Hi Betsy, no, as IHH spotted, it does not mean that at all.

The piece says exactly what it means, it's talking about how RSD presents itself "at the onset", meaning right off the bat, from the very start. You'll see more in the article itself if you care to look - as I said, I included just examples, extracts.

Many things have changed in just a few years regarding RSD literature, we're trying to keep up to date.

I posted it precisely to make that point, not everyone begins with a hot stage. Since we're discussing "cold RSD" here, some hard reference seemed helpful - (but only if you read it!).

Anyway, here's a link (from the 3rd edition Clinical Guidelines) about the old concept of stages that I think you were talking about:
http://www.guidelines.gov/summary/su...2&string=treat
Reflex sympathetic dystrophy/complex regional pain syndrome clinical practice guidelines - third edition.
Stages of RSD/CRPS:

"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. The following stages are presented in these guidelines merely for historical significance."

If anyone needs further info on the old staging descriptions, they're here:
http://www.ninds.nih.gov/disorders/r..._dystrophy.htm

BTW, While that "staging" concept may not be used any more, my RSD *has* progressed, from hot and swollen at first, then cooling. Not cold yet, though and more greyish, dry and withered. I think RSD does progress, but they superceded the "staging" because everyone is so different and we don't fall into nice, neat categories.

all the best