Monthly Archives: July 2005

Walk Two Miles in My Shoes
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Walk Two Miles in My Shoes for R.D.S., a benefit walk for reflex sympathetic dystrophy. McDade Park, off Keyser Avenue, Scranton. Oct. 2 with registration noon to 1 p.m. followed by the walk. Information: 876-4034.

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RSDSA: Sports Injuries Linked to Chronic Pain Syndrome
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RSDSA: Sports Injuries Linked to Chronic Pain Syndrome

Wednesday July 27, 11:42 am ET

Injuries and the surgeries to treat them may lead to onset of disabling syndrome

MILFORD, Conn., July 27 /PRNewswire/ — The link between sports injuries — and the surgeries that treat them — and the risk of developing Complex Regional Pain Syndrome (CPRS), also known as Reflex Sympathetic Dystrophy Syndrome (RSD), should be understood by every athletic trainer, coach, and athlete, as well as the medical professionals who treat them. Current research suggests that a percentage of orthopedic surgeries result in the development of CRPS/RSD and, for people who are at risk for CRPS/RSD, using preemptive regional anesthesia could prevent a recurrence.

“It is imperative that everyone associated with sports understand the signs, symptoms, and potential risks of CRPS/RSD, especially before recommending surgery. If you suspect that one of the athletes you are treating has already developed it, make sure they are directed to the appropriate treatment. Awareness is our best defense in the war against the disability of pain caused by CRPS/RSD,” says Jim Broatch, executive director, The Reflex Sympathetic Dystrophy Syndrome Association (RSDSA).

RSDSA has just published a brochure, CRPS/RSD and Sports Injuries: Prevention is the Name of the Game, to educate those involved in athletics about the potential risk of developing CRPS/RSD, a neurological syndrome characterized by severe and relentless pain associated with autonomic changes, such as abnormal skin color and temperature, sweating, or swelling in the affected part. Left untreated, the syndrome can be disabling. Although the syndrome can develop after any trauma, researchers are finding that CRPS/RSD has developed following common orthopedic surgical procedures, such as arthroscopic knee surgery, wrist fractures, total knee arthroplasty, ankle fractures, carpal tunnel surgery, and Dupuytren’s surgery.

The number of cases of CRPS/RSD could be reduced by using preemptive regional anesthesia, according to research conducted by Scott Reuben, MD, Professor of Anesthesiology and Pain Medicine, Tufts University School of Medicine. His studies suggest that preemptive regional anesthesia, such as a stellate ganglion block, intravenous regional block, and epidural block, may help decrease the recurrence of post operative CRPS/RSD.

Free copies of the brochure are available from RSDSA by calling toll-free 877-662-7737 or sending an e-mail to

RSDSA is a national not-for-profit organization, headquartered in Milford, Connecticut, that promotes greater public and professional awareness of CRPS/RSD. For more information, please visit

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Skandia Squad chosen

yachting world – ybw
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Skandia has chosen the five crews who will sail as the Skandia Squad at this year’s Skandia Cowes Week (30 July – 6 August) and three of them are all-female teams.

This year’s Squad involves all five crews competing against each other in the Sonar class.

Each crew represents a different region in the UK: South, Midlands, West, East and North. The crews were selected following a nationwide competition to find people who would like to race at Skandia Cowes Week but either do not have the resources or experience to do so.

Tim Sewell, Skandia’s sponsorship manager said: “We wanted to open up the Squad to people who would love to compete at this major event but don’t feel they can because they either don’t have a boat or don’t think they have got enough sailing experience to take on the challenge. We’ve had a terrific response – particularly from women – and it was very difficult to make the final choices. However, the final line-up promises to provide some great racing.”

Each Skandia Squad crew comprises four people: three competition winners and one qualified instructor from the Cowes-based United Kingdom Sailing Academy (UKSA). The UKSA are also providing food and accommodation for all the crews for the entire week of racing.

As in previous years, each crew will sail under one of Skandia’s core values: Courage; Contribution; Commitment; Creativity and Passion.

The five teams are as follows

* MIDLANDS: Contribution. Ruth Marrison (19), who has been deaf since birth; Rosemary Ellis (38) and Karen Glisson (39) – all from Oxford

* NORTH: Commitment Kirsten Pollock (25) from Halifax, West Yorkshire, who has Reflex Sympathetic Dystrophy/Complex Regional Pain Syndrome as a result of slipping on the stairs aged 21; Lucy Hodges (29) from Rochford, Essex is registered blind; Megan Pascoe (18) from Ardingly, West Sussex is Hemiplegic down one side of her body.

* WEST: Passion Nikki Sitwell (30); Jane Caldwell (35) and Emma Reynolds (26) – all living in Bristol (Emma is originally from Australia)

* EAST: Creativity Alan Ambridge (58) from Little Clacton, Essex; David Potter (53) from Orpington, Kent and Geoffrey Deverill (53) from Sutton, Surrey

* SOUTH: Courage Nigel Gallimore (41) from Bournemouth; David Donovan (31) from Basingstoke and Shirley Roberts (49) from the Isle of Wight. All were winners in a competition run by BBC South Today to find people who have demonstrated courage

In addition to being provided with use of a boat, accommodation and expert instruction by UKSA, each crew member receives Henri Lloyd clothing; Wightlink travel to and from the Isle of Wight; Mumm Champagne and access to the Skandia marquee.

Press report/Yachting World, 18 July 2005

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Volunteers needed for complex regional pain syndrome study

Washington University in St. Louis
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Volunteers needed for complex regional pain syndrome study

By Jim Dryden

July 22, 2005 — Researchers at Washington University School of Medicine in St. Louis are seeking volunteers to test an investigational drug for the treatment of complex regional pain syndrome (CRPS). The syndrome is a chronic nerve disorder that often affects the arms and legs after injuries such as trauma or infection.

Washington University pain researcher Anthony H. Guarino, M.D., instructor of anesthesiology, is joining scientists from around the country to test the drug called CC-5013.

“These patients can have very severe pain,” Guarino says. “The pain often lingers, and although available drugs can help, some evidence suggests that CC-5013 might have more success regulating this difficult-to-treat pain.”

The drug also is being tested for treatment of various cancers. It is thought to act by regulating certain chemicals produced in the body that contribute to pain and inflammation following injury.

To be eligible for the study, volunteers must be at least 18 years old and have had pain from CRPS for at least one year. Those who qualify will receive a daily dose of either the study medication or an inactive placebo for 12 weeks. After 12 weeks, all study subjects will receive the drug. If the drug is helping to control pain from CRPS, subjects will be able to remain on the drug and in the study for about a year.

Volunteers will receive free study-related physical exams, laboratory tests and investigational study medication. They also will be compensated for time and travel. The study requires visits to the Washington University Pain Management Center, located at 969 N. Mason Rd. Patients will have blood samples drawn and receive electrocardiograms at Barnes-Jewish Hospital West County.

For more information, call study coordinator Martha Cornell at (314) 996-8887.

Washington University School of Medicine’s full-time and volunteer faculty physicians also are the medical staff of Barnes-Jewish and St. Louis Children’s hospitals. The School of Medicine is one of the leading medical research, teaching and patient care institutions in the nation, currently ranked third in the nation by U.S. News & World Report. Through its affiliations with Barnes-Jewish and St. Louis Children’s hospitals, the School of Medicine is linked to BJC HealthCare

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Have you ever heard of RSDS???

Village Soup
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Many of you may be saying what the heck is that??? That is what I said when my surgeon told me I had it from my knee surgery healing wrong. I have met a man with full blown RSDS through his whole body, he live’s very near me. We are not sure what is worse, the pain and agony, or trying to explaine to people and doctors what it is and the strange looks we get.

I encourage any one of you to read this as it can happen by a simple bee sting, a sprain,a bruise and many live in pain never knowing what it is.

I can say my RSDS is in remission and has been for aver a year now. I do still suffer from the nerve damage in my whole left leg, also my knee ache’s 24/7 and I will be soon having a full leg brace on my left leg to try and get the muscle back over my knee cap as well as make my muscles stronger, if that don’t work it’s surgery again which could flare up the RSDS again. I have to be very careful as to what I do, a fall can flare it back up however I have had a few fall’s from my knee giving out and thank god no flare up.

RSDS also effect’s your memory, that is why my spelling is not so good, it’s made me a bit dyslexic and have to work very hard to re-read everything i write.

Here are some good fact’s of RSDS

What is RSD?

Reflex Sympathetic Dystrophy Syndrome (RSD) – also known as Complex Regional Pain Syndrome (CRPS) – is a chronic neurological syndrome characterized by:

severe burning pain

pathological changes in bone and skin

excessive sweating

tissue swelling

extreme sensitivity to touch

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 (allodynia). 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 (hyperpathia). 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 (myofascial pain syndrome). There may be spontaneous sharp jabs of pain in the affected region that seem to come from nowhere (paroxysmal dysesthesias and lancinating pains).

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. 8 Although extremely rare, some patients have required amputation of an extremity due to life-threatening reoccurring infections of the skin. Abnormal sympathetic (vasomotor changes) 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 (vasomotor changes). The skin may show increased sweating (sudomotor changes) or increased chilling of the skin with goose flesh (pilomotor changes). 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.

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.

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. 6 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).

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: 9

A “continuity type” of spread where the symptoms spread upward from the initial site, e.g. from the hand to the shoulder.

A “mirror-image type” where the spread was to the opposite limb.

An “independent type” where symptoms spread to a separate, distant region of the body. This type of spread may be related to a second trauma

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.

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. 10

RSD/CRPS may present in three stages:

The staging of RSD/CRPS is a concept that is dying. The course of the disease seems to be so unpredictable between various patients that staging is not helpful in the treatment of RSD/CRPS. Not all of the clinical features listed below for the various stages of RSD/CRPS may be present. The speed of progression varies greatly in different individuals. Stage I and II symptoms begin to appear within a year. Some patients do not progress to Stage III. Furthermore, some of the early symptoms (Stage I and II) may fade as the disease progresses to Stage III.


Onset of severe, pain limited to the site of injury

Increased sensitivity of skin to touch and light pressure (hyperasthesia).

Localized swelling

Muscle cramps

Stiffness and limited mobility

At onset, skin is usually warm, red and dry and then it may change to a blue (cyanotic) in appearance and become cold and sweaty.

Increased sweating (hyperhydrosis).

In mild cases this stage lasts a few weeks, then subsides spontaneously or responds rapidly to treatment


Pain becomes even more severe and more diffuse

Swelling tends to spread and it may change from a soft to hard (brawny) type

Hair may become coarse then scant, nails may grow faster then grow slower and become brittle, cracked and heavily grooved

Spotty wasting of bone (osteoporosis) occurs early but may become severe and diffuse

Muscle wasting begins


Marked wasting of tissue (atrophic) eventually become irreversible

For many patients the pain becomes intractable and may involve the entire limb.

A small percentage of patients have developed generalized RSD affecting the entire body. 5

Figure 1

Activation of the sympathetic nervous system following an injury is part of a fright-flight response to an emergency situation. This response is very important for survival. For example, firing of sympathetic nerves causes blood vessels in the skin to contract, forcing blood deep into muscle and enabling the victim to use his muscle to get up after an acute injury and escape from further danger. Also the decreased supply of blood to the skin reduces blood loss through superficial injuries that may occur on the surface of the body. Ordinarily, the sympathetic nervous system shuts down within minutes to hours after an injury. For reasons we do not understand, individuals who go on to develop RSD/CRPS, the sympathetic nervous system appears to assume an abnormal function. Theoretically, this sympathetic activity at the site of injury could cause an inflammatory response causing the blood vessels to spasm leading to more swelling and pain. (See B, C, and D in Figure 1) The events could lead to more pain which triggers another response, establishing a vicious cycle of pain.

Laboratory Diagnostic Aids:

There is no laboratory test that can stand alone as proof of RSD/CRPS. However, there are a couple of tests (thermogram and bone scan) which can be useful in providing evidence for RSD/CRPS.

Thermogram – A thermogram is a noninvasive means of measuring heat emission from the body surface using a special infrared video camera. It is one of the most widely used tests in suspected cases of RSD/CRPS. As noted, detecting an abnormal change in skin temperature in RSD/CRPS depends on many factors. A normal thermogram does not necessarily mean the patient does not have RSD/CRPS. An abnormal thermogram may be helpful before a jury in a court of law when there are minimal objective findings for RSD/CRPS documented in the medical record. Furthermore, certain patterns of abnormal heat emission from the body (e.g. circumferential versus dermatomal changes) are more indicative of the existence of RSD/CRPS than others. The thermogram should be performed at a reputable medical facility. The quality of the test may vary among providers.

Three phase radionuclide bone scanning – the role of the 3 phase bone scan in the diagnosis of RSD/CRPS has been debated and is controversial.

Sympathetic blocks – See below under “sympathetic blocks”.

X-rays, EMG, Nerve Conduction Studies, CAT scan and MRI studies – All of these tests may be normal in RSD/CRPS. These studies may help to identify other possible causes of pain; for example, RSD/CRPS plus a carpal tunnel syndrome.

Submitted by: Sheryl Rackliff

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Arizona Daily Star: Community calendar
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RSD and Chronic Pain Information Expo – Masonic Lodge, 3959 E. Mabel St., near North Alvernon Way and East Speedway. Learn more services, treatments, products and support groups that are available for assistance with pain. For more information, contact or call. Noon-4 p.m. Free. 579-5511.

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Chronic Pain Information Expo

KOLD News 13
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From the KOLD News 13 Newsroom
Posted: 7/15/05

People with chronic pain are often looking for information to help them, and on Saturday, June 16, there will be a pain expo in Tucson, designed for them.

The RSD Care and Share Support Group of Tucson is hosting the Chronic Pain Information Expo, from noon until four at the Masonic Lodge at 3959 E Mabel.

RSD stands for reflex sympathetic dystrophy, an often misdiagnosed, painful condition that affects millions of Americans.

The Expo will provide those affected by chronic pain with information on services, treatments, products and support groups that are available to them.

The RSD support group says exhibitors include the Arthritis Foundation, Tucson Touch Therapies, Advanced Neuromodulation Systems, Advanced Bionics, and area support groups for Fibromyalgia, RSD, and Endometriosis.

The group recommends the American Chronic Pain Association web site if you’d like more information on chronic pain.

The expo is free, and open to the public.

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