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In Remembrance
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Join Date: Nov 2006
Location: SE Kansas.
Posts: 374
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In Remembrance
Join Date: Nov 2006
Location: SE Kansas.
Posts: 374
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Hi again, carose,
Looking back over my last post, I realilze that I said a lot about what I'm going to say, but never got around to explaining exactly why I disagree with this author.
I have to begin by saying that doctors don't research RSD; they are busy treating patients with a wide variety of disorders, and they don't have the time to thoroughly investigate all of them. Even pain docs who routinely treat RSD patients don't see enough of us to justify hundreds of hours of research. They relied on PubMed and Medscape when they first learned of this disease.
This particular doctor probably learned about RSD before 1999. Until about then, the literature was full of talk about the SNS. That is about the same time I began researching this disease, and I found the kind of stuff he wrote.
He wrote, RSD comes from an injury that recruits the autonomic nervous system, the subcortical apparatus dedicated to the control of blood flow , into misbehavior . From 1916 until the late 1940s, everyone in RSD agreed that damage to sympathetic nerves caused them to abnormally constrict arteries until blood-flow was so reduced that the limb became cyanotic because the arteries themselves were so oxygen-starved that they were leeching the O2 out of the blood before it reached the cells.
Then someone invented a way to measure arterial blood-flow, and someone else measured it in RSD patients, where they found that the SNS is not constricting arterial blood-flow at all. Something is causing our cyanosis, but it isn't the SNS and it doesn't involve the arteries.
From the 1950s to the late 1990s, most RSD experts stopped talking about cyanosis, because they couldn't explain it anymore, but they obviously clung to the belief that the SNS must somehow be involved, so they talked about the SNS being somehow "recruited" by another sort of nerve damage.
Translated, that means: "We're sure that someone, someday, will find out what the SNS is doing wrong. Then we can stop pretending that cyanosis doesn't exist in RSD".
The reason I think he learned about RSD before 1999, is that in 1995, a consensus of the International Association for the Study of Pain (IASP) rejected the SNS hypothesis. In order to leave no doubt about it, they renamed the disease CRPS, which has no sympathetic connotation at all,
It took a while, however, for CRPS to replace RSD, and for the "experts" to come up with a new neurological explanation for this disease. It wasn't until 2002 before someone came up with a new hypothesis, so the sympathetic view still pretty much dominated the literature for another few years.
Had he begun reading about this disease after 2002, he would probably have explained it in terms of central sensitization (CS). Today, just about all of the RSD "experts" have joined the CS parade.
So, those of you whose docs still talk about the SNS just aren't keeping up with the times. They still believe the nonsense that was taught until shortly after the IASP completely rejected it. Those docs probably haven't read anything about the disease since before 2000.
Lest anyone think that I agree with the CS view: It only tries to explain pain in RSD; just like the "experts" from the 1950s until the1990s pretended cyanosis doesn't exist. the "experts" today pretend that osteoporosis; hair and nail growth; skin lesions, and, of course; cyanosis, don't exist. Spinal cord dysfunction can't explain these things.
On the bright side: I rarely agree with RSD "experts", but we all seem to agree that "autonomic dysfunction" as the cause of RSD is balderdash...Vic
PS: I started using a larger font because my vision is failing too.
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Last edited by Vicc; 02-17-2008 at 08:26 AM.
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