but of associated sensations and of emotional and affective states as well. . . Such a concept does not fail to take into account the fact that important bodily reactions to noxious stimulation, themselves entirely below the level of conscious activity, may contribute new sources of noxious stimulation and pain. Also, because of the intimate linkage of pain sensation with strong emotions, feelings, and behavior patterns, these may be dominant in the experience. However, since by definition the pain experience must include pain sensation, associated phenomena, although important, are given secondary consideration in this essay." (From: James D. Hardy et al. Pain Sensations and Reactions. New York: Hafner, 1967)
Henry Knowles Beecher (1904-1976)
The Hardy-Wolff-Goodell method was challenged by anesthesiologist Henry Knowles Beecher at Harvard. Serving as an Army medical consultant on the Anzio beachhead, he observed that soldiers with serious wounds complained of pain much less than did his postoperative patients at Massachusetts General Hospital. Beecher hypothesized that the soldier's pain was alleviated by his survival of combat and the knowledge that he could now spend weeks or months in safety and relative comfort while he recovered. The hospital patient, however, had been removed from his home environment and now faced an extended period of illness and the fear of possible complications. Beecher argued that "the reaction component" made pain such a complex and individualized phenomenon that it could only be studied effectively in the clinical setting. Patients with real pain would not exhibit the same physiologic manifestations or the same responses to analgesics as experimental subjects, who knew that they were in no serious danger and that the pain would soon cease."Thus emotion can block pain; that is common experience. It is difficult to understand how emotion can affect the basic pain apparatus than by affecting the reaction to the original sensation." Certainly psychological effects have great influence on subjective responses, not only pain but other responses as well. Every small boy has learned, knows, even though he does not consciously recognize the fact, that emotion can block the pain of a wound received during fighting but not perceived until the fight and the emotion have subsided." (From: Henry K. Beecher. Measurement of Subjective Responses: Quantitative Effects of Drugs. New York: Oxford University Press, 1959)
Henry Knowles Beecher and Raymond W. Houde
Beecher's research team at the Anesthesia Research Laboratory at Harvard and Raymond Houde's group at Memorial-Sloan-Kettering developed new methods of testing analgesics on clinical patients, in which each patient received different analgesics in sequence, serving "as his own control." This "crossover" method controlled for the subjective experience of each patient. Beecher asked each patient to report whether she experienced 50% relief of her pain, yes or no, while Houde and his associate, Ada Rogers, asked their subjects to quantify their pain on a scale of 1-4.
Raymond W. Houde describes how he began his research in the early 1950s:
"And in those days I had no help and I had my responsibilities in the Department of Medicine, so I made my own charts and everything. And they were mostly handmade charts and I'd have the patients keep them. And I learned to use, I developed a simple scale, and it was an ordinal scale primarily. They would note that severe pain was more than moderate pain, that's more than slight pain. . . and it was sort of quasi-quantitative, because we had no way of knowing how much slippage there is between the various categories. And we had no precise way of measuring it. I learned by this time that I wasn't going to depend upon the Wolff-Hardy-Goodell apparatus or anything else, because from my experience, it didn't add to what I knew. In fact, in my few experiments in that early time, I found that I got the same answer from just asking the patient, as I did by going through a long series of testing." (From the Oral History of Raymond W. Houde, 1995)
Ther is so much more to read about the history of rsd/crps but in the old days it was called causalgia they didnt have any other name for it . But you would think that if mumps , measles , and chicken pox remain , why not rsd /crps . It seems dr's. forgot about it since they were never fully educated on this subject .
Take Care & Soft Hugs
Hi everyone , I dont know if most of you go through this but me and a few others have notice since dealing rsd/crps and the meds we take , we breath heavier . We get out of breath faster then normal . I have mentioned this to my dr. and he says its because of all the meds i take . So i am wondering how many others out there are going through the same thing so i decided to investagate and see what i could come up with . This only seems to happen when i do small things around my home such as feeding hay to my horses , vaccuming , alot of walking etc . As always Take Care & Soft Hugs ....
Disorders affecting breathing nerves and muscles
RSD / CRPS
Dyspnea or dyspnoea (pronounced disp-nee-ah,IPA /dɪsp'niə/), from Latin dyspnoea, from Greek dyspnoia from dyspnoos, shortness of breath) or shortness of breath (SOB) is perceived to be difficulty of breathing or painful breathing. It is a common symptom of numerous medical disorders.
Dyspnea on exertion (DOE or exertional dyspnea) indicates dyspnea that occurs (or worsens) duringphysical activity. Dyspnea on exertion is considered medically normal and does not warrant the ICD-9 786
where i found this information .... http://en.wikipedia.org/wiki/Dyspnea#Medications
by Sunil Kothari, MD
Complex RegionalPain Syndrome (CRPS):
CRPS is a condition of the arms or legs that is sometimes seen after TBI. The symptoms include significant pain, often appearing to be more severe than one would expect. For instance, many times even light touch to the affected limb can cause severe pain. In addition, there can be swelling and changes in color of the affected area. There can also be changes in temperature and sweating. Later on, there can be loss of hair and changes in the texture of the skin. Many times, the diagnosis is clear based on the symptoms. However, during early stages when just a few of the symptoms are present it may be harder to make a diagnosis. There is no definitive test for the condition. However, many physicians obtain a triple phase bone scan (TPBS). This test starts with an injection of a medicine into an IV. Pictures are then taken of the body.
The treatments for CRPS do not work for everyone. However, some combination of physical or occupational therapy and medications is often successful. In therapy, it is important to keep the limb moving as much as possible. This includes bearing weight (through the leg and arm) as much as possible. The therapists may also try other treatments such as hot wax baths or applying a medication to the skin and using electric pulses to help the medication spread through the skin. Other medicines to be put on the skin may also be prescribed. In addition, many oral medications are available that have helped some (but not all) patients. These include standard pain medicines, steroids, anti-seizure medications and anti-depressants.
Table 10. Medication Types Used to Treat Complex Regional Pain Syndrome (CRPS)
(Examples in Parentheses)
If the CRPS persists despite medications and therapy, injections can be tried. There is some evidence that injection of botulinum toxin into the affected limb can help. More commonly used is a nerve block performed by apain specialist. These are known as sympathetic ganglion blocks. CRPS can be a difficult condition to treat. In most cases, one or more of the treatments described will be successful. However, the condition can be chronic in some cases.
Valproic Acid (Depakote)
All patients with aTBI are at risk of having a seizure. It is estimated that people with severe closed brain injuries have about a 10-15 percent risk of having a seizure in the first five years after a brain injury. Despite this risk, there is no evidence that giving someone an anti-seizure medication for more than a few weeks after his brain injury can help prevent seizures. So, most TBI patients will have their anti-seizure medications stopped if they have never had a seizure (unless the physicians believe that there are special circumstances that place the patient at a higher risk). The situation is a little different for penetrating injuries (for instance, from a gunshot wound). In these cases, the risk of having a seizure might be as high as 50 percent. For that reason, some physicians might choose to leave the patient on an anti-seizure medication for a longer period of time, even if he has never had a seizure.
In dysautonomia, patients have episodes of elevated heart rate, high blood pressure, sweating, muscle tightness, and sometimes fever. Another name for this condition is sympathetic storming. It is most commonly seen early afterTBI and in those patients who remain in a vegetative or minimally conscious state for a long period of time. After the doctors decide that there is nothing else causing the symptoms (such as agitation, pain, seizures, etc.), they will start medications to try to control the symptoms. Unfortunately, no single medicine works for all patients, so the doctors may have to try several of them before finding one that works best in a particular patient. The most commonly used medications are listed in the table below.
Table 14. Some Medications Used to Treat Dysautonomia (Sample Brand Names in Parentheses)
Almost all cases of dysautonomia get better over time.
Hydrocephalus refers to a condition in which there is too much fluid in the brain. Brains have hollow spaces inside them called ventricles. The ventricles are always filled with cerebrospinal fluid (CSF). AfterTBI, however, the fluid sometimes builds up because the brain injury damages the parts of the brain that help drain the extra fluid. If the fluid accumulates, the ventricles grow in size and put pressure on the brain. The condition is not dangerous but it can slow recovery. The fluid almost always builds up over time, so the symptoms of hydrocephalus rarely come on suddenly.
One of the most common symptoms is for the patient to have a mild decline in his overall condition. Just as often, however, the patient does not decline but rather just stops getting better (plateaus). More specific symptoms can include increased confusion, more spasticity, trouble walking, and worsening problems with bladder control. Sometimes the hydrocephalus is just discovered accidentally when a follow-up CT scan or MRI is done. A CT scan is the easiest way to make the diagnosis. In hydrocephalus, the scan will show enlarged ventricles.
In many cases, the diagnosis of hydrocephalus is obvious: the patient is having symptoms and the ventricles are much larger than normal. In other cases the diagnosis is not as obvious. Two situations might make it harder to decide if the patient needs to be treated. One is when the ventricles are only mildly enlarged. Since many of the symptoms of hydrocephalus can be caused by thebrain injury itself (problems with thinking, walking, bladder control, etc.), it is hard to know if the mildly enlarged ventricles are truly causing the patient’s symptoms or not.
Another issue that sometimes confuses the decision as to whether to treat or not is that, in severeTBI, a certain amount of ventricular enlargement is normal, especially after a few weeks. This is because the brain shrinks (atrophies) after brain injury. As the brain shrinks, the ventricles enlarge to compensate for the extra space. This is not considered true hydrocephalus; it is called hydrocephalus ex vacuo (since the extra fluid is there to fill the vacuum that was caused by the brain shrinkage). If the enlarged ventricles are due to hydrocephalus ex vacuo (and not true hydrocephalus), the patient would not benefit from treatment. In fact, since the treatment involves surgery, the patient would be exposed to unnecessary risks if he were treated. Because it is sometimes hard to tell if enlarged ventricles are caused by real hydrocephalus or hydrocephalus ex vacuo, some doctors will perform extra tests to help them distinguish the two conditions. Unfortunately, there is no definitive test and there are differences of opinion between brain injury doctors about which tests, if any, can help in the diagnosis.
One test that is commonly performed is sometimes called the "tap test." This involves performing a spinal tap (lumbar puncture) on the patient to drain CSF (since the CSF in the back is directly connected to the fluid in the brain). Then the patient is monitored over the next few days for any signs of improvement. If improvement does occur, it indicates that the patient probably has true hydrocephalus and would benefit from treatment. However, if he does not get better, it does not mean that he would not benefit from treatment, since almost half of patients who do not improve with a tap test still benefit from treatment.
The standard treatment of hydrocephalus is to put in a ventriculoperitoneal shunt (VP shunt). This tube is surgically placed inside the ventricle and extends from the ventricle through the neck and into the abdomen. The tube is entirely inside the body and only rarely can the outline of the tube be seen on the surface of the neck. The tube is constantly draining the extra fluid from the ventricles into the abdomen, where it is absorbed by the body. The shunt has a valve that controls the amount of fluid that is drained. Newer shunts have adjustable valves so that the pressure setting can be adjusted by a computer without having to re-operate to change the shunt. The older shunts require another operation if the setting on the valve needs to be adjusted.
Although relatively minor as far as brain surgery goes, the placement of a VP shunt does have some risks. In addition to the risks of anesthesia, there is a small risk of some injury or bleeding to the brain when the shunt is placed. The shunt itself can also get infected or malfunction over time. In some case, if the shunt drains too much fluid off (over-drains), a patient can develop bleeding in the brain (known as a subdural hematoma). However, in skilled hands and in appropriate patients, the probabilities of these risks are very low and patients with hydrocephalus can significantly improve after successful treatment with a VP shunt.
Dizziness is common after aTBI. When someone reports that he is dizzy, it is important to distinguish between light-headedness and vertigo. Light-headedness refers to feeling faint, often after sitting or standing up. One feels like one might pass out. In vertigo, however, the patient feels as if the room is spinning around him, whether or not the patient is moving or standing still. Often the vertigo is triggered by movement of the head. The patient can also have trouble seeing and feel nauseous at the same time as he feels the vertigo. Vertigo is caused by damage to the vestibular system, which is made of the inner ear (which controls balance) and the areas of the brain that control balance. It is important to distinguish where the problem is, because the treatment will differ depending on whether the problem is in the inner ear or in the brain. Most of the time, one can decide between these two causes by the physical examination. Occasionally diagnostic tests might be required. In either case, the treatment is fairly effective and usually just involves certain exercises done with a therapist or physician with some knowledge of vestibular dysfunction.
Problems with vision are common after aTBI. The most common problems that patients report are not seeing as well or seeing double. People see double when the two eyes are not exactly aligned with one another. For instance, one eye may not move all the way to the right. So, when the patient looks to the right, only one eye will move and the patient will see double in that direction. The problem is not in the eye itself but in the muscles and nerves that move the eye. Early on, the treatment is usually to place a "pirate’s patch" over one eye so that the brain only receives one image. Patients usually alternate wearing the patch over each eye, regardless of which one is not moving as well. If the problem persists for a long time, other treatments might include botulinum toxin injections to the eye muscles or even surgery. Unlike double-vision, problems with one’s vision (that is, not seeing clearly) are usually due to problems with the eye, the nerve that goes from the eye to the brain, or the parts of the brain that control vision. In all cases of visual problems, it is helpful to have a neuro-optometrist or ophthalmologist evaluate the patient to determine what is causing the problem and what can be done to improve it.
where i found this information .... http://www.disaboom.com/Health/traumaticbraininjury/traumatic-brain-injury-medical-issues.aspx
This is some of what I endure, daily, due to RSD/ CRPS.
**The pain in my feet, hands, forearms, spine, and head is relentless and excruciating. ** I endure extremely sharp, fast jolts which race up from the base of my spine to my neck, frequently. They also take my breath away.
Just getting through, each day, has become an increasingly difficult struggle, for me, despite doing my best to maintain a positive attitude.
Imagine, if you will, watching your body 'betray' you in so many ways, while putting you through the most excruciating pain imaginable and 'piece-by-piece' taking away the ability to live as you always had and hoped to live.
There are numerous other areas affected by the RSD, but hopefully, you have a sense of what I endure. And why it is so imperative that I am able to get to Germany for the'Ketamine Coma' procedure which has helped so many others who suffered as I do. And who have also tried what is available here, without success.
where i found this information ... http://www.setmattfreeofrsd.com/
THERE ARE CONTRADICTIONS IN REGARD TO THE USE OF NARCOTICS"
This is an excellent question. First of all no RSD patient will have a day of rest or any improvement unless the pain is effectively suppressed with the help of strong pain medications, nerve blocks, and large enough doses of antidepressants.
On the other hand, addiction is a handicap in long term treatment of RSD because addiction in itself aggravates RSD, causes stress and alarm in the sympathetic system resulting in more severe sympathetic dysfunction, and results in perpetual presence of rebound (withdrawal) pain.
To be able to understand the principles of narcotic use as well as the reason for non-addicting nature of Morphine pump, one has to understand the principles of addiction. The following may be helpful.
3. PAIN DISORDER
a. Pain in one or more anatomical sites is the predominant focus of the clinical presentation and is of sufficient severity to warrant clinical attention.
b. The pain causes clinically significant distress or impairment i social, occupational, or other important areas of functioning.
c. Psychological factors are judged to have an important role in the onset, severity, exacerbation, or maintenance of the pain.
d. The symptom or deficit is not intentionally produced or feigned (as in factitious disorder or malingering).
e. The pain is not better accounted for by a mood, anxiety, or psychotic disorder and does not meet criteria for dyspareunia.
Complex Regional Pain Syndrome (CRPS) The most important role for testing is to help rule out other conditions: a samatoform disorder, a factitious disorder, malingering or narcotic seeking and/or narcotic dependence.
Although CPRS differs from somatoform pain disorder specifically because of the objective evidence of disturbed peripheral blood flow, it has many similarities. Patients with CPRS invariably have significant psychological pathology, typically, but not always pre-existing the specific injury. These factors must always been identified, whether causally related to the specific injury or not.
The term "complex regional pain syndrome" was introduced to replace the term "reflex sympathetic dystrophy."
CRPS Type I used to be called "RSD," absence of causative nerve injury
CRPS Type II used to be called "causalgia," a definable peripheral nerve injury
Both Type I and Type II are differentiated from a somatoform pain disorder by objective presence of disturbed peripheral blood flow
The terminology was changed because the pathophysiology of CRPS is not known with certainty. It was determined that a descriptive term such as CRPS was preferable to "reflex sympathetic dystrophy" which carries with it the assumption that the sympathetic nervous system is important in the pathophysiology of the painful condition.
The terms CRPS Type I and CRPS Type II are meant as descriptors of certain chronic pain syndromes. They do not embody any assumptions about pathophysiology. For the most part the clinical phenomena characteristics of CRPS Type I are the same as seen in CRPS Type II.
Pain that can be abolished or greatly reduced by sympathetic blockade (for example, a stellate ganglion block) is called sympathetically maintained pain.
Pain that is not affected by sympathetic blockade is called sympathetically independent pain. The pain in some CRPS patients is sympathetically maintained; in others, the pain is sympathetically independent.
If a physician believes the CRPS condition is related to an accepted occupational injury, written documentation of the relationship (on a more probable than not basis) to the original condition should be provided. Treatment for CRPS will only be authorized if the relationship to an accepted injury is established.
Key Issues in Making a Diagnosis:
At least four of the following must be present in order for a diagnosis of CRPS to be made.
increased skin sensitivity
changes in skin temperature: warmer or cooler compared to the opposite extremity
changes in skin color: often blotchy, purple, pale, or red
changes in skin texture: shiny and thin, and sometimes excessively sweaty
changes in nail and hair growth patterns
swelling and stiffness in affected joints
motor disability, with decreased ability to move the affected body part
atrophy over limbs over time
Some experts believe there are three stages associated with CRPS, marked by progressive changes in the skin, muscles, joints, ligaments, and bones of the affected area, although this progression has not yet been validated by clinical research studies.
Stage one is thought to last from 1 to 3 months and is characterized by severe, burning pain, along with muscle spasm, joint stiffness, rapid hair growth, and alterations in the blood vessels that cause the skin to change color and temperature.
Stage two lasts from 3 to 6 months and is characterized by intensifying pain, swelling, decreased hair growth, cracked, brittle, grooved, or spotty nails, softened bones, stiff joints, and weak muscle tone.
Stage three the syndrome progresses to the point where changes in the skin and bone are no longer reversible. Pain becomes unyielding and may involve the entire limb or affected area. There may be marked muscle loss (atrophy), severely limited mobility, and involuntary contractions of the muscles and tendons that flex the joints. Limbs may become contorted.
Cause of CRPS
Doctors are not sure what causes CRPS. In some cases the sympathetic nervous system plays an important role in sustaining the pain. The most recent theories suggest that pain receptors in the affected part of the body become responsive to a family of nervous system messengers (catecholamines). Animal studies indicate that norepinephrine, a catecholamine released from sympathetic nerves, acquires the capacity to activate pain pathways after tissue or nerve injury. The incidence of sympathetically maintained pain in CRPS is not known. Some experts believe that the importance of the sympathetic nervous system depends on the stage of the disease.
There is no specific cause, but stress or conflict may be evident. The pain may have a special significance or may serve as a way to receive attention. People with this disorder may receive attention, sympathy or relief from responsibilities from others, or financial compensation from disability that may sustain the pain and behavior.
Another theory is that post-injury CRPS (CRPS II) is caused by a triggering of the immune response, which leads to the characteristic inflammatory symptoms of redness, warmth, and swelling in the affected area. CRPS may therefore represent a disruption of the healing process. In all likelihood, CRPS does not have a single cause, but is rather the result of multiple causes that produce similar symptoms.
How is CRPS diagnosed?
The differential diagnosis of this disorder includes peripheral neuropathy, myofascial pain, somatoform pain disorder and malingering. Opinions should always been obtained, ideally from a neurologist with experience with these disorders, specifically to objectively document skin and/or temperature changes and to consider alternative diagnoses.
Causes, incidence, and risk factors:
Sedative or analgesic dependence (drug abuse and dependence) can develop.
Most experts agree that it is more common in young women.
·Sympathetic nerve block:
·Spinal cord stimulation:
·Intrathecal drug pumps:
where i found this information ... http://www.psychological.com/RSDpain.htm
What is methadone?
Methadone is a narcotic pain reliever, similar to morphine.
What is the most important information I should know about methadone?
Taking methadone improperly will increase your risk of serious side effects or death. Even if you have used other narcotic medications, you may still have serious side effects from methadone. Follow all dosing instructions carefully.
Like other narcotic medicines, methadone can slow your breathing, even long after the pain-relieving effects of the medication wear off. Death may occur if breathing becomes too weak. Never use more methadone than your doctor has prescribed. Call your doctor if you think the medicine is not working.
You may have withdrawal symptoms when you stop using methadone after using it over a long period of time. Do not stop using methadone suddenly without first talking to your doctor. You may need to use less and less before you stop the medication completely. Do not drink alcohol while you are taking methadone. It can increase your risk of a fatal overdose. Check the labels of any food or medicines you use to make sure they do not contain alcohol (also called ethanol).
Avoid using drugs that make you sleepy (such as cold medicine, pain medication, sleeping pills, muscle relaxers, and medicine forseizures, depression or anxiety). Methadone may increase the effects of these other drugs and could also result in a fatal overdose.
Methadone can cause side effects that may impair your thinking or reactions. Be careful if you drive or do anything that requires you to be awake and alert.
What should I discuss with my healthcare provider before using methadone?
Taking methadone improperly will increase your risk of serious side effects or death. Even if you have used other narcotic medications, you may still have serious side effects from methadone. Follow all dosing instructions carefully. Do not use this medication if you are allergic to methadone, or if you have:
a stomach condition called paralytic ileus (intestinal blockage).
Before taking methadone, talk to your doctor if you have:
curvature of the spine;
a personal or family history of "Long QT syndrome";
low blood pressure;
Addison's disease; or
a history of drug or alcohol addiction.
If you have any of these conditions, you may not be able to use methadone, or you may need a dosage adjustment or special tests during treatment.
FDA pregnancy category C.
Methadone may be harmful to an unborn baby. It could also cause addiction or withdrawal symptoms in a newborn if the mother takes methadone during pregnancy. Tell your doctor if you are pregnant or plan to become pregnant during treatment. Methadone can pass into breast milk and may harm a nursing baby. Do not use methadone without telling your doctor if you are breast-feeding a baby.
Older adults and people with debilitating conditions may be more sensitive to the effects of methadone.
How should I use methadone?
Use methadone exactly as it was prescribed for you. Do not use the medication in larger amounts or for longer than recommended by your doctor. Follow the directions on your prescription label.
Like other narcotic medicines, methadone can slow your breathing, even long after the pain-relieving effects of the medication wear off. Death may occur if breathing becomes too weak. Never use more methadone than your doctor has prescribed. Call your doctor if you think the medicine is not working.
When methadone is used as part of a treatment program for drug addiction or detoxification, you will receive the medication through a clinic or special pharmacy.
Your doctor may recommend that methadone be given to you by a family member or other caregiver. This is to make sure you are using the medicine as it was prescribed as part of your treatment.
Additional forms of counseling and/or monitoring may be recommended during treatment with methadone.
Methadone is available in tablets, dispersible tablets, oral solution (liquid) and as an injection. The pill and oral liquid forms of methadone must never be used to make a methadone injection.
Measure the liquid form of methadone with a special dose-measuring spoon or cup, not a regular table spoon. If you do not have a dose-measuring device, ask your pharmacist for one.
The methadone dispersible tablet (Diskets) is made to be dissolved in water. Do not chew, crush, or swallow the tablet whole. Place the tablet into a 4-ounce glass of water, orange juice, or other citrus-flavored non-alcoholic beverage and allow the tablet to disperse in the liquid. The tablet will not dissolve completely. Drink this mixture right away. To make sure you get the entire dose, add a little more liquid to the same glass, swirl gently and drink right away.
Methadone may be habit-forming and should be used only by the person it was prescribed for. Methadone should never be shared with another person, especially someone who has a history of drug abuse or addiction. Keep the medication in a secure place where others cannot get to it. Store methadone at room temperature away from moisture and heat.
Keep track of how many pills have been used from each new bottle of this medicine. Methadone is a drug of abuse and you should be aware if any person in the household is using methadone improperly or without a prescription.
What happens if I miss a dose?
Use the medication as soon as you remember. If it is almost time for the next dose, skip the missed dose and wait until your next regularly scheduled dose. Do not use extra medicine to make up the missed dose.
What happens if I overdose?
Seek emergency medical attention if you think you have used too much of this medicine. An overdose of methadone can be fatal, especially if you take it with alcohol or other narcotic medications.
Symptoms of a methadone overdose may include slow heart rate, small pupils, cold, clammy skin, coma, weak or shallow breathing, or breathing that stops.
What should I avoid while using methadone?
Do not drink alcohol while you are taking methadone. It can increase your risk of a fatal overdose. Check the labels of any food or medicines you use to make sure they do not contain alcohol (also called ethanol).
Avoid using drugs that make you sleepy (such as cold medicine, pain medication, muscle relaxants, and medicine for seizures, depression or anxiety). Methadone may increase the effects of these other drugs and could also result in a fatal overdose.
Methadone can cause side effects that may impair your thinking or reactions. Be careful if you drive or do anything that requires you to be awake and alert.
What are the possible side effects of methadone?
Get emergency medical help if you have any of these signs of an allergic reaction: hives; difficuly breathing; swelling of your face, lips, tongue, or throat. Call your doctor at once if you have any of these serious side effects:
hallucinations or confusion; or
fast or pounding heartbeats, chest pain, trouble breathing, feeling light-headed, fainting.
Other, less serious side effects may be more likely to occur, such as:
feeling anxious, nervous, or restless;
sleep problems (insomnia);
dizziness, drowsiness, or weakness;
dry mouth, nausea, vomiting, diarrhea, constipation, loss of appetite; or
decreased sex drive, impotence, or difficulty having an orgasm.
Side effects other than those listed here may also occur. Talk to your doctor about any side effect that seems unusual or that is especially bothersome.
What other drugs will affect methadone?
Do not use methadone with any of the following drugs without first talking to your doctor:
a diuretic (water pill)
antibiotics such as azithromycin (Zithromax), ciprofloxacin (Cipro), clarithromycin (Biaxin), erythromycin (E-Mycin, Ery-Tab), itraconazole (Sporanox), ketoconazole (Nizoral), metronidazole (Flagyl) or voriconazole (Vfend);
heart or blood pressure medication such as diltiazem (Cardizem, Dilacor, Tiazac) or verapamil (Calan, Covera, Isoptin, Verelan);
HIV medicines such as abacavir (Ziagen), amprenavir (Agenerase), didanosine (Videx), efavirenz (Sustiva), lopinavir/ritonavir (Kaletra), nelfinavir (Viracept), nevirapine (Viramune), ritonavir (Norvir), stavudine (Zerit), or zidovudine (Retrovir);
an MAO inhibitor such as isocarboxazid (Marplan), tranylcypromine (Parnate), phenelzine (Nardil), or selegiline (Eldepryl, Emsam);
other narcotic medications such as pentazocine (Talwin), nalbuphine (Nubain), buprenorphine (Subutex), or butorphanol (Stadol);
rifampin (Rifadin, Rimactane, Rifater); or
seizure medication such as phenobarbital (Luminal, Solfoton) or phenytoin (Dilantin).
If you are using any of these drugs, you may not be able to use methadone, or you may need dosage adjustments or special tests during treatment.
There are many other medicines that may cause serious medical problems if you take them together with methadone. Tell your doctor about all the prescription and over-the-counter medications you use. This includes vitamins, minerals, herbal products, and drugs prescribed by other doctors. Do not start using a new medication without telling your doctor. Keep a list with you of all the medicines you use and show this list to any doctor or other healthcare provider who treats you.
Where can I get more information?
Your pharmacist has information about methadone written for health professionals that you may read.
What does my medication look like?
Methadone is available with a prescription under the brand names Dolophine and Methadose. Other brand or generic formulations may also be available. Ask your pharmacist any questions you have about methadone, especially if it is new to you.
Every effort has been made to ensure that the information provided is accurate, up-to-date, and complete, but no guarantee is made to that effect. Drug information contained herein may be time sensitive. Multum's drug information is an informational resource designed to assist licensed healthcare practitioners in caring for their patients and/or to serve consumers viewing this service as a supplement to, and not a substitute for, the expertise, skill, knowledge and judgment of healthcare practitioners. The absence of a warning for a given drug or drug combination in no way should be construed to indicate that the drug or drug combination is safe, effective or appropriate for any given patient. The information contained herein is not intended to cover all possible uses, directions, precautions, warnings, drug interactions, allergic reactions, or adverse effects
where i found this information ... http://rsdhealthcare.org/PatientInfo/Medications_Methadone.htm
A proprietary preparation containing morphine (a controlled narcotic drug, which is the principal alkaloid of opium). Also known as Morphine Sulphate, MST is normally taken twice a day and is designed as a slow release variant of Morphine.
Nausea, vomiting, loss of appetite, urinary retention, confusion, mental detachment, sedation.
Should not be administered to patients who have depressed breathing and should be used with caution with patients who have low blood pressure, impaired liver or kidney function of under-activity of the thyroid gland. Avoid using for pregnant or nursing mothers.
What is ketamine injection?
KETAMINE (Ketalar®) reduces anxiety and tension, and promotes relaxation and sleep before surgery or other procedures. Ketamine is used before short diagnostic tests and surgical procedures and may supplement other types of general anethesia. Generic ketamine injections are available.
What should I tell my health care provider before I take this medicine?
They need to know if you have any of these conditions:
• if you frequently drink alcohol-containing beverages
• brain tumor or head injury
• eye injury
• glaucoma or increased pressure in the eye
• heart disease, including angina, heart failure, or heart attack
• high blood pressure
• psychosis or schizophrenia
• an unusual or allergic reaction to ketamine, anesthetics, other medicines, foods, dyes, or preservatives
How should I use this medicine?
Ketamine is for injection into a muscle or infusion into a vein. It is given by a trained anesthesia professional in a controlled environment, like a hospital or surgical clinic.
What if I miss a dose?
This does not apply.
What drug(s) may interact with ketamine?
• barbiturate medicines for inducing sleep or treating seizures (convulsions)
• medicines for high blood pressure
• medicines for anxiety or sleeping problems, such as diazepam or temazepam
• medicines for hay fever and other allergies
• medicines for mental depression
• medicines for mental problems and psychotic disturbances
• medicines for pain
• muscle relaxants
• thyroid hormones
Tell your prescriber or health care professional about all other medicines you are taking, including non-prescription medicines, nutritional supplements, or herbal products. Also tell your prescriber or health care professional if you are a frequent user of drinks with caffeine or alcohol, if you smoke, or if you use illegal drugs. These may affect the way your medicine works. Check with your health care professional before stopping or starting any of your medicines.
What should I watch for while taking ketamine?
You will be closely monitored following administration of ketamine.
Ketamine can cause significant drowsiness, dizziness, and lack of coordination lasting many hours after the dose is given. Do not attempt to drive or operate machinery for at least 24 hours after a dose of ketamine.
Avoid alcohol, mood-altering drugs, or any other medicines for at least 24 hours after a dose of ketamine, unless approved by your prescriber or health care professional.
What side effects may I notice from receiving ketamine?
Side effects that you should report to your prescriber or health care professional as soon as possible:
• lightheadedness or fainting spells
• fast or slow heartbeat, palpitations
• involuntary and uncontrollable muscle movements (may appear like seizures)
• slow breathing, difficulty breathing
Side effects that usually do not require medical attention (report to your prescriber or health care professional if they continue or are bothersome):
• dizziness, drowsiness
• double vision, involuntary eye movements
• hallucinations, nightmares, a feeling of floating, or unreality (these usually go away within a short time)
• nausea, vomiting
• loss of appetite
• pain or irritation at the injection site
Where can I keep my medicine?
This does not apply. You will not be taking this medicine at home.
Important Disclaimer: The drug information provided here is for educational purposes only. It is intended to supplement, not substitute for, the diagnosis, treatment and advice of a medical professional. This drug information does not cover all possible uses, precautions, side effects and interactions. It should not be construed to indicate that this or any drug is safe for you. Consult your medical professional for guidance before using any prescription or over the counter drugs.
Ketamine is a dissociative anesthetic for use in human and veterinary medicine developed by Parke-Davis (1962). Its hydrochloride salt is sold as Ketanest, Ketaset, and Ketalar. Pharmacologically, ketamine is classified as an NMDA receptor antagonist, and, like other drugs of this class such as tiletamine, and phencyclidine (PCP), induces a state referred to as "dissociative anesthesia." As with other pharmaceuticals of this type, ketamine is used illicitly as a recreational drug, sometimes referred to as Special K.
Ketamine has a wide range of effects in humans, including analgesia, anesthesia, hallucinations, neurotoxicity, arterial hypertension, and bronchodilation. It is primarily used for the induction and maintenance of general anesthesia, usually in combination with some sedative drug. Other uses include sedation in intensive care, analgesia (particularly in emergency medicine), and treatment of bronchospasm. It is also a popular anesthetic in veterinary medicine.
Ketamine is a chiral compound. Most pharmaceutical preparations of ketamine are racemic; however, some brands reportedly have (mostly undocumented) differences in enantiomeric proportions. The more active enantiomer, S-Ketamine, is also available for medical use under the brand name Ketanest S.
Clinical trial : Neurotropin to treat Chronic Neuropathic Pain
If you would like to take part in this trial contact them A.S.A.P.
before they are filled up and no more room .... But think twice about what you could get yourself into ...
Take Care & Soft Hugs
Neurotropin to Treat Chronic Neuropathic Pain
This study is currently recruiting participants.
( They are still accepting people )
Partners or Care Givers Understanding Our Pain
Ever wonder if your husband / wife or even caregiver fully understand what it is you feel and go through ? I do all the time altho my hubby would do anything for me , i can help but let it run through my mind ever now and then . I wonder sometimes if they could be in my shoes for 1 day , Could they handle what i do everyday ? Makes you think dont it ? I,m lucky to have a caring hubby whos there for me , & would help me anyway he can . But he works nights and i am alone , By myself and have to deal the best way i can . As i,m sure others out there are just like me . So here is an article about partners or care givers understand what we go through .....
Take Care & Soft Hugs .....
The Partners for Understanding Pain is a loose consortium of organizations with an interest in the personal, economic, and social impact of pain on our society. Members include health-condition-specific groups as well as those with broader mandates that touch the lives of people with chronic, acute, and cancer pain.
The Partners mission is to:
Create greater understanding among health care professionals, individuals and families who are struggling with pain management, the business community, legislators, and the general public that pain is a serious public health issue;
Offer a comprehensive network of resources and knowledge about issues in pain management through the members, each of which brings its unique perspective to the dialogue; and
Build understanding and support that can help people with chronic, acute and cancer pain lead better lives.
where i found this information ... http://www.theacpa.org/partners/index.asp
Coping with servere pain
All of us at one time or another has had to cope with severe pain , But people with chronic pain deal with it alot more then normal people , So i did some searching on how to help cope with it . If you think about it when we are in a bad flair up and tears running down our faces do we take more meds or go to the ER room , I cant live without my heating pads which are used daily almost 24 / 7 . Another thing is a hot towel from the micro wave or even a wet hot towel . Anything that will give heat in a hurry . I have used every muscle rub that gives off deep heat it help some but dont take all the pain away but its worth a try . when you verse the cost of an ER bill even with insurance theres still a cost to us . Which would cost us $500.00 for walking in the door , get a shot another $150.00 to $250.00 .So that ranges from $650.00 to $750.00 . Not to mention the sometimes long wait while your trying your best to keep it together or crying in front of a bunch of people . Oh and of course those so called MD's who dont belive us and think we are looking for a high price get high , or manuver us all over so we are in even more pain . I myself will make them call my DR right away so cut out ( excuse me )the Bullshit , because they want to practice on me or someone else . So i wont go to the ER room to save myself from what torture they may do to me .............
Take Care & Soft Hugs .......
Coping With Chronic Cancer Pain
Weill Cornell Study Compares Two Promising Therapies
Many cancer patients experience moderate or severe pain. While medical advances have led to more effective treatments for the management of pain, the presence of chronic pain in cancer remains a difficult problem and is often associated with suffering and distress.
Now physicians at New York Weill Cornell Medical Center are seeking participants with chronic pain from cancer to undergo two different kinds of psychotherapy to determine which may be more effective in helping them cope with their pain.
Over recent decades, it has become understood that a patient's thoughts and emotions and how they frame the meaning of pain can mediate levels of distress. Psychotherapists have gained experience in helping people who have chronic, severe pain.
The new Weill Cornell study, under the leadership of Dr. Susan Evans, Assistant Professor of Psychology in Psychiatry, seeks to compare therapeutic methods known as cognitive-behavioral therapy (CBT) and standard supportive psychotherapy (SSP).
Cognitive-behavioral therapy engages the patient in finding coping strategies to allow the patient to gain a sense of control and mastery over pain and the suffering associated with pain. This therapeutic approach has been used successfully for the treatment of headaches, lower back pain, and rheumatoid arthritis. One of its techniques is "cognitive restructuring," or having the patient become aware of his or her thoughts while experiencing pain. For example, when some patients engage in "catastrophizing" (thinking, "This will be the end of me"), their self-awareness at such moments can be made a basis for coping. CBT sometimes uses "guided imagery" and visualization to relax the patient and induce almost a kind of self-hypnosis or distraction.
Standard supportive psychotherapy is a more non-specific therapeutic approach, allowing the patient to discuss and explore issues with an empathetic therapist. It allows the patient to vent, and express feelings.
"Both cognitive-behavioral therapy and standard supportive psychotherapy are thought to be possibly useful in helping patients cope with chronic pain," said Dr. Evans. "In our study, we hope to refine our understanding of the proper application and the effectiveness of these two therapies."
She added, "While there have been many studies of pain management and different methods of therapy, this Weill Cornell study is unusual, possibly even unique, as a randomized study of the psychotherapeutic management of chronic cancer pain."
The 20 to 40 pilot participants of the study—all patients with chronic cancer pain—will first be assessed in a thorough interview. Over the course of a week, their experience of pain will be monitored. Then they will be randomly assigned to one of the two forms of therapy.
Each patient will receive six sessions of therapy, which will be videotaped and monitored to ensure adherence to the correct method. At the end, patients will meet with an assessor and fill out a questionnaire evaluating the effectiveness of their treatment. Patients will be reimbursed for participation.
Further information on the Coping with Chronic Cancer Pain study is available by calling (212) 821-0621.
Tips for coping with RSD
Although there is no cure for RSD, there are many ways to manage its symptoms. Typical treatment incorporates a variety of therapies such as electrical nerve stimulation, anesthetic blocks, injection therapy and physical therapy. Drug therapy often includes anti-inflammatory drugs, muscle relaxants and antidepressants.
Some RSD patients find relief in alternative medicine such as acupuncture, or in relaxation therapy and hypnosis. Psychological counseling can also help patients cope with the frustration and depression that often accompany the disease.
Following are more strategies for managing RSD:
Be a partner with your physician. "Visit your doctor regularly. The doctor-patient relationship is critical, because the disease is so individualized," says Plaster.
Eat properly. A healthy diet is especially beneficial to people with RSD, notes Schwartz. Avoid coffee, processed foods, sugar and fried foods. Also, leave off foods containing nitrites, such as bacon, sausage and hot dogs. Eat lots of fresh fruits and vegetables, fish and poultry, and drink six to eight glasses of water a day. Some RSD patients also find nutritional supplements beneficial.
Become a volunteer. Doing something for other people helps you stop focusing on your own problems, say Plaster and Calhoun. They practice what they preach: Plaster is the director of the South Carolina RSD Association, and Calhoun runs an Internet support group called RSDRebels.
Keep moving. Stretching and walking on a treadmill are particularly good exercises, says Schwartz.
Take a time-out when you need it. "If you need a nap, take one," advises Calhoun. "Don’t push yourself too hard."
Don’t face it alone. Check out local support groups and the Internet for information. "You are not alone, and you are not crazy," says Orsini, who founded American RSDHope Group, a non-profit organization for RSD sufferers and their families.
For more information, contact the following organizations:
American Academy of Physical Medicine & Rehabilitation, One IBM Plaza, Suite 2500, Chicago, IL 60611; 312/464-9700; www.aapmr.org. National medical society representing more than 6,500 physiatrists, physicians who specialize in restoring function to patients suffering from acute or chronic pain, musculoskeletal problems and neurological disorders.
American Chronic Pain Association, P.O. Box 850, Rocklin, CA, 95677; 800/533-3231; www.theacpa.org. Offers support and information for people suffering with chronic pain.
American RSDHope Group, P.O. Box 875, Harrison, ME 04040; 207/583-4589; www.rsdhope.org. Offers discussion groups, educational information and support to RSD sufferers and their families.
National Institute of Neurological Disorders and Stroke, P.O. Box 5801, Bethesda, MD 20824; 800/352-9424; www.ninds.nih.gov. A division of the National Institutes of Health that conducts and supports research on disorders affecting the nervous system.
Reflex Sympathetic Dystrophy Syndrome Association of America, P.O. Box 502, Milford, CT 06460; 877/662-7737; www.rsds.org. Provides education and support as well as contact information for RSD support groups in the United States, Canada, Europe and Australia.
where i found this information ... http://www.yourfamilyshealth.com/articles/msd.html
Home remedies for foot pain
If your anything like me my feet hurt 95% of the time , i use heating pads , foot massagers ( water type with dufferent settings ) muscle rubs , Anything i can think of . So i decided to search for some home remedies i could try and may also help you as well .Shoes are one thing to start with you can buy diabetic shoes or what i use is any good type of air walkers ,Also shoe insert double pillow ones ...
Take Care & Soft Hugs ....
The natural treatment for foot pain is to soak the feet in a bucket of warm water for at least 15 minutes. The warm water will soothe the leg muscles and help in expanding again. Follow this method at least three times in a day. Due to rigorous physical activity, the muscles in the leg tend to contract. Use vicks vapor rub .
It is very important to expand the leg muscles again as it may cause further leg problems. Another remedy for foot pain is to give a hot and cold treatment. Apply a heat pad and an ice pack for 10 to 15 minutes each. This is considered to be one of the most effective foot pain remedies.
Whenever your feet tend to sweat, wash and dry them as quickly as possible. Wash the feet with an antiseptic soap and rinse thoroughly. Dry the feet with a soft dry cloth. The reason to follow this method is because germs and bacteria generate in moist situations.
If you do not follow this method, you may suffer from various foot problems.
Apart from the remedies, there are a few measures which you can apply in order to reduce or prevent foot pain. Since improper footwear is a common problem, it is advisable to buy shoes one size bigger so that the feet can fit properly and have an extra space to breathe. Lack of healthy diet is also considered to be one of the major causes of foot pain.
It is very important to consume a healthy diet so that the feet become immune to pain. Fresh green vegetables, fresh fruits, meat, eggs, fish and milk products are some of the most essential food products which should be consumed on a daily basis. In case the foot pain occurs due to sports, it is recommended to use proper safety gear which will not cause any kind of injuries. In case you sit or stand for long hours, the muscles in the leg contract. In order to expand them, there are various stretching exercises for the leg which you can conduct on a daily basis. Stretch your legs half way in the way simultaneously and hold it for five seconds each. This exercise can be done while sitting at home or work. These are some of the best treatments for foot pain.
where i found this information ... http://www.home-remedies-for-you.com/articles/498/medicines-and-remedies/home-remedies-for-foot-pain.html
For many of us, putting the heat on in the winter drops the humidity in our homes and dries our skin. People with dry, sensitive skin often have trouble with commercial products that contain scents or added coloring. I learned about this trick when caring for people at home with very dry skin from radiation therapy. Here's do-it-yourself skin care.
What you need
An old, clean pair of pantyhose
1 cup of rolled oats in each leg
At your choice, dried lavender, rose petals, eucalyptus
6 tea bags
A warm -- not hot -- bath
Choose a pair of pantyhose that can eventually go in the trash. Cut off the legs. Slip 1-2 cups of rolled oats in each leg and tie the end so the oats won't spill out. Place the oats in the bathtub and then fill it with warm water. Hot water can dry your skin further. Soak the "oat legs" in the water until they are good and water-logged. Then, soak in your bath. Use the "oat legs" to pat areas of particularly dry or irritated skin. Drain the tub and pat -- don't rub -- your skin dry.
Some of my patients saved the "oat legs" to use more than once -- that's up to you. There are plenty of variations on this concept as well:
Make little bags out of muslin and fill them with oatmeal or other dried herbs you like and find soothing such as rose petals or lavender or eucalyptus (I get my scented eye pillows from It's My Nature, and you can get dried herbs there, too)
Grind up fresh rolled oats in a food processor to make colloidal oatmeal and put this powder directly in the bath water. You may have to experiment -- too coarse and it will clump in the water. Caution! It will make your tub very slippery
Tie 6 tea bags together and use the strings to hang them below the faucet while you fill the bath. Tannins in the tea will soothe irritated skin. Use tea of your choice. (Herb tea also available from It's My Nature).
where i found this information .... http://www.nursesnotebook.com/home_remedies.htm
Home Remedies for Foot Pain
How to Cure Foot Pain with Natural Treatments
Pour hot water into a tub, add 2 teaspoons of salt. Soak your feet for 20 minuets.
To reduce the foot pain soak your feet in hot water for 20 minuets.
Put mustard seeds into hot tub or foot tub and soak your feet.
For foot pain put heating pad on the foot for 20-30 minutes.
Home remedy for foot pain: elevate your feet for 40 minutes, then rub the feet for 10 minutes.
where i found this information .... http://www.grannymed.com/meds/foot-pain.aspx
Tips for Pain Management
By Peter Ganther
Almost all seniors today face some degree of pain and soreness. But up to 35% of all seniors face chronic pain resulting in depression and can greatly affect their daily life. Often this chronic pain goes undiagnosed or overlooked, and only after life is negatively altered is it caught and treated. Some of the obvious chronic pain symptoms include limping, moaning, spending more time in bed, and reduction in activity. Often it is left up to the caregiver’s discretion surrounding the severity of the pain, because the loved one usually refuses help and does not want to visit a doctor. Once the pain is realized, the next step is finding the right doctor who can locate the pain and find a probable cause.
As a caregiver, understanding the aspects of pain management can greatly help your loved one return to better health and daily living. The most common recommendations made by doctors in the treatment of pain include:
Medication- Doctors usually are not eager to prescribe pain relievers that may be abused or simply looked at to numb the pain. Commonly prescribed medications include analgesics and narcotics, but both have potentially adverse effects associated with them.
Cortisone Treatments- This can be done through creams or injections into the affected muscles, but it usually only dulls the pain and should not be used for any extended period.
Regular Exercise- Routines that involve weights and stretching can correct one’s pain and body movement, as well as enhancing your loved one’s well-being in the process.
Other Health Alternatives- Treatments such as acupuncture, yoga, and meditation may correct some pain, but these approaches are not for everyone, and do not work on all pain sufferers.
Advice to Caregivers- Doctors are always reminding caregivers to remain positive and supportive to ensure that they can cope and deal with the daily pain and struggle their loved one faces.
Dietary Changes- Doctors also urge your loved ones to cut back on any high fat, cholesterol rich foods that may dampen their ability to respond to treatment.
Lifestyle Changes- Often it is activities such as smoking, excessive sleeping, and general laziness that prevents the body from reaching its daily potential and causes pain to begin in other parts of the body. Avoiding such unnecessary habits could spell less pain for your loved one.
where i found this information .... http://www.caregiver.com/articles/general/manage_pain.htm
Caregiver & Family understanding Chronic Pain
Sometime in the back of your mine you wonder do they belive you , Your caregiver , Your family , Your doctor etc . I know i wonder this from time to time as i,m sure we all have at one time or another .We need caregivers and family to understand that this is a very painful disablity , Its not a game to get attention . Altho it is hard for them to sit back and see what we deal with and can sometimes make them feel helpless just as much as we are helpless in what is happening to us . I do want to take a second to say thank you to all those caregivers and family who stand by us and help us when its needed . So i decided to search for some answers to help them understand a bit more .....
Take Care & Soft Hugs
An estimated 50 million Americans suffer from chronic pain, and an additional 25 million experience acute pain as a result of surgery or injury. Many people assume they must live with pain, but this is simply untrue. Most pain can be managed or greatly eased with proper pain management; however, the reality is that most pain goes untreated, under-treated, or improperly treated. With proper management the overall health, well-being, and quality of life of millions of Americans can be improved.
Understanding Pain provides a comprehensive guide for individuals who do not have medical training yet experience chronic pain and wish to improve their understanding about the problem they live with each day. Chapters include:
Explanation and rationale for acute and chronic pain treatments A self-evaluation to collect and organize important information that should be communicated to the healthcare provider An explanation of how pain is perceived and processed by the brain to equip patients with a basis for understanding the selection of treatment options Resources for patients, caregivers and healthcare professionals And much more…
This book will help patients understand the multifaceted nature of pain and the range of treatment options available for its management. It will also enable them to communicate more effectively with their doctors and other healthcare providers. This latest volume in the American Academy of Neurology Press Quality of Life Guide series is an essential tool for all individuals coping with chronic pain, caregivers, and allied healthcare professionals.
"The book does a good job of considering all aspects of pain management treatment, allowing the reader to understand and compare the available options... This book is loaded with information on how the field of pain medicine works... well-written and easy to understand. I highly recommend it in your quest for taking responsibility for your own pain."--About.com
"Any suffering from chronic pain need this primer... Patients, caregivers, and any library catering them will find Understanding Pain offers key insights into neurology often limited to health professionals--and enables patients to both understand and consider options in pain management."--The Midwest Book Review
"Among the unique characteristics of the book are the suggestions on how to give a complete pain history to a healthcare provider and the emphasis on the importance of a multidisciplinary approach...The glossary is comprehensive and the list of resources is excellent ... The book meets a need for many patients and families struggling to deal with this very common condition."--Doody's Reviews
"The book delivers a reassuring message for people experiencing pain... [and] provides strategies for patients to communicate the nature of their pain to their providers... Well-researched chapters cover medications, alternative therapies, surgery, special issues of pain in children and the elderly, and a resource guide."--CAPHIS Consumer Connections
Pain Defined—What Are We Treating?; The Evaluation—What Should I Tell My Doctor?; The Multidisciplinary Approach—The Best Way to Treat My Pain; The Anatomy of Pain—The Basis for Selecting Treatment Options; Non-Pharmacologic Options in Pain Management; Pharmacological Options in Pain Management—Non-Opinoid Analgesics; Pharmacological Options in Pain Management—Opinoid Analgesics; Opioid Analgesics—Myth vs. Benefit; Pharmacological Options in Pain Management—Adjuvant Medications; Pharmacological Options—Dosing and Alternate Routes of Administration; Invasive Options and When to Consider; Sex and Age—Special Considerations; Resources.
About the Author
Harry Gould, III, MD, PhD
Harry J. Gould, III, MD, PhD, is Director of the Pain Mastery Center in the Department of Neurology at Louisiana State University.
where i found this information .... http://www.demosmedpub.com/prod.aspx?prod_id=9781932603583
Information for Caregivers
Diabetic nerve damage can affect people with type 1 or type 2 diabetes. No one yet knows exactly what causes the nerve damage. Having high blood sugar (glucose) levels over time is likely to be involved. People who have had problems controlling their blood sugar levels, have high blood pressure, are overweight, or have had diabetes for at least 25 years may also have a greater risk of developing diabetes-related nerve damage.
Fortunately, studies have shown that patients with diabetes may lessen the chance of further nerve damage through a combination of diet, exercise, and improved control of blood sugar. Some ways you can play a role in helping your loved one manage their diabetes and blood sugar include:
if they're able, and they have their physician's recommendation, help them incorporate moderate exercise or activity
recommending healthy food choices to help them maintain or achieve a healthy weight
Your support is vital, and your loved one will appreciate your kindness and compassion.
Tools and Resources
Use the tools and resources below to help your loved one with diabetic nerve pain.
Where Your Loved One Can Find Support
American Diabetes Association
National Institutes of Health (NIH)
The Neuropathy Association
Centers for Disease Control and Prevention (CDC), Division of Diabetes Translation
National Diabetes Education Program (NDEP)
American Podiatric Medical Association (APMA)
Lower Extremity Amputation Prevention (LEAP)
where i found this information .... http://www.cymbalta.com/diabeticnervepain/informationforcaregivers.jsp
More than 50 million Americans experience chronic pain and more than half of dying patients experience moderate to severe pain during the last days of their life. Pain is a frequent cause for clinical visits, with approximately 45% of the population seeking medical help for pain at some point in their lives. Pain occurs across the lifespan, and it has been estimated that four out of every ten people with moderate or severe pain do not get adequate relief.
Unlike the short-term, acute pain that people feel when they cut or burn themselves, chronic pain is a disorder that persists for months or years and cannot be fully relieved by standard pain medications. Chronic pain is widely believed to represent a disease itself, causing long-term detrimental changes in the nervous system. It does manifest however, with many other physiologic and psychosocial disorders, including depression and anxiety, increasing the disability and impairment of these conditions. Pain interferes with sleep, activities of daily living, and productivity. It not only lowers the quality of life but also is a risk factor for suicide in patients who suffer from depression. Chronic pain conditions are an enormous burden on health care resources.
Compounding the problem of unrelieved chronic pain is the issue of under-treatment. While advances have been made in the management of pain, these advances have not translated into standard-of-care practices in the clinical setting. A significant proportion of patients report that they are not routinely asked about their pain, are reluctant or afraid to report pain, are unaware of available pain management treatments, do not adhere to pain treatments when provided, and at times are not offered any treatment even when they do report problematic symptoms. Under-treatment is related to fears surrounding the use of opioids, which include concerns about addiction, respiratory depression and other side effects, tolerance, diversion, and fear of regulatory action. These concerns are often exaggerated or unfounded. Pain management has been well studied, resulting in the publication and wide dissemination of clinical practice guidelines through multiple channels and organizations. Despite the long publication history of such guidelines, patients continue to suffer from inadequate relief of their pain.
The NIH investment in pain research has grown considerably over the last several years, increasing from $82 million in 1997 to $223 million in 2004. Perhaps equally significant has been the NIH commitment to a more coordinated, inter- and multi-disciplinary approach to pain research.
Whereas current analgesic drugs help many ease discomfort, millions of others have pain management needs that remain completely or partially unmet. Nearly all available analgesics were developed based on overly simplified, linear models of pain transmission. Recent advances show that pain transmission is a far more dynamic process that often involves multiple routes, or pathways. Each pathway integrates a convergence of molecular signals, and then relays them, in several steps, along their own specific routes to the brain. The research challenge is to define the molecular details of these multiple routes of pain transmission with the aim of increasing the repertoire of pain management strategies. NIH-funded research is helping to identify new factors that alter peripheral neural pathways under conditions of long-term pain. Other research programs are helping to understand changes in neural transmission and signaling in the part of the brain where pain perception is processed. New imaging techniques that allow patients to view brain activity related to pain in real time show promise for pain management.
For example, NIH-funded researchers are investigating the function of specific brain structures in mediating pain responses. Other researchers are examining the role of pain as a stressor and its effect on certain inflammatory responses. Still other investigators are researching the possible effects of Brain-Derived Neurotrophic Factor (BDNF) on pain levels in animals. Yet others focus on chronic pain in rehabilitation medicine; over the past five years their work has focused on measurement and treatment of pain in individuals with chronic inherited conditions, including Duchenne muscular dystrophy and cerebral palsy. NIH also supports studies on treatment of low back pain and on the use of virtual reality to reduce pain in children with medical problems such as severe burns who must undergo periodic painful procedures.
A number of behavioral and cognitive-behavioral techniques for managing pain also are under study. Some of the techniques under investigation are spouse-assisted coping training, tailoring treatment approaches to patient coping styles, interventions such as guided relaxation, tai chi, and exercise for pain management, behavioral treatment for the disordered sleep that frequently accompanies chronic pain conditions, and studies of adaptation to pain and stress that might inform future treatment approaches. Other grants have included evaluations of the efficacy of hypnosis and biofeedback.
PAIN PERCEPTION AND TRANSMISSION
Progress is being made to define the biological pathways and networks of pain. This knowledge is important to provide future pain management options. A multidisciplinary group of NIH grantees have discovered several biological factors that influence pain perception using novel, real-time imaging techniques that track the mu-opioid system, a specific type of protein receptor in the brain that researchers have long suspected triggers a dampening of the pain. In a seminal study published last year, the team confirmed the role of the mu-opioid system in enhancing a person's tolerance of pain. This marked the first study ever that combined prolonged pain with simultaneous brain scan monitoring of the mu-opioid system and self-reported pain ratings of human volunteers. The scientists noted that their results establish that people vary both in their capacity to produce mu-opioid receptors and in their ability to release the anti-pain chemicals themselves. This variability appears to determine the emotional and sensory aspects of a painful experience and might explain why some people react to pain differently than others. It may also help to explain why some people are more prone to chronic pain conditions or do not benefit from certain anti-pain medications. Other NIH-funded scientists are investigating whether some chronic pain conditions (fibromyalgia, for example) may arise from an impairment of central sensory processing that results in a higher likelihood of experiencing sensations as painful.
Various models of neural stimulation have been used with success to treat severe cases of chronic pain. These methods work by either electrically activating pain control areas in the brain, or by disrupting the patterns of pain signals that are generated by the brain itself in conditions of neuropathic pain. Though often effective, these types of procedures are invasive.
A novel way to stimulate areas of the brain involved in pain control has been recently developed by NIH researchers, which is completely non-invasive. This technique involves using an fMRI scanner to scan a pain patients brain activity. The patient is then shown the activity of a pain control area of their own brain in real time. The patients are then asked to use this feedback to try to increase the activity in this pain control area of the brain. It has been found not only that pain patients can control this area of the brain when given feedback, but that this also results in a significant decrease in their pain levels. The patients come out of this treatment feeling significantly less pain and saying things like how wonderful it is that for the first time in their life they feel they have control over their own pain.
where i found this information ... http://www.hhs.gov/asl/testify/t051208a.html
Subcutaneous Infusion of Lidocaine Provides Effective Pain Relief for CRPS Patients.
Clinical Journal of Pain.
Linchitz, Richard M. M.D., F.A.A.P.M.; Raheb, Janet C. B.S., P.A.-C.
Case Report: Nine patients with Complex Regional Pain Syndrome types I and/or II (CRPS), previously known as reflex sympathetic dystrophy (RSD) and causalgia, respectively, were selected for treatment with a continuous four to eight week subcutaneous infusion of 10% lidocaine.
Results and Conclusions: Five patients completed the infusion treatment. The treatment significantly alleviated much of the pain and other symptomatology (i.e., dysesthesia, allodynia, hyperpathia, color and temperature changes, decreased range of motion of involved extremities, changes in hair and nail growth, etc.) commonly observed for CRPS/RSD patients. Upon discontinuation of the continuous subcutaneous infusion, patients appear to maintain the pain relief obtained. Periodic maintenance infusions may be needed.
where i found this information ... http://www.clinicalpain.com/pt/re/clnjpain/abstract.00002508-199903000-00010.htm;jsessionid=JjNc1slfl1p1MXzCcjHQn1rQw5CsgdXYrQyyZJy2LzK2YqKd8Q30!-409308177!181195629!8091!-1
The Two Faces of Pain: Acute and Chronic
What is pain? The International Association for the Study of Pain defines it as: An unpleasant sensory and emotional experience associated with actual or potential tissue damage or described in terms of such damage.
It is useful to distinguish between two basic types of pain, acute and chronic, and they differ greatly.
Acute pain, for the most part, results from disease, inflammation, or injury to tissues. This type of pain generally comes on suddenly, for example, after trauma or surgery, and may be accompanied by anxiety or emotional distress. The cause of acute pain can usually be diagnosed and treated, and the pain is self-limiting, that is, it is confined to a given period of time and severity. In some rare instances, it can become chronic.
Chronic pain is widely believed to represent disease itself. It can be made much worse by environmental and psychological factors. Chronic pain persists over a longer period of time than acute pain and is resistant to most medical treatments. It can — and often does — cause severe problems for patients.
The A to Z of Pain
Hundreds of pain syndromes or disorders make up the spectrum of pain. There are the most benign, fleeting sensations of pain, such as a pin prick. There is the pain of childbirth, the pain of a heart attack, and the pain that sometimes follows amputation of a limb. There is also pain accompanying cancer and the pain that follows severe trauma, such as that associated with head and spinal cord injuries. A sampling of common pain syndromes follows, listed alphabetically.
Arachnoiditis is a condition in which one of the three membranes covering the brain and spinal cord, called the arachnoid membrane, becomes inflamed. A number of causes, including infection or trauma, can result in inflammation of this membrane. Arachnoiditis can produce disabling, progressive, and even permanent pain.
Arthritis. Millions of Americans suffer from arthritic conditions such as osteoarthritis, rheumatoid arthritis, ankylosing spondylitis, and gout. These disorders are characterized by joint pain in the extremities. Many other inflammatory diseases affect the body's soft tissues, including tendonitis and bursitis.
Cancer pain can accompany the growth of a tumor, the treatment of cancer, or chronic problems related to cancer's permanent effects on the body. Fortunately, most cancer pain can be treated to help minimize discomfort and stress to the patient.
Muscle pain can range from an aching muscle, spasm, or strain, to the severe spasticity that accompanies paralysis. Another disabling syndrome is fibromyalgia, a disorder characterized by fatigue, stiffness, joint tenderness, and widespread muscle pain. Polymyositis, dermatomyositis, and inclusion body myositis are painful disorders characterized by muscle inflammation. They may be caused by infection or autoimmune dysfunction and are sometimes associated with connective tissue disorders, such as lupus and rheumatoid arthritis.
Neuropathic pain is a type of pain that can result from injury to nerves, either in the peripheral or central nervous system. Neuropathic pain can occur in any part of the body and is frequently described as a hot, burning sensation, which can be devastating to the affected individual. It can result from diseases that affect nerves (such as diabetes) or from trauma, or, because chemotherapy drugs can affect nerves, it can be a consequence of cancer treatment. Among the many neuropathic pain conditions are diabetic neuropathy (which results from nerve damage secondary to vascular problems that occur with diabetes); reflex sympathetic dystrophy syndrome (see below), which can follow injury; phantom limb and post-amputation pain, which can result from the surgical removal of a limb; postherpetic neuralgia, which can occur after an outbreak of shingles; and central pain syndrome, which can result from trauma to the brain or spinal cord.
Reflex sympathetic dystrophy syndrome, or RSDS, is accompanied by burning pain and hypersensitivity to temperature. Often triggered by trauma or nerve damage, RSDS causes the skin of the affected area to become characteristically shiny. In recent years, RSDS has come to be called complex regional pain syndrome (CRPS); in the past it was often called causalgia. Repetitive stress injuries are muscular conditions that result from repeated motions performed in the course of normal work or other daily activities. They include:
writer's cramp, which affects musicians and writers and others,
compression or entrapment neuropathies, including carpal tunnel syndrome, caused by chronic overextension of the wrist and
tendonitis or tenosynovitis, affecting one or more tendons.
Sciatica is a painful condition caused by pressure on the sciatic nerve, the main nerve that branches off the spinal cord and continues down into the thighs, legs, ankles, and feet. Sciatica is characterized by pain in the buttocks and can be caused by a number of factors. Exertion, obesity, and poor posture can all cause pressure on the sciatic nerve. One common cause of sciatica is a herniated disc.
where i found this information .... http://www.partnersagainstpain.com/patient-scales/acute-and-chronic.aspx
Complex Regional Pain Syndrome (CRPS) Affects More Than Twice as Many Women as Men
Complex Regional Pain Syndrome (CRPS), also known as Reflex Sympathetic Dystrophy Syndrome (RSD), is a complex and poorly understood neurological syndrome characterized by severe pain. CRPS/RSD affects from 2.3 to 3 times more women than men and is a major cause of disability -- only one in five patients is able fully to resume prior activities. Equally frightening is the increasing diagnosis of CRPS/RSD in children and adolescents.
CRPS/RSD is a common complication after surgery or a minor injury, but the resulting pain is disproportionate. A recent web-based epidemiological survey of 1,610 people with CRPS, sponsored by the Reflex Sympathetic Dystrophy Association of America (RSDSA) and conducted by Johns Hopkins University, showed that common events leading to the syndrome were surgery (29.9%) fracture (15%), sprain (11%) and crush injuries (10%).
Telltale signs and symptoms of CRPS/RSD include: moderate-to-severe pain, often caused by stimuli that would not normally provoke pain (the water in a shower, light breezes, the touch of clothing, etc.); abnormal skin color or temperature changes; and sweating. The continuing tragedy is that many physicians are not familiar with its telltale symptoms and do not consider the diagnosis in their examination. Experience has shown that early diagnosis promotes more successful outcomes for people with the syndrome.
Linda Lang, co-author of Living With RSDS, suffered for many years before her syndrome was appropriately diagnosed. Although people with CRPS/RSD often talk about pain, "There is an awful lot we leave out -- how a productive member of society can become too disabled to work or to take care of her children. We don't discuss the tremendous personal losses-families, friends, jobs-that CRPS/RSD wreaks, nor do we discuss the outrageously difficult time we have negotiating the red tape that binds insurance, medical, and social security benefits. Evaluating pain is subjective, but the losses are measurable, and often, substantial."
The RSDSA suggests that anyone who thinks that they or a family member might have CRPS/RSD visit http://www.rsds.org or contact the association call toll-free (877)662-7737 for an information packet.
RSDSA is a national not-for-profit organization, headquartered in Milford, Connecticut, that promotes greater public and professional awareness of CRPS/RSD and educates those afflicted with the syndrome, their families, friends, insurance and healthcare providers on the disabling pain it causes.
Reflex Sympathetic Dystrophy Association of America
where i found this information ... http://www.medicalnewstoday.com/articles/24046.php