There are other treatments available outside of the United States that I will go into with you later.
CRPS is associated with dysregulation of the central nervous system[5] and autonomic nervous system resulting in multiple functional loss, impairment and disability. 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. With the vast majority of patients diagnosed with CRPS being of this type, most of the literature thus refers to type I.
- Type II, formerly known as causalgia, has evidence of obvious nerve damage. Type II CRPS tends towards the more painful and difficult to control aspects of CRPS; type II scores 42 out of 50 on the McGill pain scale [6] (however there is seemingly little or no data pertaining to type I specifically here). In Type II the "cause" of the syndrome is the known or obvious nerve injury, although the cause of the mechanisms of CRPS Type II are as unknown as the mechanisms of Type I. In type II it seems less likely that pain from the site of the original obvious nerve trauma will spread to other areas of the body for no apparent reason, as in type I; however established type II sufferers may be more prone to developing new areas of type II CRPS. For instance, a person with an established type II area of pain (for clarity, say somewhere in the head or face) is likely more prone to develop a new area of type II with, for instance, a herniated disc causing sciatica and low back pain. Timely corrective surgery for such a scenario, as well as proper pain control during the whole episode, may well be the difference between adding a new area of severe perpetual pain for a type II causalgia patient, or limiting the suffering to the original area. One could imagine how pain control could become difficult for such a patient when a new source of bad pain is introduced into the mix, especially temporary, resolvable pain--when the patient is already on pain meds to deal with the original type II pain.
Evidence suggests that CRPS has both physical and psychological factors. CRPS is said to cause physiological problems (rather than physiological problems causing CRPS); whilst "research does not reveal support for specific personality or psychopathology predictors of the condition" there are psychosocial factors to CRPS (such as reduced quality of life and impaired occupational function) and psychological problems (which include increased depression and anxiety).[10] Unsurprisingly, there is overwhelming evidence of limbic system involvement.[11] Sadly this very poor quality of life for some has led to high rates of depression and suicide among sufferers, which has motivated appeals for greater understanding. The AFPS leaflet on CRPS and prevention of suicide is available online here.[12]
Daily vitamin C has been shown to reduce the chance for the occurrence of CRPS after an injury, leading to calls for greater awareness, especially in the emergency room setting.[13] In two placebo-controlled randomized clinical trials Zollinger et al. showed that patients who took 500 mg of vitamin C daily after a wrist fracture were less likely to incur the problem.[14] The cause of CRPS is currently unknown. Precipitating factors include injury and surgery, although there are documented cases that have no demonstrable injury to the original site.
With the growing body of evidence persuasively indicating the progressive and systemic implications of chronic CRPS,[15] there is concern that these patients may be erroneously also diagnosed with fibromyalgia. Fibromyalgia has a MPQ score of 35.7/50,[16] whereas CRPS averages a 42/50 MPQ. Chronic CRPS patients would react to the pressure points of the brachial plexus, the intercostobrachial (ICB) nerve and concomitant L5-S1, injury.[17] Similarly, when patients with multiple sclerosis were tested for CRPS, incidents of the disease was more than 50 times higher than in the average population.[18] This has led to calls for research and more understanding of chronic CRPS symptoms which may include muscle twitching and tremors, wobbliness, falling and visionary disturbances.[9]
As Complex Regional Pain syndrome is a systemic disease, any organ could potentially be affected.[19] There are many internal complications which are frequently not acknowledged, "CRPS affects the systems of: cognition; constitutional, cardiac, and respiratory complications; systemic autonomic dysregulation; neurogenic edema; musculoskeletal, endo-crine and dermatological manifestations; as well as urological and gastrointestinal function".[20
CRPS has many affects that can arise. As the patient you need to take the lead in your treatment. Don't be afraid to ask questions, if you don't understand an answer from a medical professional then ask them to explain it to you again, research your options and don't feel like you have to do exactly what has been suggested. This is your body, your life and the road that you are having to go down. Take the time to get educated on the condition, and know that you are not alone!
If you have specific questions or would like to communicate with me please feel free to either leave your comments on the blog or you can email me at: rsd.crpsforum@gmail.com.
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