Question about RSD diagnosis
 

Hey you guys, I'm new to this crowd. I had my first visit with a pain specialist a few weeks ago. I was sent to him after a botched knee surgery and suffering a DVT from the surgery, which led to Post Thrpmbotic Syndrome. Upon examining me initially, he noticed hair loss , loss of feeling, and major atrophy in the affected foot and leg. He then told me he suspects RSD, and then schedued me for an nerve tes, an EMG I think, for this week.

Okay, so after reading up on RSD and that there is no test to diagnose it, and that the doctor can only diagnose it through physical examination/symptoms experienced, I can't help but wonder what the test this week is for. But primarily, I've been circling around one question in particular: If my doctor suspects RSD, does that more or less mean that I do in fact have it, more or less?

Thanks in advance.

They may be doing the test to exclude out any other possible cause, like a nerve entrapement or other nerve issue that the emg could detect.

You are correct that rsd is a clinical diagnosis, but it's usually only made when all other possible causes have been excluded, so that's likely why your doctor is ordering the test. There is currently no test that can show positivly that one has rsd.

If you do have something like a nerve entrapement then it's usually something that can be fixed with surgery :) so that would be a good thing. If it does turn out that rsd is your diagnosis, aggressive treatment is neccesary to try to put it into remission. The odds are the best when it's treated in the first 6 months to year of injury, and physical therapy and keeping moving even though it hurts is really important to avoid the permanent damage that can occur with rsd. It SUCKS! And it HURTS. You've got to learn how to push yourself, but not hurt yourself too much.

Someone told me life with rsd is like living on the edge of a sharp knife. You've got to balance yourself - do to little excersize and you'll hurt yourself, do too much and you'll hurt yourself, and everyones knife has a different blade. You've got to figure out how sharp your blade is and figure out how to balance on it . . . And your blade can change each day. It's tough, so you've got to be strong, but you will find that you are a much stronger person then you may have thought you were.

This place is a wonderful place to come for information and support, or a place to vent your frustrations, get advice, or just find some people who can understand what you're going through. It can really be an invauluable resource when you have a question or just need someone to talk to that knows what it's like to live with rsd.

hi
 

how is an emg done? I've heard that they stick you with needles and it is very painful. I need to get one as well...is this true?:eek:

Well, an EMG certainly isn't up there on my list of favorite things, that's for sure, but I've had worse too.

As my orthopedist is fond of telling me whenever I ask whether something is going to hurt, "What you're about to feel is nothing compared to all you've already been through!"

I think it partly depends on where you're having the EMG and what your injury is, to be honest. It's a good diagnostic tool though, especially if you're showing some deficiency, so they can track your long-term progress.

Here's hoping it's "just" an entrapment. Please keep us posted. :hug:

Hi,
 

I have had 4 EMG's before I realized they most likely will show nothing on them. They are very painful also. Mine were done to diagnose Thoracic Outlet and every idiotic Neurologist I had thought if it didn't show anything then there wasn't anything. I don't know what kind of Dr. you are seeing but I would hope he won't be like those I've seen. I will say too it can cause a worse flare for sure. The ones I had did. I finally said never again on EMG's.

Hopefully it will not be RSD that you are dealing with. If it turns out to be, learn all you can about it and pick and choose what treatments you will let a Dr. do. Pick and choose your Drs. too, no matter how many you have to see.

Welcome to the forum.

Ada

Since I probably have neuropathy now, an EMG would be a test for that. I discussed it with my PM doc at Clev Clinic last week. She said she never recommends them to anyone with RSD. And, she said it won't affect the outcome. Not like the would find a broken bone or something that can be fixed. EMGs just confirm diagnosis of some things. Maybe it's different if you have RSD from a cut nerve or something.

My wife (who has RSD) has had at least 2 EMG to check for trapped nerves. Why so many is beyond me. She dreaded the tests but she seemed to deal with it ok and said the last one wasn't too bad.

I have read of RSD cases where the patient had all or most of the signs of RSD and in one case in particular the patient was treated for RSD for several years, as I recall, until they found a trapped nerve. They removed or untrapped the nerve which cured all symptoms. This patient used to post on this RSD forum.

Thanks for all the replies, everyone! Holly, the problem with getting it into remission, if in fact I do have RSD, is that the injury happened over a year ago. So I guess I'll know more after tomorrow. Will let ya'll know what happens!

Hi there. The problem is that "small-fiber neuropathy," the hallmark of RSD/CRPS isn't picked up by an EEG/Nerve Conduction Study. See, The diagnostic criteria for small fibre neuropathy: from symptoms to neuropathology, Grazia Devigili, ValeriaTugnoli, Paola Penza et al, Brain (2008), 131, 1912-1925, FULL TEXT @ http://brain.oxfordjournals.org/cgi/...131/7/1912.pdf:

Abstract
Small fibre neuropathy (SFN), a condition dominated by neuropathic pain, is frequently encountered in clinical practise either as prevalent manifestation of more diffuse neuropathy or distinct nosologic entity. Aetiology of SFN includes pre-diabetes status and immune-mediated diseases, though it remains frequently unknown. Due to their physiologic characteristics, small nerve fibres cannot be investigated by routine electrophysiological tests, making the diagnosis particularly difficult. Quantitative sensory testing (QST) to assess the psychophysical thresholds for cold and warm sensations and skin biopsy with quantification of somatic intraepidermal nerve fibres (IENF) have been used to determine the damage to small nerve fibres. Nevertheless, the diagnostic criteria for SFN have not been defined yet and a 'gold standard' for clinical practise and research is not available. We screened 486 patients referred to our institutions and collected 124 patients with sensory neuropathy. Among them, we identified 67 patients with pure SFN using a new diagnostic 'gold standard', based on the presence of at least two abnormal results at clinical, QST and skin biopsy examination. The diagnosis of SFN was achieved by abnormal clinical and skin biopsy findings in 43.3% of patients, abnormal skin biopsy and QST findings in 37.3% of patients, abnormal clinical and QST findings in 11.9% of patients, whereas 7.5% patients had abnormal results at all the examinations. Skin biopsy showed a diagnostic efficiency of 88.4%, clinical examination of 54.6% and QST of 46.9%. Receiver operating characteristic curve analysis confirmed the significantly higher performance of skin biopsy comparing with QST. However, we found a significant inverse correlation between IENF density and both cold and warm thresholds at the leg. Clinical examination revealed pinprick and thermal hypoesthesia in about 50% patients, and signs of peripheral vascular autonomic dysfunction in about 70% of patients. Spontaneous pain dominated the clinical picture in most SFN patients. Neuropathic pain intensity was more severe in patients with SFN than in patients with large or mixed fibre neuropathy, but there was no significant correlation with IENF density. The aetiology of SFN was initially unknown in 41.8% of patients and at 2-year follow-up a potential cause could be determined in 25% of them. Over the same period, 13% of SFN patients showed the involvement of large nerve fibres, whereas in 45.6% of them the clinical picture did not change. Spontaneous remission of neuropathic pain occurred in 10.9% of SFN patients, while it worsened in 30.4% of them.

PMID: 18524793 [PubMed - indexed for MEDLINE] PMCID: PMC2442424

http://www.ncbi.nlm.nih.gov/pubmed/18524793

My neurologist has been mapping the areas in which, in response to a pin prick, I feel pressure but without any sense of sharpness. And quite surprisingly, even though the CRPS has by all appearances been centered in both my feet and ankles, I exhibit the same symmetrical response in all four extremities. There is little if any sense of sharpness "below" my knees and elbows, to the point that I looked down a few years back, and happened to see a hornet grinding its stinger into my wrist, but felt nothing!

And for the classic article tieing CRPS to small-fiber neuropathy, see, Evidence of focal small-fiber axonal degeneration in complex regional pain syndrome-I (reflex sympathetic dystrophy), Oaklander AL, Rissmiller JG, Gelman LB, et al, Pain 2006;120:235-243, FULL TEXT @ http://www.rsds.org/2/library/articl..._pain_2006.pdf.

Mike

EMGs
 

I had 3 EMGs over a year and a half by 3 different Dr.s
2 showed no problem but right after the 2nd. one I had surgery on my right wrist only to find the radial nerve completely severed. 10 months after the 1st. nerve surgery I went to another hand Dr.s complaining about burning pain in my hand and that I could not be in any A/C buildings or vehicles. This is when I had the 3rd. EMG along with a ultra-sound. The EMG gave a false positived reading saying the nerve was in tact, the ultra-sound confirmed the radial nerve never grew and was still severed.

Oww, an EMG! Hope all goes well for you. It should give your doctor a good starting-point for the diagnosis.

I've had two, and I hope to never have another. I take Valium prior to mine. Really seems to help me relax and be more open to the "honest" results of the exam. The meds help me get over my fear of needles and can give a better "true" result. Good luck!

Well I had my appointment today, and well, the EMG test was nothing short of absolute, unadulterated, pure torture. The test began simple enough, with the doctor (not the pain doctor, another specialist that travels from office to office) placing electrodes on my leg and shocking my leg. After the second shock, everything he did was total h-e double hockey sticks...my entire leg felt like it was on fire, every muscle was cramping, and every joint was aching tremendously. That wasn't even the bad part. He then stuck this needle in my shin that burned just like a syringe, and began telling me to move my toes...but I couldn't! They were locked up for some reason, so he flexed them upwards by hand. He then progressed to place these needles in my calf, above and behind my knee, and in my lower back. By the time he was doing my back, I was punching the wall above my head, and when I finally sat up I saw a puddle where my face was...didn't even realize I was shedding so many tears during the test! I guess the point of all this is it was awful, and while it's true that it wasn't worse than some of the other stuff I've suffered through since my injury, like Coumadin therapy, it's certainly something I never want to do again.

So there I am, sitting on the table, writhing in pain from this test, thinking that now I'm going to see my pain doctor...nope! I was there only for the test...but I only had three days of my medicine left, and I needed to talk to him about the hydrocodone not working. I was about to freak out.

Well, what happened next made all the other bad stuff I went through a little better. After explaining my med. situation to the receptionist, she called my doctor (I guess he wasn't there) and told him what I told her, and he switched me from 7.5/500 lortab 3x/day to 7.5/325 oxycodone 4x/day...without even seeing me! I'm guessing from that gesture that 1)he's a compassionate human being, and 2) he trusts me. I can't begin to describe how much better I feel about my relationship with him. At least I have one doctor whom I feel really understands me and what I'm going through.

Oh, he didn't see any nerve issues or entrapments...oh boy...

I wish a pain-free day to you all!

Tim

Hi Tim -

As others have mentioned, you can't rely on the results of the EMG's to determine whether or not you have nerve issues. I had an EMG which the doctor said was negative in the early phases of my RSD, but I very definitely have RSD. I wish the EMG had been right, and that there was nothing wrong with my nerves. IMHO, EMG's are pretty much useless as far as RSD is concerned.

If you have to go through another one, you may want to ask for some chill meds in advance.

So sorry for your pain, and I hope you get the treatment you need ASAP. The RSDSA is an excellent resource - see RSDSA.org.

XOXOX Sandy

thanks Sandy!

Reflex Sympathetic Dsytrophy is what they'll call it if they can't find anything. It's the least satisfying kind of diagnosis as it explains nothing. I'm not saying there's nothing wrong, just that if you have a diagnosis of RSD, it means they didn't find anything.

Tim, welcome to the confusing world of RSD.

My neurologist last fall gave me an EMG in both arms as I complained of a burning right shoulder (pre-RSD dx). I also had lower right burning back pain but he said that an EMG couldn't be done in the back for some reason (too many nerves?). The electrical part of the EMG didn't bother me - all I said was 'don't taze me bro!' and finally got a smile out of this guy. The needles didn't bother me either. Results were normal.

I've been seeing a pain manager for a few months and they diagnosed me with RSD lower and upper extremity after sympathetic blocks helped a little. Recently I asked my pain manager if I really had RSD and she replied that RSD is a diagnosis of eliminating other things. She suggested an EMG. After reading the results of my previous EMG she said that the normal results were further evidence that I DO have it.

I agree with Neoplasm, a very unsatisfying diagnosis.

I have pain but do not have it anywhere near what some of you experience.

Well I think the way my situation was handled was due to it being covered under Workers Compensation. they were awful...for example, when the DVT was discovered in my leg at the ER, the ER doctor wanted to admit me, but had to call the doctor's office I was being treated by, and the next thing I knew I was on my way home. and there I sat, for FOUR DAYS, before they sent me to a vascular surgeon. Then, when the vascular surgeon prescribed the blood thinners, WC took three days to approve the medication simply because of the cost of the meds. So in all, SEVEN days went by from initial diagnosis to beginning treatment.

What is this that you speak of with Allen? Fill me in please.

There's plenty of ways to diagnose RSD
 

If you've got RSD, trust me - there's all sorts of ways to prove it, and sadly enough with some of the things you've listed in your posting, it sounds like you might be on this path, but don't assume the worst, but instead just try and work each problem as they arise. Those who claim you can't prove it, or that the doctor's don't know anything but that they do, are sadly enough not nearly as educated as they believe they are. The physical changes that takes place when you've got RSD can be rather alarming I'm afraid to admit.

After crushing some nerves from the waist down, I was diagnosed by the chief of orthopedics at MO State University Medical school 2 weeks after the accident. Never in my whole life have I wished someone could have been wrong. Within just 3 months my bone mass was down by 50% for example and the list just goes on and on from there.

From what I've learned firsthand and seen in others, it appears that RSD and the severity of it is more dependent upon the actual injury and resulting damage than just about anything else. For example if there's extensive neurological damage that's irreversible, that's when there's greater odds that it could progress further, but other injuries can also be equally as facilitating the progression of RSD. For those who are dealing with RSD over a sprain that will in time heal, the odds are so will the RSD in time. Most reports I've read state that around 90% of all RSD does actually burn itself out within the first 24 months, but it's more about the actual injury than the RSD that decides this. Sort of like, "what's feeding the fire?"

After loosing total usage of my left leg it was 7 years before we crossed hemisphere's over to my right. Within 24 months it had done around 80% of the total damage I had on my left leg. Wow did it spread and fast! Between narcotic tissue, infections, blood clots and loss of use, it eventually led to the amputation of my left leg high above the knee. I was scheduled for a duel above the knee operation, but I backed out the day before surgery. Only a month ago I was reminded we still need to take the right leg. It's a ride I never would have dreamed possible, but like all challenges in life - we do learn how to live with whatever changes come our way.

As long as you don't go shopping for problems that don't exist and you just keep working the problem to the best of your abilities with a great doctor as you go along, you'll do just fine. It's when you allow the RSD/injury to take over your entire life when there's the real damage but you're to smart a person to allow that to happen. Here's hoping only the best for your future, Bob.

[QUOTE=tatertim;679976]Well I think the way my situation was handled was due to it being covered under Workers Compensation. they were awful...for example, when the DVT was discovered in my leg at the ER, the ER doctor wanted to admit me, but had to call the doctor's office I was being treated by, and the next thing I knew I was on my way home. and there I sat, for FOUR DAYS, before they sent me to a vascular surgeon. Then, when the vascular surgeon prescribed the blood thinners, WC took three days to approve the medication simply because of the cost of the meds. So in all, SEVEN days went by from initial diagnosis to beginning treatment.

What is this that you speak of with Allen? Fill me in please.[/QUO

[/I]

I can't believe what I here about W/C cases and how horrible they are. I do independant bookkeeping for 2 clients and I see the cost of W/C insurance it's so high. For example a small business but profitable with 8 employees cost over $4000.00 a year. Yet they don't want pay out on claims it really boggles my mind.

Wish you the best..

Gabbycakes

[QUOTE=gabbycakes;680775]My understanding is that WC companies have to have money in "reserves" to cover claims. A surgical lower back disc surgery might cost $100K or more, cheap compared to a RSD/CRPS case! That does not even include future medical costs for the life of the patient.

I am not justifying the carriers charges but I do as an employer and prior evaluator, understand that while many employers will not have many claims, when they do occur, they are expensive!

[QUOTE=Dubious;680830]My client has been in business 25 years and we have never had a W/C Claim in all those years. The rough math for preiums over 25 years = $100,000.00 and that's just one small company. Of course the charge have gone up so let's take $30,000.00 off, so it's $70,000.00 rough. W/C insurance prices are calulated by the dollar amount of your payroll and the number of employess. So just imagine a large company like Wal-Mart who employess thousands or many thousands. Sorry, W/C Insurance Companies are earning tons of profits and just working on the basis pay as least as you can and fight the claimant until they give up...

[QUOTE=gabbycakes;680865]I certainly am not an insurance company apologist, but you just made my point! One low back surgery claim over the last 25yrs and 4 employees, not unlikely odds, would cost well over $100k for surgery not to mention a disability settlement that could reach the same and then future medical care for life (ave. age of a disc patient is around 40), say another 25 years, might be another $50-$100k, or more. And if revision surgery was necessary.....

So while I again, am no advocate for that industry, I can understand that one claim, as above, may generate medical costs of $200-300K+ over the life of the claim, compared to the $70k for 25 yrs of premiums. So the cost to insure 4 for 25 yrs, is a fraction of what the employer would be responsible for (personally, if he carried no WC insurance) in the above scenario, just for one employee; one injury!

It is rather moot, though, as I am sure that all states mandate that all employers carry WC insurance.

I am totally with you! I do agree as an employer, it is crazy what we must spend for WC premiums!

Well in my case, Workers Comp rushed to settle my claim, but refused anything that wasn't a full release...almost like they knew that something major was wrong with me and wanted to get out before I realized it. But I digress...:mad:

Getting back to my health, I had my initial visit with my new Ortho today. He was a total jerk, no bedside manner at all, but I'm not seeing him for a friendship after all. After jerking my knee around and grilling me interrogation-style (with the help of two interns) he proceeds to tell me, as every other doctor initially says, that he finds it hard to believe that I've been diagnosed with Post Thrombotic Syndrome, Patellar Femoral Syndrome, Grade III Chondromalacia, and then tells me that it's (the PTS) an old person's disease, and I'm too young and fit to have it. I had a fresh set of X rays done today too, and after inspecting them he says that they "support an RSD diagnosis"...crap. I mean how does an x ray help diagnose RSD?

I have an MRI and bone scan pending sometime in the next 2 weeks. I'm kinda iffy on the bone scan, I mean it can't be good to pump you full of radioactive isotopes, can it? (FEEL FREE TO MAKE ME FEEL BETTER ABOUT THIS!!!)

Will keep you guys posted, ALL OF YOU ARE THE ABSOLUTE BEST!!

God bless,

Tim

[QUOTE=Dubious;680946]I think we agree on most but you kind of made my point,2 small companies 1 claim. We agree the premiums are high but like I said what about a company like Wal-Mart that employees thousands and has 500 claim out of 20,000 employees, just an example. My business believe with insurance companies are that if they are not making BIG PROFITS they are not going to be in the insurance business.

Hi Tim,

I never went through any of these test for RSD i.e bone scans, MRI's, e-rays etc to dx. my RSD. I feel I got RSD right after my first surgery I did have a lot of those test for the inquiry. I was fighting saving my arm and trying to get the rsd under control, it was a real balance for my doctors. When I finally found doctors who would work with me, I went around for about 3 weeks without any doctor and none that we even see me due to the difficulty of my case. Finally I found a pain doctor first and just by the look and symtoms of the arm he told me I had RSD after just sitting there for 5 minutes. Then he introduced me to a surgeon and both worked together for like 3-4 years to get me put back together without making the RSD worse. Sorry to ramble. Anyway I would ask my pain doctor how can you just tell my looking. He explained the over grown nails on the one hand, the extreme growth of hair on the one arm, discoloration of the arm oh let's not forget the pain and at that time you couldn't even touch me. He also explained that the way to really tell is to start with a procedure and see if it works. The first procedure I had was a Stellate Gaglion Block and yes it did work. But we all know that only last for a couple of weeks or month. I had to have many surgeries which ofcourse made me worse but they told me that. They just went through this balance routine for a while as I said. I truly believe it was the PM doctor who was able to get me to as normal as I am going to get and ofcourse my surgeon was incredible also. But each surgery was a major production because of the blocks I had to have just prior, they always used ketamine as part of the anesthetic cocktail. Once my surgeon came out while I was waiting to go into the OR and said we are running late because DR....... wants you to have ketamine while having this surgery, he joked "it's like killing a fly with a sledge hammer" but he new what he was doing.

Maybe question some of these test and what they are suppose to determine. I have learned that the medical industry is no different from any other business it all about dollars. Even the best of the best yes they do a incredible job but they want to make money. Good luck....Keep the faith..

Gabbycakes

Oh Noooooooooooooooo I go for my first EMG later this month on the 16th & I am NOT looking forward to it at all. YIKES!!!

And btw, I have had it since 03 unless it turns out I have entrapped nerves in both feet........*sighing* I am so scared to have surgery though. After what I went thru last June after back surgery......I am scared to death. I have had 13 surgeries & I have never in my life been scared to have surgery until now........because of the 13th surgery.

DebbyV

Allow me...
 

I just find it so sad that our condition and it's discovery process has to revolve around the almighty dollar amount..We all understand the depth of our pain and our future with it and no dollar amount can substantiate that..

Sleep well all...

Hugz, Kathy:grouphug:

I don't want to scare you, but my EMG was one of the worst experiences of my life. On the day that I had it my leg was really dry and scaly, so the adhesive to the electrodes wouldn't stick and they came out with a inconclusive results...the next one was still inconclusive and I refused to have a third one. It hurt soooo bad and you could just look at my leg and see the mottling and swelling, hair growth..the whole nine yards.....

I got my diagnosis by process of elimination because I was born with Cerebral Palsy and they thought all the symptoms came from that. My RSD started after a bout with a serious internal MRSA infection. It took over a year and a half and about 5 neurologists until my PM doc just tooj one look and said beyond a doubt I had RSD. I was treated like crap until I found him and and he works along side of my GP and they are starting to get it right after 2 years. I am in the process of getting SSDI and I am waiting for my date for the judge.

In the meantime while trying to get my diagnosis my RSD has been spreading, so each appt for SSDI I have a new symptom....I almost have my med "cocktail" figured out so that I can function as a wife and mother and a new grandma. This is the only thing that I have been asking for. I know that I can't work my job as an autism mentor, which I have been doing for 24 years, but I try to stay positive and try to find out what it is that will make me learn to live with this crazy disorder.

Good Luck with the EMG and I hope it goes better than mine
God Bless,
Cindi:hug:

My CRPS was as result of a shoulder arthroscopy and resultant brachial plexus damage. Numerous issues resulted, one of which was near anesthesia of much of my affected shoulder, arm and hand. I couldn't feel most of both of my EMG's and over several areas, didn't even know when the neurologist put in and took out the needles! Weird.

Anyway, good luck!

hello
 

Where did you hear this? I am sory but you have been missinformed, RSD is what they used to call this condition before a group of medical doctors and scientists got together and renamed it in complex regional pain syndrome in1994, alot of doctors and such still call it RSD.. Technicaly though RSD now only consists of patients who's pain is still sympatheticaly maintained.. meaning origionating from the sympathetic nervous system.

CRPS/RSD, whatever, in practice people use the terms interchangeably. Doesn't really change my point anyway.

oojoaj
 

Hi,

I am new to NeuroTalk, I registered today. I am hoping that with the help of others who suffer with RSD I will be better able to deal with it. I was diagnosed with RSD five years ago after a compartment syndrome injury while riding a bicycle! After three surgeries and six weeks in the hospital I was dishchared and went for six ambulatory surgical surgeries as well, to save my foot. I was extremely grateful to say the least.

I have tried to learn to live with chronic unrelenting pain, and for the most part I am. However, this has changed my life considerabaly. I can no longer some of the things I used to enjoy. I suffer with depression and have to manage that as well.

My doctor wants me to have another EMG next month to see if this has progressed. The thought of that happening is quite discouraging. The pain with this diagnosis is very difficult to be managed very well. It feels as if my foot is on fire and the nerves are right on the surface. Wearing anything on my foot is painful, even a sock. Sometimes vibrations can even make it worse. My family does not understand and that is upsetting for me. I rarely even complain or talk about it. I do not baby myself, I walk with a cane and walk a great deal. I have some paralysis due to the surgeries and I refuse to let it get worse. I have extreme sensitivity to hot and cold as well. I am insane or is this what happens with RSD.

I am hoping to learn and share with others from this and this seems like the perfect place to do this. I thank you all for sharing your experience and your hope. Maybe one day they will find a cure, but more money is needed for research.

oojoaj
 

Hi Tatertim,
I am also new to this site. I registered today hoping that through the help of others I will be able to live with this and to get the proper treatment. I have had RSD for five years after a compartment syndrome injurt to my foot. I had three major surgeries and six ambulatory surgical procedures. I had three EMG's done at the time which can only detect nerve damage, thereby confirming my doctors "opinion" that I had RSD. To my knowledge there is no definitive test to diagnoosis RSD. Basically the signs and symptoms are what tell a doctor what it is. It is a very difficult thing to live with because for me, I have unrelenting pain which is difficult to manage. I will have another EMG next month to seee if there is any progression. I would certainly have the EMG because perhaps it will rule out anything else. I wish you luck and hope you will post your experience and results.