Hi In His Hands--According to the AMA, the eight signs that MUST be CONCURRENT include:
Vasomotor changes:
skin color: mottled or cyanotic
Skin timperature: cool
Edema

Sudomotor Changes:
Skin dry or overly moist

Trophic Changes:
Skin texture sooth, non-elastic
Soft-tissue atrophy, especially at the fingertips
Joint stiffnes and decreased passive range of motion
Nail changes: blemished, curved, talon-like
Hair growth changes: falls out, longer, finer

Radiographic Signs:
trophic bone changes, osteoporosis
Bone Scan findings consistent with CRPS

Eight or MORE= "Probable CRPS"
Less than Eight; "NO CRPS"

Wow... this is an awful way to be diagnosing your patients with RSD... how does somebody have 8 symptoms all at one time for the Dr to see?!

Good grief, a lot of RSD patients probably wouldn't have the RSD diagnosis if the Drs. all followed this list of rules! I mean, at time of the examination, how many patients actually have 8 symptoms???!... swelling, color change, sweating all flucuate over time, at least for me they do.

I hope that many RSD patients were not affected by this list of rules, be it getting treatment, insurance to cover it, etc...

Thanks, BrokenWings for posting that list for me.

Hi In His Hands-- I TOTALLY AGREE!!! Gosh--well, one has to consider the "motive" behind this "criteria". FORTUNATELY, MOST Doctors who KNOW about RSD would NEVER EXCLUDE someone from the diagnosis just because they didn't witness the patient's fingernails changing before their very eyes at the time of exam!!

In my humble opinion-- this list was "created" by the INSURANCE CO--specifically, Workers's Compensation, especially in CALIF--WHY??

Because, NOW, the AMA Guides are the "new Bible" for diagnosing certain medical conditions--and ALL WORK COMP DOCS are SUPPOSED to "use this Bible". Naturally, VERY FEW people could EVER meet this criteria--so it is a "tool" designed to DENY BENEFITS AND TREATMENT,, which is COSTLY!

Very, very SAD....(not to mention CRUEL)

Hi In His hands--you know, I don't even know WHY the AMA even bothered to say that "radiographic findings" were part of the criteria:

First--the scientific literature is REPLETE with EVIDENCE that BONE scans are NOT to be "relied on", because they are basically "50-50"--just because someone has a NEGATIVE bone scan, that does NOT EXCLUDE RSD/CRPS as a diagnosis--and the AMA even CONCEDES THAT POINT!!!!

As you correctly observed, by the time MOST people have all EIGHT criteria--they have very ADVANCED RSD--and from what I understand, it is then VERY difficult to treat and control.

Now, I do not know about anyone else, but my RSD STARTED with swelling, skin discolouration, and VERY COLD skin temperature, and BURNING PAIN...
It took quite a WHILE for the PROLONGED vasoconstriction, etc., to MANIFEST itself with the CHANGES in my SKIN and FINGERNAILS, and the hair on my arms.

Fortunately, I DID receive Nerve-blocks and MEDICATION (Neurontin, in particular, PLUS Diltiazam (a vaso-dilator)) relatively early on, to help stabalize the SEVERE vaso-motor instability...I still HAVE it, and it still can really Flare-up at times. (Even "lay people" ask "why are your arms/hands red/purple? Why are your hands/arms like ICE", etc? ) My Pain Doctor is a "stickler" when it comes to EXERCISING/DESENSITIZATION--he has "beat it into my head" that the muscles will ATROPHY, my joints could get really stiff, possibly have contractures, and that the BONES will be affected due to LACK OF USE--so, i FAITHFULLY do my exercises the best I can everyday to MINIMIZE THESE POTENTIAL PROBLEMS... (and, if I DON'T do my exercises, I quickly lose what function I have...)Therefore, it is a CONTINUAL EFFORT.

Ok--so when we are receiving TREATMENT, Nerve-blocks, doing our exercises, etc., and SOME of the "objective findings" are somewhat controlled--according to the AMA--it "DOESN'T COUNT" --we DO NOT HAVE RSD because we DON'T HAVE ALL EIGHT CONCURRENT CRITERIA!

This is just CRAZY!!!!

You stated that you hoped that this "criteria" was not hurting people with RSD--very unfortunately, I know AT LEAST SIX people who are running into real problems getting the RSD CORRECTLY diagnosed and treated--the Insurance Co's are unscrupulously REFUSING to consider EVIDENCE contained in their MEDICAL RECORDS that actually VERIFY that these individuals have in fact HAD ALL EIGHT (and MORE) of the necessary criteria--JUST NOT ALL AT THE SAME TIME!!! That is the "caveat" that the ICs and their "Doctors" CONTINUE to "hang their hat on", and quite ARROGANTLY, at that!!! (But, let us not forget--the IC Doctors are IMMUNE from MALPRACTISE, because they are "Not Treating Physicians"......

Sorry for the long "vent"...thank GOODNESS that there are Doctors out there who REFUSE to "buy into" the "lunacy" of this!!!!

honestly, i have NO IDEA how, when or IF the AMA will ever "back off" on this issue-- If Dr. Fitzpatrick and his esteemed collegues can't do it, then I don't know who CAN. Any ideas, anyone?? This has to CHANGE..

I'd like to thank Curious and Artist for those EXTREMELY valuable links - They have proved useful to us just today.

(Thanks HwRSD.) I know I'm repeating myself, but intentionally so - with regard to the criteria for RSD diagnosis, the Dutch have just published their Guidelines for diagnosis and treatment of RSD.

The Dutch say 4 out of 5 clinical signs should be present; read the Guidelines, they make so much sense, and the recommendations for treatment make very interesting treatment.

I've given the link in my thread "the Dutch are streets ahead..", here it is again:
http://pdver.atcomputing.nl/english.html
This has been compiles after 15 years of research in Holland and is quite simply invaluable to anyone with RSD. I hope other doctors worldwide will adopt these Guidelines. You have to download the PDFs - they are very clear, very well-written.

Background to the development of the guidelines can be found at:
http://www.rsdcanada.org/parc/englis...anderlaan.html
"A huge committee of doctors, researchers and experts in Holland worked tirelessly for 5 years to write the standard treatment protocols for treating CRPS in Holland...."

Any doctor in the UK or US will take the Guidelines seriously because it's all based on clinical research, and the PDF for Physicians has been written by very highly respected doctors, for doctors, so it's all in medspeak, the one for Patients is written in normalspeak - so give the PDFs to your doc.....

I feel it's of such vital importance that I've added it to the stickies as well, so the info is easily available to everyone.

All the best!