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Senior Member
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Join Date: Sep 2006
Location: California
Posts: 1,239
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Senior Member
Join Date: Sep 2006
Location: California
Posts: 1,239
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Ada -
Sorry to getting in late here. No you are not alone in this. As set forth in The Natural History of Complex Regional Pain Syndrome, Schwartzman RJ, Erwin KL, Alexander GM, Clin J Pain 2009; 25:273-280, full text at http://www.rsds.org/2/library/articl...lexanderGM.pdf :
More than half of the patients in this study reported cognitive and memory difficulties. Deficits in information processing48 and short-term memory49 have been reported in patients afflicted with chronic pain. Chronic pain has also been shown to impair working memory50 and decision-making.51 The disruption of cognitive performance in chronic pain patients could result from a number of factors such as pain medications,50 stress,52 the engagement of the prefrontal cortex by chronic pain,51 and the fact that pain may act as a distractor resulting in impaired working memory.50 Pain alleviation in CRPS treated by ketamine coma has been shown to result in a significant improvement in attention and information processing.53 The quality of life and work history component of the questionnaire demonstrate the great social and employment disruption caused by refractory CRPS. [Emphasis added.]
Footnotes
48. Grigsby J, Rosenberg NL, Busenbark D. Chronic pain is associated with deficits in information processing. Percept Mot Skills. 1995;81:403–410.
49. Ling J, Campbell C, Heffernan TM, et al. Short-term prospective memory deficits in chronic back pain patients. Psychosom Med. 2007;69:144–148.
50. D_i_c_k* BD, Rashiq S. Disruption of attention and working memory traces in individuals with chronic pain. Anesth Analg. 2007;104:1223–1229.
51. Apkarian AV, Sosa Y, Krauss BR, et al. Chronic pain patients are impaired on an emotional decision-making task. Pain. 2004;108:129–136.
52. Patil PG, Apfelbaum JL, Zacny JP. Effects of a cold-water stressor on psychomotor and cognitive functioning in humans. Physiol Behav. 1995;58:1281–1286.
53. Koffler SP, Hampstead BM, Irani F, et al. The neurocognitive effects of 5 day anesthetic ketamine for the treatment of refractory complex regional pain syndrome. Arch Clin Neuropsychol. 2007;22:719–729.
*Don't you just love the Nannieware?
And as to my personal and ongoing experience, which may not be that different from your own, please look over the following excerpt from a post I just put up in debbiehub's thread http://neurotalk.psychcentral.com/thread111163.html:
I used a PubMed function looking for "related" articles, and after going through over a hundred listings, found nothing on the effect of CRPS on organs, I did find, among other articles dealing with blood flow in the extremities, one I didn't recall reading before, it is a deep and amazing article that should be required reading for anyone in the area, Pathologic alterations of cutaneous innervation and vasculature in affected limbs from patients with complex regional pain syndrome, Albrecht PH, Hines S, Eisenberg E, et al, Pain 2006;120:244-266 full text at http://www.rsds.org/2/library/articl..._PAIN%2006.pdf:
Abstract
Complex regional pain syndromes (CRPS, type I and type II) are devastating conditions that can occur following soft tissue (CRPS type I) or nerve (CRPS type II) injury. CRPS type I, also known as reflex sympathetic dystrophy, presents in patients lacking a well-defined nerve lesion, and has been questioned as to whether or not it is a true neuropathic condition with an organic basis. As described here, glabrous and hairy skin samples from the amputated upper and lower extremity from two CRPS type I diagnosed patients were processed for double-label immunofluorescence using a battery of antibodies directed against neural-related proteins and mediators of nociceptive sensory function. In CRPS affected skin, several neuropathologic alterations were detected, including: (1) the presence of numerous abnormal thin caliber NF-positive/MBP-negative axons innervating hair follicles; (2) a decrease in epidermal, sweat gland, and vascular innervation; (3) a loss of CGRP expression on remaining innervation to vasculature and sweat glands; (4) an inappropriate expression of NPY on innervation to superficial arterioles and sweat glands; and (5) a loss of vascular endothelial integrity and extraordinary vascular hypertrophy. The results are evidence of widespread cutaneous neuropathologic changes. Importantly, in these CRPS type I patients, the myriad of clinical symptoms observed had detectable neuropathologic correlates.
PMID: 16427199 [PubMed - indexed for MEDLINE] http://www.ncbi.nlm.nih.gov/sites/entrez
Not coincidently, I found the last article when I searched PubMed for "arteriole CRPS" and it was the ONLY article that came up. And the search occurred to me a couple of weeks after my neurologist advised me that if we were going to look for an organic cause of my striking loss of organizational abilities, spatial reasoning and the ability to calendar simple things in my head (all under the heading of executory functioning), on the one hand, and on significant and increasing memory issues, from not unusual word recall problems, to having to sneak a look at my check book to avoid transposing the 5 digits in my street address and having no memory of something I had read the day before, to literally the ability at times to form new memories, on the other hand. What he said was, if I wanted to focus specifically on he effect of CRPS induced vasoconstriction in the brain, we would have to look at the arterioles, the smallest blood vessel with any muscle tissue that could respond to nerve signaling. And that would require a brain CT angiogram. [Emphasis added.]
However, with a lot of nuclear studies and the like under my belt in the last few years, including a coronary CT angiogram, my internist is advising me that this is something I may want to give some reflection to jumping into. That said, if you are seriously concerned about the risk of specific organ damage secondary to CRPS, I would suggest you consider discussing with your physicians a CT angiogram of said organ(s), with specific emphasis on the arterioles; I would also show them Pathologic alterations of cutaneous innervation and vasculature in affected limbs from patients with complex regional pain syndrome, Albrecht PH, Hines S, Eisenberg E, et al. That's about what I know. I'm sorry you are going through this, but it appears to be a widespread aspect of the disease process that doesn't get the attention it deserves.
Mike
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