Monthly Archives: April 2005

Reflex Sympathetic Dystrophy Web Forum


Neurology Deptartment at Massachusetts General Hospital
Originally uploaded by rsdscrpsnews.

This might be helpful to people that are newer to learning about RSDS/CRPS. It’s an archive of a web forum of questions and responses. The forum is a bit old.. but there is a lot of interesting information inside. The forum is a part of the Department of Neurology at Massachusetts General Hospital website.

Click here to acess the forum

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Complex Regional Pain Syndrome


MayoClinic
Originally uploaded by rsdscrpsnews.

Complex Regional Pain Syndrome

By Mayo Clinic staff

Overview

Complex regional pain syndrome (CRPS) — one type of which was formerly known as reflex sympathetic dystrophy syndrome — is an uncommon, chronic condition that usually affects your arm or leg. Rarely, the disease can affect other parts of your body. You may experience intense burning or aching pain along with swelling, skin discoloration, altered temperature, abnormal sweating and hypersensitivity in the affected area.

The nature of CRPS is puzzling, and the cause isn’t clearly understood.

Women are more likely to be affected by CRPS than men are. The condition is most common in people between the ages of 40 and 60, but it can occur at any age. Treatment is most effective when started early in the course of the syndrome.

Signs and symptoms

CRPS occurs in two types, with similar signs and symptoms but different causes:

* Type I. Previously known as reflex sympathetic dystrophy syndrome, this type occurs after an illness or injury that didn’t directly damage the nerves in your affected limb.

* Type II. Once referred to as causalgia, this type follows a distinct nerve injury. Signs and symptoms of both types of CRPS vary in severity and duration.

The main symptom of CRPS is intense pain, often described as “burning.” Additional signs and symptoms include:

* Skin sensitivity.

* Changes in skin temperature, color and texture. At times your skin may be sweaty; at other times it may be cold. Skin color can range from white and mottled to red or blue. Skin may become tender, thin or shiny in the affected area.

* Changes in hair and nail growth.

* Joint stiffness, swelling and damage.

* Muscle spasms, weakness and loss (atrophy).

* Decreased ability to move the affected body part.

Causes

Complex regional pain syndrome may result from disturbances in the sympathetic nervous system, the part of the nervous system that controls blood flow and your sweat glands. This syndrome commonly follows an acute problem.

Many cases of CRPS occur after a forceful trauma to an arm or a leg, such as a gunshot wound or shrapnel blast. Other major and minor traumas — surgery, heart attacks, infections, fractures and even sprained ankles — also can lead to CRPS. It’s not well understood why these injuries sometimes trigger CRPS.

The syndrome was first described after the Civil War when soldiers continued to report severe pain after their wounds had healed. It was often referred to as “hot pain” during that period.

When to seek medical advice

If you experience constant, severe pain that affects a single limb and makes touching or movement of the limb seem intolerable, see your doctor to determine the cause. It’s important to treat CRPS early.

Screening and diagnosis

Your doctor may base a diagnosis of CRPS on:

* Review of your medical history. The onset of CRPS symptoms can often be traced back to an accident, illness or injury.

* Physical examination. An examination of your skin, muscles and joints may reveal information about the source of your tenderness and pain. There may be changes in the normal texture and color of your skin, and you may have problems with range of motion of one or more of your joints.

* Bone scan. A radioactive substance injected into your veins permits viewing of your bones with a special camera. This procedure may show increased circulation to the joints in the affected area.

* Sympathetic nervous system tests. These tests look for disturbances in your sympathetic nervous system. For example, thermography measures the skin temperature and blood flow of your affected and unaffected limbs. Other tests can measure the amount of sweat on both limbs. Dissimilar results can indicate CRPS.

* X-rays. Loss of minerals from your bones may show up on an X-ray in later stages of the disease.

Complications

If CRPS isn’t diagnosed and treated at an early stage, the disease may progress to more disabling signs and symptoms. If you avoid moving an arm or a leg because of pain, or if you have trouble moving a limb because of stiffness, your skin and muscles may begin wasting (atrophy). You may also experience tightening of your muscles as they lose their tone. This may lead to a condition in which your hand and fingers or your foot and toes contract into a fixed position.

The illness may also spread from its source to elsewhere in your body in these patterns:

* Continuity type. The symptoms may migrate from the initial site of the pain — for example, from your hand — to your shoulder, trunk and face, affecting a quadrant of your body.

* Mirror-image type. The symptoms may spread from one limb to the opposite limb.

* Independent type. Sometimes, the symptoms may leap to a distant part of your body.

Treatment

Dramatic improvement and even remission of CRPS is possible if treatment begins within a few months of your first symptoms. Treatment options include:

* Medications. Doctors use many types of medications to treat the symptoms of CRPS. Over-the-counter nonsteroidal anti-inflammatory drugs (NSAIDs) such as aspirin, ibuprofen (Advil, Motrin, others) and naproxen sodium (Aleve) may ease pain and inflammation. In some cases, doctors may recommend prescription medications. For example, antidepressants, such as duloxetine (Cymbalta), and anticonvulsants, such as gabapentin (Neurontin), are used to treat pain that originates from a damaged nerve (neuropathic pain). Corticosteroids, such as prednisone, may reduce inflammation.

Your doctor may also have you take bone-loss medications, such as risedronate (Actonel) and calcitonin (Miacalcin). Opioid medications may be another option. Taken in appropriate doses, they may provide acceptable control of pain. However, they may not be appropriate for people who have a history of substance abuse or lung disease.

Some pain medications, such as COX-2 inhibitors (Celebrex), may increase your risk of heart attack and stroke. It’s wise to discuss your individual risk profile with your doctor.

* Applying heat and cold. Applying cold may relieve swelling and sweating. If the affected area is cool, applying heat may offer relief.

* Physical therapy. Gentle, guided exercising of the affected limbs may improve range of motion and strength. The earlier the disease is diagnosed, the more effective exercises may be.

* Sympathetic nerve-blocking medication. Injection of an anesthetic to block pain fibers in your affected nerves may relieve pain in some people.

* Transcutaneous electrical nerve stimulation (TENS). Chronic pain is sometimes eased by applying electrical impulses to nerve endings.

* Biofeedback. In some cases, learning biofeedback techniques may help. In biofeedback, you learn to become more aware of your body so that you can relax your body and relieve symptoms of pain.

* Spinal cord stimulation. Your doctor inserts tiny electrodes along your spinal cord. A small electrical current delivered to the spinal cord sometimes results in pain relief.

Coping skills

Living with a chronic, painful condition can be challenging, especially when — as is often the case with CRPS — your friends and family don’t believe you could be feeling as much pain as you describe. Share information from reliable sources about CRPS with those close to you to help them understand what you’re experiencing.

Take care of your physical and mental health by following these suggestions:

* Maintain normal daily activities as best you can.

* Pace yourself and be sure to get the rest that you need.

* Stay connected with friends and family.

* Continue to pursue hobbies that you enjoy and are able to do.

If CRPS makes it difficult for you to do things you enjoy, ask your doctor about ways to get around the obstacles.

Keep in mind that your physical health can directly affect your mental health. Denial, anger and frustration are common with chronic illnesses.

At times, you may need more tools to deal with your emotions. Professionals such as therapists or behavioral psychologists may be able to help you put things in perspective. They can also teach you coping skills that may help you, including relaxation techniques.

Sometimes, joining a support group, where you can share experiences and feelings with other people, is a good approach. Ask your doctor what support groups are available in your community.

Mayo Clinic

Reflex Sympathetic Dystrophy Syndrome May Affect More Than 1.2 Million


PR Newswire, United Business Media
Originally uploaded by rsdscrpsnews.

Early Diagnosis and Appropriate Treatment Key to Any Possibility of Recovery

MILFORD, Conn., April 22 /PRNewswire/ — Paula Abdul’s story about her struggle with Reflex Sympathetic Dystrophy Syndrome (RSD), also known as Complex Regional Pain Syndrome (CRPS) highlights this complex and poorly understood disorder. CRPS/RSD is a neurological syndrome characterized by severe and relentless pain that, according to the McGill Pain Index, is greater than that experienced by cancer patients. A common complication after surgery or minor injury, CRPS/RSD is a major cause of disability-only one in five patients is able fully to resume prior activities. 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.

Telltale Signs and Symptoms of CRPS 1/ RSD

CRPS/RSD is a diagnostic consideration for patients who have pain
(moderate to severe) that is disproportionate to any inciting event (surgery, sprain, fracture, etc.) and has some of the following characteristics:

* Pain is described as deep, aching, cold, burning, and/or increased skin sensitivity

* The presence of an initiating noxious event (surgery, sprain, fracture, etc.)

* Continuing pain (moderate to severe) associated with allodynia (pain due to stimulus that does not normally provoke pain) or hyperalgesia (excessive sensitivity to pain)

* The pain is disproportionate to any inciting event.
* Abnormal swelling in the affected part
* Abnormal hair or nail growth
* Abnormal skin color changes
* Abnormal skin temperature (greater than 10C asymmetry)
* Abnormal sweating
* Limited range of movement, weakness, or other motor disorders (paralysis, dystonia, etc.)
* CRPS/RSD is excluded by the existence of conditions that would otherwise account for the degree of pain and dysfunction

Treatment options generally include pain management-nerve blocks and analgesics-plus physical therapy; psychological therapy helps people manage their pain.

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. For more information, please visit http://www.rsds.org. For interviews with physicians, researchers, or patient, please call toll-free (877)662-7737

SOURCE Reflex Sympathetic Dystrophy Syndrome Association
Web Site: http://www.rsds.org

Anti-Epilepsy Drug May Reduce Nerve Pain


Reuters
Originally uploaded by rsdscrpsnews.

Anti-Epilepsy Drug May Reduce Nerve Pain
Thu Apr 21, 2005 06:43 PM ET

This story originally appeared HERE.

NEW YORK (Reuters Health) – A new study indicates, that the drug Gabitril (tiagabine) is effective in easing a disorder termed complex regional pain syndrome, which involves diffuse pain in the arms or legs, often following a localized injury.

Gabitril is a drug commonly used to treat epilepsy. Studies in animals suggest that it would be effective in treating pain caused by nerve damage as well, Dr. Raymond Sorensen and Michael G. Jenson note in their report, published in the American Journal of Pain Management.

The researchers, based at PETC Research Group in Tulsa, Oklahoma, treated 20 patients with complex regional pain syndrome type — also commonly called reflex sympathetic dystrophy — with Gabitril, started at 2 to 4 mg daily and escalating to doses of up to 12 mg.

The patients, who had never been tried on anti-epilepsy drugs or for whom such drugs had been ineffective, took the new drug for 24 weeks.

Sixteen patients reported either excellent or good reduction in their symptoms. The other four reported little improvement (less than 20 percent reduction in symptoms).

Three patients discontinued treatment due to nausea and one because it wasn’t helping.

“Placebo-controlled trials are needed to better assess this most promising agent,” the authors conclude.

SOURCE: American Journal of Pain Management, April 2005.

© Reuters 2005. All Rights Reserved.

Magnet Therapy


TT Put Magnets To The Test
Originally uploaded by rsdscrpsnews.

This story originally appeared at http://seven.com.au/todaytonight/story/?id=20239

Magnet therapy
REPORTER: Rohan Wenn
BROADCAST DATE: April 21, 2005

Magnets have long been touted as an alternative pain relief. Do they have any healing powers? Today Tonight put magnets to the test.

Dick Wicks suffers from a condition called Reflex Sympathetic Dystrophy Syndrome (RSDS), also known as Complex Regional Pain Syndrome (CRPS).

“I had eight years of pain and suffering, in and out of hospital 26 times,” Mr Wicks said.

Mr Wicks began manufacturing magnetic products he said could be used to relieve pain by acting on iron in the blood.

“They say the iron ions are attracted to the magnets in your haemoglobin and it creates a lovely warm feeling,” Mr Wicks said

Grant Stevenson from The Australian Skeptics is sceptical.

“We need some short term studies, more research and longer term studies too,” Mr Stevenson said.

Putting magnets to the test

Today Tonight tested the product with the help of six retirees.

Cliff, Tess, Daphne, Gilda, Irene, and Marshall rated their current pain levels on a scale of one to five then wore a knee support for six weeks, noting how their knee felt each week.

Only three knee supports contained magnets.

The results

By week three Cliff was feeling some benefit and believed he had one of the knee supports that contained magnets.

“I am getting a bit less pain, I am getting more movement, and more confidence, I don’t have to struggle down there and then struggle up,” he said.

Marshall and Tess also felt improvements, although Marshall said it might have as much to do with the brace as any magnets.

“Whether it’s the result of the support or the warmth of it, I wouldn’t know with any certainty, there is no doubt my knee is feeling better,” Marshall said.

After six weeks the retirees were asked how they had been feeling.

Tess felt a substantial reduction in pain. Marshall reported some fluctuation in pain levels, and suspected he had a fake.

“My knee does feel more free and it’s comfortable though whether it’s the support, or the magnets I don’t know who to give credit to,” Marshall said.

He did not have magnets in his support. But Cliff did, and he experienced a significant drop in pain.

Irene did not experience any reduction in pain.

“I think I had the fake one I hope I had the fake one,” she said.

She did. Daphne was equally disappointed, with no real reduction in pain. Her brace was also a fake.

“It didn’t make any difference,” Daphne said.

Gilda had the magnets and experienced a big reduction in pain levels.

Mr Wick said the TT test was proof magnets seem to make life a little easier for people in pain.

“We work with chronic pain sufferers and the results have been fantastic over the years,” Mr Wicks said.

Dick Wicks’ products are available at www.dickwicks.com.au or phone 1800 662 000.

The Australian Skeptics: www.skeptics.com.au

Australian reflex sympathetic dystrophy syndrome support group: www.ozrsd.org/web/main.htm

Aware-RSD: www.aware-rsd.org

Disclaimer
The information on seven.com.au/todaytonight is made available for information purposes only, and is not intended to be a substitute for professional medical advice, diagnosis, or treatment. Also, the accuracy, currency and completeness of the information is not guaranteed. The Seven Network does not accept any liability for any injury, loss or damage incurred by use of or reliance on the information.

Abdul says odd behavior not drug-related (from USA Today)


paula-abdul
Originally uploaded by rsdscrpsnews.

By César G. Soriano, USA TODAY
American Idol judge Paula Abdul, responding to questions about her erratic behavior on the hit Fox talent show, says she is suffering from a rare neurological disorder and does not have a drug problem.

“Drugs? I’m not addicted to pills of any kind,” Abdul says in the new issue of People magazine (on newsstands Friday).

Abdul, 42, says she has been battling chronic pain that began after a cheerleading accident at age 17 left her with an injured disc in her neck.

The pain got worse after “a couple of car accidents” in the 1980s and a plane crash in 1992, which led to seizures, bulimia and depression, she says. In search of relief, Abdul had 12 operations and used medications she says left her so “loopy” that she chose to live with the pain.

The turning point came last summer, she says, when she began taking Enbrel, an anti-inflammatory drug normally used to treat rheumatoid arthritis and psoriasis.

A spokeswoman for the drug says it does not have psychological side effects.

In November, Abdul says, she was diagnosed with Reflex Sympathetic Dystrophy (aka Complex Regional Pain syndrome), a chronic neurological disorder that causes severe, debilitating pain. It affects 500,000 to 1 million Americans and is more prevalent in women, according to the Reflex Sympathetic Dystrophy Syndrome Association.

The disease is treatable and usually involves physical and sometimes psychological therapy, says Norman Harden, director of the Center for Pain Studies at the Rehabilitation Institute of Chicago. “People can do well and get on with their lives.”

Abdul says she kept her condition secret from her fellow Idol judges but decided to go public after reading message boards about her behavior on and off the set.

“Between getting up and dancing at the drop of a hat, and her refusal to let Simon (Cowell) finish a sentence … she’s become both distracting and annoying,” says Idol fan Steve Walker of Memphis.

Abdul says she is now pain-free, and her happy-go-lucky demeanor is proof of how good she feels.

“If people only knew what I’ve gone through with pain and pills. I’m dancing for joy at the fact that not even a year ago I was in so much pain I could barely get up,” she tells People.

Last month, she was sentenced to two years’ probation after pleading no contest to a misdemeanor count of hit-and-run driving.

Idol producers and her castmates declined to comment on Wednesday.

“It was getting ugly with the lies people were saying,” Abdul tells Entertainment Tonight in an interview airing today and Friday. “It was time to set the record straight. I want America to know that I have never been addicted to anything, no chemical dependency, nothing for recreational purposes.”

Medtronic Receives FDA Approval for Rechargeable Neurostimulation System

MINNEAPOLIS
(BUSINESS WIRE)
April 12, 2005

Device with Most Powerful, Longest Lasting Battery Now Available to Help Patients with Difficult-to-Treat Chronic Pain

Medtronic, Inc. (NYSE:MDT) today announced that its Restore(TM) Rechargeable Neurostimulation System is now available, following approval granted by the United States Food and Drug Administration (FDA). The Restore System offers the most powerful and longest-lasting rechargeable battery available. It is a new treatment option for people suffering from complex, difficult-to-treat chronic pain, and those requiring high-power stimulation for pain relief.

The Restore battery can last for up to nine years, exceeding that of any other rechargeable spinal cord stimulator on the market. And like a cell phone battery, the Restore System’s battery can be recharged. When battery levels are low, an alarm sounds and an icon appears on the system’s programmer screen, alerting patients of the need to recharge. Recharging can occur without interrupting delivery of the stimulation.

The System’s high-power battery offers Restore patients the convenience and flexibility of the longest time between recharge periods. Patients will typically need to recharge the Restore battery approximately once per month, whereas other devices on the market may require recharges as frequently as once per week.

Another feature of the Restore System is the hand-held programmer that is similar to a remote control. Patients use it to manually choose from an unmatched number of program options – as set by a physician – to meet his or her individual treatment needs.

The launch of Restore marks a significant step forward in the treatment of chronic pain, according to David Caraway, MD, PhD, medical director of the Tri-State Regional Pain Management Service at St. Mary’s Hospital, Huntington, WV. “Medtronic’s newest spinal cord stimulator should help us treat some of the most complex forms of chronic pain better than we have in the past,” says Caraway. “This is welcome news for patients who haven’t had much success with other chronic pain treatments. By delivering a high level of sustainable power, this new rechargeable device will provide relief to many who suffer greatly and may be functionally impaired by pain. With this device, the patient controls the pain – the pain doesn’t control the patient.”

About the Restore(TM) Rechargeable Neurostimulation System

The Restore System is indicated to manage chronic, difficult-to-treat pain in the trunk and/or multiple limbs that is associated with failed back syndrome, post laminectomy pain, unsuccessful disc surgery or degenerative disc disease, among others.

The device, about the size of a stopwatch, is implanted under the skin. Up to two leads – with eight electrodes each – deliver electrical pulses to the spine. Based on individual patient need, doctors can customize the positioning of the electrodes to deliver stimulation directly to the target area on the spine, and in doing so, block pain signals from reaching the brain. “Restore is the most advanced neurostimulation system on the market today,” said Jon Tremmel, president, Medtronic Neurological. “With the Restore System, Medtronic now provides the broadest range of chronic pain management therapies and devices to best address patient needs.”

For more information on the Restore(TM) Rechargeable Neurostimulation System, visit www.medtronicrestore.com, or call 800-510-6735.

About Chronic Pain

Defined as pain that persists or recurs for more than six months, chronic pain can be caused by a variety of injuries and diseases, and most commonly affects the lower back and legs. Left untreated or under-treated, chronic pain can destroy a person’s life. Beyond the physical disability that often results, it can lead to difficulty holding a job, low self-esteem, strained relationships, depression, and suicide.

It is estimated that chronic pain affects approximately 25 percent of the U.S. population. Chronic pain accounts for an estimated $100 billion per year in medical costs, including 515 million lost workdays and 40 million physician visits.

For more information on chronic pain, visit the American Pain Foundation web site at www.painfoundation.org.

About Medtronic Neurological Therapies

The Restore System is the latest advancement to join the Medtronic portfolio of neurostimulation and pump pain therapies. Along with Restore, a number of Medtronic pain therapies are currently available to clinicians specializing in the management and treatment of chronic pain.

Medtronic’s neurostimulation therapy already has achieved worldwide medical acceptance for the management of chronic, intractable, unilateral or bilateral pain associated with many pain-related conditions. Patients can obtain information on Medtronic neurostimulation at www.medtronicpaintherapies.com.

About Medtronic, Inc.

Medtronic, Inc., headquartered in Minneapolis, is the world’s leading medical technology company, providing lifelong solutions for people with chronic disease.

Any forward-looking statements are subject to risks and uncertainties such as those described in Medtronic’s Annual Report on Form 10-K for the year ended April 30, 2004. Actual results may differ materially from anticipated results.