There is also a physiological reason for the emotional lability. In a flare, emotions are not going to the upper parts of the brain where we analyze and respond appropriately, so we "react" only through the limbic system (or the instinctual reactions that are created in the base of the brain like a reflex). It is actually a part of this disease for our emotions to go nuts. It sucks, but at least once I was told this, I was a bit less hard on myself.
Corinne89

I personally think we have earned the right to be a bit "unstable" from time to time..others must give us that right..and forgive... life is very complicated and a daily struggle for us...I really, really believe that only the strong are dealt the cards of the "RSD illness" as those weaker than us would not be able to cope with it!!!!!!

Hugz to all... Kathy

Hi there, new members akgh, hannah, Azailia and Corinne -

You have all touched on an important question. First of all, living in chronic pain wears us raw. The first so-called "pain psychologist" I saw (a psychologist who happened to get a job at a pain clinic, more like it) told me, when I brought it up maybe 8 -10 months into this, that it, just "went with the territory" and there was nothing I could do about my occasional rudeness to random sales clerks, etc. That was only a small part of the reason I left that pain clinic.

A couple of months later, a new neurologist with many years of experience wanted be evaluated by his pain psychologist, who was also an analyst by training. We had only one two hour session but it changed my life, fundamentally. When I got to the part of being told that anger "went with the territory," she basically uttered that two letter acronym and handed me the card of a woman who taught the Mindfulness Based Stress Reduction course, developed 30 years ago by Jon Kabot-Zinn at the Univ. of Mass. Medical School, which still administers the program nationwide. http://www.umassmed.edu/Content.aspx?id=41252 If you're interested you can go on their site to find some 543 currently accredited teachers around the world, 60 in California, and three of those I can personally vouch for!

Eight years later my MBSR teacher is still one of my closest friends, and through the eight week class, which met for two and a half hours once a week with daily guided meditations and yoga exercises - probably the most efficient way to understand the literal position of our body in space (proprioception) ever devised - I started to see that there was no reason why, for instance, we couldn't just note searing pain as sensation, map it, explore it is detail in parts of the body where it wasn't so intense, and not most importantly, not spend my energy trying to push away something that was unavoidable.

The flip side of course is giving up attachments, specifically in our cases, to the lives we lead before this all started. For example, check out a post I put up a couple of years ago about a talk given in San Francisco, post-stroke and from his wheelchair, by famed Guru Ram Das, fka Richard Alpert, PhD, and the son of the president of the New York, New Haven and Hartford Railroad. (Talk about a lot of past lives all rolled up into one.) http://neurotalk.psychcentral.com/sh...d.php?p=252371 [post no. 2] In my case, it was "walking" away from being a business bankruptcy lawyer, where I was well past the point - due to illness - of being able to make a profit doing it, but I had so much attachment to a career I spent 20 years developing and going to endless professional programs, etc., and then, after 18 months, one day I finally had to freedom to just let go and start the wind down process.

Anyhow, there have been lots of posts on this one before. But for new members, MBSR, which was developed in large part with the need of the chronic pain patient in mind, is something to be checked out. And for those how aren't up for a whole class, it's definitely worthwhile checking out Shinzen Youn's little 80 page book and CD of guided meditations. BREAK THROUGH PAIN: A Step-by-Step Mindfulness Meditation Program for Transforming Chronic and Acute Pain (2005). No one claims you can make pain go away, but dealing with it directly is a whole lot better than having it deal with you.

In fact, doing it right, pain can actually be the vehicle through which we learn to pass through suffering altogether.

Then there is what Corinne refers to, how intense stress, especially that which perfectly pushes our buttons (my spouse in full tirade for some screw up on my part) translates immediately into the sharpest possible pain. Personally, I've assumed for years that this was mediated through the release of adrenals which in turn produced an immediate ischemic response, but I'm open to the suggestion that there is a more direct relationship.

Finally, there is a dark side to all of this in the case of chronic RSD/CRPS.

A couple of posts in recent days have mentioned research linking CRPS to the "limbic system" without saying more about it. Yet, based solely upon the fact that a PubMed search of "CRPS limbic" generates only a single article, the suggestion is there that the definitive and in fact only published work to date is that based on functional MRI studies coming out of the "Pain and Passions Lab" http://www.apkarianlab.northwestern.edu/ of A. Vania Apkarian, PhD at Northwestern possibly the leading neuroscientist in the county specializing in research on chronic pain. See, Geha PY, Baliki MN, Harden RN, Bauer WR, Parrish TB, Apkarian AV, "The brain in chronic CRPS pain: abnormal gray-white matter interactions in emotional and autonomic regions," Neuron 2008 Nov 26;60(4):570-81, FREE FULL TEXT AT APKARIANLAB SITE http://www.apkarianlab.northwestern....00811_Geha.pdf

Abstract
Chronic complex regional pain syndrome (CRPS) is a debilitating pain condition accompanied by autonomic abnormalities. We investigated gray matter morphometry and white matter anisotropy in CRPS patients and matched controls. Patients exhibited a disrupted relationship between white matter anisotropy and whole-brain gray matter volume; gray matter atrophy in a single cluster encompassing right insula, right ventromedial prefrontal cortex (VMPFC), and right nucleus accumbens; and a decrease in fractional anisotropy in the left cingulum-callosal bundle. Reorganization of white matter connectivity in these regions was characterized by branching pattern alterations, as well as increased (VMPFC to insula) and decreased (VMPFC to basal ganglion) connectivity. While regional atrophy differentially related to pain intensity and duration, the strength of connectivity between specific atrophied regions related to anxiety. These abnormalities encompass emotional, autonomic, and pain perception regions, implying that they likely play a critical role in the global clinical picture of CRPS.

PMID: 19038215 [PubMed - indexed for MEDLINE]

This is an article that has been discussed before in this forum but is deserving of another thread in it's own right, along with whatever I can come up with on other sources. The apparent consequences of the research are staggering, first at to the direct relationship between CRPS and an organic loss of skill in "emotional decision making," which had been previously noted in psychological studies with matched control groups, only to have the mechanism of action verified through fMRI studies showing a significant loss of gray matter cortical thickness in the brain's "anterior insula" which is believed to play a direct role in emotional regulation. I'll try to get that up tomorrow.

Moral of the story: we will probably need all of the "mindfulness" skills we can get.

Mike

Hi AKGH, If you don't have an attorney, GET ONE who specializes in WC
Get a journal and date and write in it every day. You'll need it if you end up in court. You have legal rights, you probably have no idea you have.WC should be providing you with counseling, a Tens Unit if your dr. orders it. and replacement leads. It does sound like you are getting spread. It is important to get physical therapy and massage therapy so you do loose range of motion. It took a year and 100 treatments in pt and massage to get the use of one shoulder. a year remission and then the other shoulder. Water therapy is very good and water should be 86 degrees. Hot tubs are too hot at 104
NO ICE
pAIN shortens our fuse and we don't even know it sometimes. My husband says are you mad at me? and I say I'm sorry I'm not mad at you it's the pain. It sneeks up on us. I'm grateful my husband, family and close friends have some sort of understanding. It's tough.
Glad you joined us. Hope we can be of some comfort to you. Stay in touch, one of your new friends, loretta with soft hugs

I am like this and angry sometimes. My meds for the mental state have helped a lot but still of course there are my times where I am a mix of emotions like I stated on the other thread. I have little patience espeically when my pain is bad. When I get like this to not take it out on anothers I try to take a deep breath and if at all possible not be near people I may explode on. I also think what people forget is yes the physical pain is so horrible but also mentally this takes a toll. Everyday waking up to the unknow of what will come pain wise or other health situations is very draining.

Loretta..once again you werea hit!! Thank you for your post...

Pain does some pretty crazy things to us...I half believe we should be entitled to become unraveled once in a while... This illness sure does test our strength and will and ability to move forward everyday... Sometimes I wonder how would I handle this if it were not me but one of my loved ones?? Very quickly I revert back to ... it has to be me..as no way would I want to share one iotta of this killer pain with anyone!! ( I am so sorry you all have it also)....But in return our loved ones close to us.. must realize that we are in a constant turmoil with juggling pain and all of the "riches" that go along with it..just the otherday I admitted that I would not mind taking a " long" nap..... knowing that if I did not wake up from it..I have zero regrets as my life has been amazing..just the way it was! No regrest!!! None!!

Love, Kathy

Thank you Loretta, I do have a wc attorney that is also very familiar with RSD, I was thankful that I got 2 in one. I had to start using a digital recorder at work, which just recently termintated me, in order to keep them from lying. I had massage therapy early on and it was a tremendous help, but they only pay for 2 sessions and I used those up already. I just hate that random cranky thing for no reason. I use deep breathing and meditation which helps a lot and am starting yoga. It's just all very frustrating as every one on here knows. I am a fighter though, my mother used to call me a "spitfire" when I was little so I guess that helps too, I'm very stubborn! I think with all that is going on with wc and now out of a job with no pay from anyone, aggravates things too. I just have to learn to let the attorney's handle it and try not to stress about the bills, as someone on here responded to. It's not our fault, we didn't ask for it but we must learn to deal with it. Every body on here is just fantastic!

Dear Kathy -

Pain can indeed do some pretty crazy things to us. And it can be induced in some pretty crazy fashions, "opioid-induced hyperalgesia" being one of them, where we can be on large enough doses of opioids that they not only become essentially useless but they ultimately reinforce and strengthen what is already CNS generated pain. For the quick treatment on Wikipedia, see, http://en.wikipedia.org/wiki/Opioid-...d_hyperalgesia

I just put up a long post on this in another thread, which path will you choose?
http://neurotalk.psychcentral.com/sh...d=1#post620879 (post no. 8.)

The post covers of few points, first, that at too high a level, opioids can actually cause more pain than they cure. Thus, before one ever assumes that the pain is as manageable is it’s going to get, you MUST have a conversation with a good pain dr. about the possibility of so-called opioid-induced hyperalgesia, it's causes and remedies: assuming of course you have been taking ant opioid at all.

The good news is that there are a number of fixes for the problem, including not only that old favorite, opioid rotation, but adding to the opioid another compound, whether it’s a so-called “NMDA receptor antagonist,” which could be as simple as the over-the-counter cough suppressant dextromethorphan in order to block pain processing from the spinal column to the brain, or the most minute amount (in millionths of a gram) of an opioid blocker which has the paradoxical effect of increasing the analgesic qualities of the narcotic while reducing the total amount taken, and therefore their side effects.

The bottom line is that no one should be resigning themselves to a life of absolutely intolerable pain, unless and until you’ve fully explored these issues and options with a good pain physician.

Mike

I really appreciate your note and all of your information...It is a large feat to "go it alone"..without pain meds of any kind.. I have been thru so much and still ready to ty as my Pain mangement Dr. reccommends..let me say I had TOS..with bilaterial rib removal..both first ribs on each side of my chest. Following the first surgery..I had the heavy stuff and boy did I need them..but had terrible ill effects..second rib..removed while taking tylenol only...even antibiotics are out but one...after 20 yrs. of trial and error.... I am still open to suggestions but must say I have had my day over the john.. lookng at the pill bottle..sends me running..My PM Dr. scratches his head... Gotta say one thing..I am either tough or stupid ..but I am almost 3 yrs. into my RSD...but the best part is I am not spending the majority time in the bathroom...tee-hee..

Have a great night, Mike...

Kathy