Vicc,

What a wonderful response and write up. I greatly appreciated all the detailed information and glad to see I was not the only one reading the inaccururate or mixed up, misconstrued information the "dr" wrote about. It makes me angry when I see someone with these opinions (which is what they are to me), it does nothing to help the real Dr's who care nor the patients and furthermore hurts the patients in the long run and that is definately something we/they dont need.

I look forward to reading more from you and your posts - your information is truly valued. Thanks so much again.

This reply from Dr. Oaklander has brought to the surface something I've been wondering about for a while concerning the current classifications of RSD/CRPS. Bear with me while I explain, and please understand that I'm a medical illiterate.

Oaklander says:
"CRPS begins in association with a trauma to either an arm or leg, and symptoms are worse in the affected limb.

Because CRPS is so poorly understood, incorrect diagnoses are common. It is most commonly confused with a generalized problem—usually a small-fiber polyneuropathy. I would be delighted to speak with Ms McNulty's friend to find out more about her condition. Accurate diagnosis is the foundation for effective treatment."

BTW, yes, Vic, wouldn't it have been useful if she'd told us what an effective treatment might be.

Anyway, she seems to be saying that if things don't fit with her classification then it's not RSD/CRPS.

But she doesn't give us her definition and in this, admittedly necessarily short statement, seems to completely ignore the 2 current classifications of CRPS type 1 and 11 and is talking solely from the perspective of CRPS Type 11 (I think, she's a bit woolly here).

The two classifications at present "...are meant as descriptors of certain chronic pain syndromes. They do not embody any assumptions about pathophysiology. For the most part the clinical phenomena characteristics of CRPS Type I are the same as seen in CRPS Type II. The central difference between Type I and Type II is that, by definition, Type II occurs following a known peripheral nerve injury, whereas Type I occurs in the absence of any known nerve injury."
http://www.guideline.gov/summary/sum...=4215&nbr=3223

Her own research used patients with CRPS Type 1:
"Study finds nerve damage in previously mysterious chronic pain syndrome - Reduction in small-fiber nerves may underlie complex regional pain syndrome-I (reflex sympathetic dystrophy)"
http://www.massgeneral.org/news/rele...oaklander.html
and
http://www.ninds.nih.gov/news_and_ev...ticle_CRPS.htm

So her own research has shown that there is, in fact, nerve injury/damage in CRPS Type 1. So does that mean that there is actually no difference between the two classifications, and that the only difference between the two has been our ability to measure nerve damage?

Back to her reply to the letter, ... "small-fiber polyneuropathy" - her own research has shown that CRPS Type 1 can be identified by a clinical test that shows evidence of small-fiber changes. Polyneuropathy can be defined as "....a neuropathy pattern, whereby the nerve damage initially starts in both feet and may progress to involve the feet, calves, and fingers/hands. Another word for this pattern is a Stocking and Glove Neuropathy.
http://www.stoppain.org/pain_medicin...neuropathy.asp

If you put these two things together they sound exactly like CRPS to me, as the vast majority of us, the sufferers, have experienced it. So I'm wondering just what her definition of RSD/CRPS is, and why she has responded from such a narrow perspective. Or has she, in her own mind, abolished the two classifications and is now treating them both as a single condition?

This quote from the original article is what started me seriously thinking about the current classification of this condition/disease:
"In time, we may recognize half a dozen different kinds of CRPS, not just two," said Ricardo A. Cruciani, MD, PhD, vice chair of the Department of Pain Medicine and Palliative Care at Beth Israel Medical Center in New York City.

I frequently see articles on conditions, like Raynaud's and erythromyalgia for example, that make me think "hang on, but isn't this RSD?": are the medics not seeing the wood for the trees? Is RSD/CRPS just one manifestation of a much wider-reaching underlying physical malfunction?

I have a gut feeling that Cruciani's musing may turn out to be true in general principle.

all the best

Is RSD/CRPS just one manifestation of a much wider-reaching underlying physical malfunction?


Right On, Artist