Thursday, January 27, 2011

Info on CPRS/RSD

I thought this was very relevant. It explains what CPRS/RSD is & how it can effect someone.

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Found at: http://www.rsdfoundation.org/

“REFLEX SYMPATHETIC DYSTROPHY SYNDROME
(RSD / CRPS)

Reflex Sympathetic Dystrophy Syndrome (RSD) is also known as Complex Regional Pain Syndrome (CRPS). RSD / CRPS is a multi-symptom, multi-system, syndrome usually affecting one or more extremities, but may affect virtually any part of the body. Although it was clearly described 125 years ago by Drs. Mitchell, Moorehouse and Keen, RSD / CRPS remains poorly understood and may go unrecognized.
The best way to describe RSD / CRPS is in terms of an injury to a nerve or soft tissue (e.g. broken bone) that does not follow the normal healing path. The development of RSD / CRPS does not appear to depend on the magnitude of the injury. In fact, the injury may be so slight that the patient may not recall ever having received an injury. For reasons we do not understand, the sympathetic nervous system seems to assume an abnormal function after an injury. There is no single laboratory test to diagnose RSD / CRPS. Therefore, the physician must assess and document both subjective complaints (medical history) and, if present, objective findings (physical examination), in order to support the diagnosis. There is a natural tendency to rush to the diagnosis of RSD / CRPS with minimal objective findings because early diagnosis is critical. If undiagnosed and untreated, RSD / CRPS can spread to all extremities, making the rehabilitation process a much more difficult one. If diagnosed early, physicians can use mobilization of the affected extremity (physical therapy) and sympathetic nerve blocks to cure or mitigate the disease. If untreated, RSD / CRPS can become extremely expensive due to permanent deformities and chronic pain. There are no studies showing that RSD / CRPS affects the patient's life span. The potential exists for long-term financial consequences. At an advanced state of the illness, patients may have significant psychosocial and psychiatric problems, they may have dependency on narcotics and may be completely incapacitated by the disease. The treatment of patients with advanced RSD is a challenging and time-consuming task.

Diagnosis
If one can demonstrate major nerve damage associated with the development of RSD / CRPS symptoms, the condition is called complex regional pain syndrome (CRPS) type II or causalgia. Generally, causalgia provides more objective evidence of disease due to neurological changes (numbness and weakness).
The terms complex regional pain syndrome (CRPS) type I and type II have been used since 1995, when the International Association for the Study of Pain (IASP) felt the respective names reflex sympathetic dystrophy and causalgia were inadequate to represent the full spectrum of signs and symptoms. 1-8 The term "Complex" was added to convey the reality that RSD and causalgia express varied signs and symptoms. Many publications, particularly older ones, still use the names RSD and causalgia. To facilitate communication and understanding the designation RSD / CRPS is generally used throughout these practice guidelines. The principles applicable to the diagnosis and management of RSD are similar to those principles applicable to the diagnosis and management of causalgia.
To make the early diagnosis of RSD / CRPS, the practitioner must recognize that some features/manifestations of RSD / CRPS are more characteristic of the syndrome than others, and that the clinical diagnosis is established by piecing each bit of the puzzle together until a clear picture of the disorder emerges. Often the physician needs to rule out other potentially life-threatening disorders that may have clinical features similar to RSD / CRPS, e.g. a blood clot in a leg vein or a breast tumor spreading to lymph glands can cause a swollen, painful extremity. Indeed, RSD / CRPS may be a component part of another disease, (e.g. a herniated disc of the spine, carpal tunnel syndrome of the hand, heart attack). Thus, treating RSD / CRPS will often be directed to treating clinical features rather than a well defined disease. When RSD / CRPS spreads the diagnosis can be more complicated. For example, if it spreads to the opposite limb, it may be more difficult to establish a diagnosis because there is no normal side (control) to compare for objective findings. On the other hand, the spreading of RSD / CRPS symptoms may actually facilitate the diagnosis of RSD / CRPS because spreading symptoms is a characteristic of the disorder.

Clinical Features of RSD / CRPS

  1. Pain - The hallmark of RSD / CRPS is pain and mobility problems out of proportion to those expected from the initial injury. The first and primary complaint occurring in one or more extremities is described as severe, constant, burning and/or deep aching pain. All tactile stimulation of the skin (e.g. wearing clothing, a light breeze) may be perceived as painful. Repetitive tactile stimulation (e.g. tapping on the skin) may cause increasing pain with each tap and when the repetitive stimulation stops, there may be a prolonged after-sensation of pain. There may be diffuse tenderness or point-tender spots in the muscles of the affected region due to small muscle spasms called muscle trigger points. There may be spontaneous sharp jabs of pain in the affected region that seem to come from nowhere.
  2. Skin changes - skin may appear shiny (dystrophy-atrophy), dry or scaly. Hair may initially grow coarse and then thin. Nails in the affected extremity may be more brittle, grow faster and then slower. Faster growing nails is almost proof that the patient has RSD / CRPS. RSD / CRPS is associated with a variety of skin disorders including rashes, ulcers and pustules. Although extremely rare, some patients have required amputation of an extremity due to life-threatening reoccurring infections of the skin. Abnormal sympathetic activity may be associated with skin that is either warm or cold to touch. The patient may perceive sensations of warmth or coolness in the affected limb without even touching it. The skin may show increased sweating or increased chilling of the skin with goose flesh. Changes in skin color can range from a white mottled appearance to a red or blue appearance. Changes in skin color (and pain) can be triggered by changes in the room temperature, especially cold environments. However, many of these changes occur without any apparent provocation. Patients describe their disease as though it had a mind of its own.
  3. Swelling - pitting or hard (brawny) edema is usually diffuse and localized to the painful and tender region. If the edema is sharply demarcated on the surface of the skin along a line, it is almost proof that the patient has RSD / CRPS. However, some patients will show a sharply demarcated edema because they tie a band around the extremity for comfort. Therefore, one has to be certain that the sharply demarcated edema is not due to a previously wrapped bandage around the extremity.
  4. 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. 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. This muscle disorder is called dystonia and it can be extremely disabling.
  5. Spreading Symptoms - Initially, RSD / CRPS symptoms are generally localized to the site of injury. As time progresses, the pain and symptoms tend to become more diffuse. Typically, the disorder starts in an extremity. However, the pain may occur in the trunk or side of the face. On the other hand, the disorder may start in the distal extremity and spread to the trunk and face. At this stage of the disorder, an entire quadrant of the body may be involved. Maleki et. al. recently described three patterns of spreading symptoms in RSD / CRPS:
    1. A "continuity type" of spread where the symptoms spread upward from the initial site, e.g. from the hand to the shoulder.
    2. A "mirror-image type" where the spread was to the opposite limb.
    3. An "independent type" where symptoms spread to a separate, distant region of the body. This type of spread may be spontaneous or related to a second trauma.
  6. Bone changes - X-rays may show wasting of bone (patchy osteoporosis) or a bone scan may show increased or decreased uptake of a certain radioactive substance (technecium 99m) in bones after intravenous injection.
  7. Duration of RSD / CRPS - The duration of RSD / CRPS varies, in mild cases it may last for weeks followed by remission; in many cases the pain continues for years and in some cases, indefinitely. Some patients experience periods of remission and exacerbation. Periods of remission may last for weeks, months, or years.

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I have CPRS type 1. My orthopedic surgeon thought I had CPRS very early on. I had some of the tell tale signs of it, change in temp of my leg, change in hair growth, a reddening on the leg & swelling. It took awhile to find the right doctor who could verify it was. I like the last sentence above “Patients describe their disease as though it had a mind of it’s own.” I feel this is so true. The disease doesn’t have one way it works, I never know when or where or how it might get aggravated & increase the pain. The reason that the sympathetic nerves blocks didn’t work well for me, is that my CPRS was not caught early enough. It had too much time to advance & has began to spread to my other leg. But I have full faith & trust in Heavenly Father that this spinal cord stimulator will work.

2 comments:

CRPS News said...

Early diagnosis and treatment is certainly crucial to limit the disability from CRPS. But don't lose hope. There is a growing community of researchers and doctors who are doing their best to help and come up with a cure.
crps specialist

Lovice Briggs said...

It took 2 years for me to finely find a doctor who belived me about my pain. I was offically diagnised soon after. Sympathetic nerve blocks didn't work, so ended up getting a stimulator March 2011. I am so gratefuk to have it! It helps my pain about 50% most days.