November 1st,
2011
First Day of
RSD Awareness Month
Today is the fist
day of 2011’s RSD Awareness Month. Here
are some definitions of CRPS/RSD from several different sources:
Informational Presentation for you to watch:
Complex regional pain syndrome
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Complex regional pain syndrome/Reflex
Sympathetic Dystrophy (CRPS/RSD)
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Classification and external resources
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Complex regional pain syndrome (CRPS) is a chronic progressive disease characterized by severe pain, swelling and changes in the skin. It often affects an arm or a leg and may spread to another part of the body .Though treatment is often unsatisfactory, early multimodal therapy can cause dramatic improvement or remission of the syndrome in some patients.[1] The International Association for the Study of Pain has proposed dividing CRPS into two types based on the presence of nerve lesion following the injury.
·
Type
I, formerly known as reflex sympathetic dystrophy (RSD), Sudeck's
atrophy, reflex neurovascular dystrophy (RND)
or algoneurodystrophy, does not have demonstrable nerve lesions.
·
Type
II, formerly known as causalgia, has evidence of obvious nerve damage.
The cause of this syndrome is currently unknown. Precipitating factors include injury and surgery, although there are documented cases that have no demonstrable injury to the original site.
What
is complex regional pain syndrome?
Complex regional pain syndrome (CRPS) is a chronic pain
condition that is believed to be the result of dysfunction in the central or peripheral
nervous systems. 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. CRPS I is frequently
triggered by tissue injury; the term describes all patients with the above
symptoms but with no underlying nerve injury. Patients with CRPS II experience the same
symptoms but their cases are clearly associated with a nerve injury.
Older terms used to describe CRPS are "reflex
sympathetic dystrophy syndrome" and "causalgia," a term first
used during the Civil War to describe the intense, hot pain felt by some
veterans long after their wounds had healed.
CRPS can strike at any age and affects both men and women, although
most experts agree that it is more common in young women.
What are the symptoms of CRPS?
The key symptom of CRPS is continuous, intense pain out of
proportion to the severity of the injury (if an injury has occurred), which
gets worse rather than better over time. CRPS most often affects one of the
extremities (arms, legs, hands, or feet) and is also often accompanied by:
- "burning"
pain
- 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
Often the pain spreads to include the entire arm or leg,
even though the initiating injury might have been only to a finger or toe. Pain
can sometimes even travel to the opposite extremity. It may be heightened by
emotional stress.
The symptoms of CRPS vary in severity and length. 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.
In 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.
What causes CRPS?
Doctors aren’t 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 known as
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.
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?
CRPS is diagnosed primarily through observation of the signs
and symptoms. But because many other conditions have similar symptoms, it can
be difficult for doctors to make a firm diagnosis of CRPS early in the course
of the disorder when symptoms are few or mild. Or, for example, a simple nerve
entrapment can sometimes cause pain severe enough to resemble CRPS. Diagnosis
is further complicated by the fact that some people will improve gradually over
time without treatment.
Since there is no specific diagnostic test for CRPS, the
most important role for testing is to help rule out other conditions. Some
clinicians apply a stimulus (such as touch, pinprick, heat, or cold) to the
area to see if it causes pain. Doctors may also use triple-phase bone scans to
identify changes in the bone and in blood circulation.
What is the prognosis?
The prognosis for CRPS varies from person to person.
Spontaneous remission from symptoms occurs in certain people. Others can have
unremitting pain and crippling, irreversible changes in spite of treatment.
Some doctors believe that early treatment is helpful in limiting the disorder,
but this belief has not yet been supported by evidence from clinical studies.
More research is needed to understand the causes of CRPS, how it progresses,
and the role of early treatment.
How is CRPS treated?
Because there is no cure for CRPS, treatment is aimed at
relieving painful symptoms so that people can resume their normal lives. The
following therapies are often used:
- Physical
therapy: A gradually increasing exercise program to
keep the painful limb or body part moving may help restore some range of
motion and function.
- Psychotherapy:
CRPS often has profound psychological effects on people and their
families. Those with CRPS may suffer from depression, anxiety, or
post-traumatic stress disorder, all of which heighten the perception of
pain and make rehabilitation efforts more difficult.
- Sympathetic
nerve block: Some patients will get significant pain
relief from sympathetic nerve blocks. Sympathetic blocks can be done in a
variety of ways. One technique involves intravenous administration of
phentolamine, a drug that blocks sympathetic receptors. Another technique
involves placement of an anesthetic next to the spine to directly block
the sympathetic nerves.
- Medications:
Many different classes of medication are used to treat CRPS, including
topical analgesic drugs that act locally on painful nerves, skin, and
muscles; antiseizure drugs; antidepressants, corticosteroids, and opioids.
However, no single drug or combination of drugs has produced consistent
long-lasting improvement in symptoms.
- Surgical
sympathectomy: The use of surgical sympathectomy, a
technique that destroys the nerves involved in CRPS, is controversial.
Some experts think it is unwarranted and makes CRPS worse; others report a
favorable outcome. Sympathectomy should be used only in patients whose
pain is dramatically relieved (although temporarily) by selective
sympathetic blocks.
- Spinal
cord stimulation: The placement of stimulating
electrodes next to the spinal cord provides a pleasant tingling sensation
in the painful area. This technique appears to help many patients with
their pain.
- Intrathecal
drug pumps: These devices administer drugs directly to
the spinal fluid, so that opioids and local anesthetic agents can be
delivered to pain-signaling targets in the spinal cord at doses far lower
than those required for oral administration. This technique decreases side
effects and increases drug effectiveness.
Is research currently being done on CRPS?
The National Institute of Neurological Disorders and Stroke
(NINDS), a component of the National Institutes of Health (NIH), supports and
conducts research on the brain and central nervous system. Some studies are
conducted at the Institute’s laboratories and clinics on the NIH campus in
Bethesda, Maryland. Others are funded through grants to major medical
institutions across the country. NINDS-supported scientists are studying new
approaches to treat CRPS and intervene more aggressively after traumatic injury
to lower the chances of developing the disorder. Other studies to overcome
chronic pain syndromes are discussed in the NINDS pamphlet, "Pain: Hope
Through Research."
For more information on neurological disorders or research
programs funded by the National Institute of Neurological Disorders and Stroke,
contact the Institute's Brain Resources and Information Network (BRAIN) at:
BRAIN
P.O. Box 5801
Bethesda, MD 20824
(800) 352-9424
http://www.ninds.nih.gov
P.O. Box 5801
Bethesda, MD 20824
(800) 352-9424
http://www.ninds.nih.gov
Information also is available from the following
organizations:
"Complex
Regional Pain Syndrome Fact Sheet," NINDS. Publication date November
2003.
NIH Publication No. 04-4173
Prepared by:
Office of Communications and Public Liaison National Institute of Neurological Disorders and Stroke National Institutes of Health Bethesda, MD 20892
NINDS health-related material is provided for information
purposes only and does not necessarily represent endorsement by or an
official position of the National Institute of Neurological Disorders and
Stroke or any other Federal agency. Advice on the treatment or care of an
individual patient should be obtained through consultation with a physician
who has examined that patient or is familiar with that patient's medical
history.
All NINDS-prepared information is in the public domain and
may be freely copied. Credit to the NINDS or the NIH is appreciated.
Last updated April 12, 2011
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You will notice that
in the treatment statement of the above they talk about Sympathectomy. My research has shown that this treatment is
no longer considered an acceptable treatment as the nerves grow back and the
pain is worse once they do.
Also you will notice
that Ketamine is not yet mentioned as a treatment for RSD even though it has
been used for over 10 years as an effective treatment for many.
Look for more
information on CRPS/RSD tomorrow! Thanks
for reading.
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