Hello everyone I hope you are all doing fine. I have a true abstract from American Journal of Pain Management from Dr. Hooshmand.

Venipuncture Complex Regional Pain Syndrome Type II
by Hooshang Hooshmand, MD, Masood Hashmi, MD, and Eric M. Phillips

Keywords: causalgia, CRPS Type I and II, neuroinflammation, sympathectomy, venipuncture
Volume: AJPM Vol. 11 No. 4 October 2001 pgs 112-124Abstract:
Venipuncture Complex Regional Pain Syndrome Type II (VP-CRPS II) is a rare and unpredictable complication of venipuncture. It is the manifestation of a minor injury leading to a severe form of CRPS. It should not be mistaken for benign forms of hematoma or phlebitis without CRPS. There is no definite causal relation with the type of needle used, nor with number of attempts at IV insertion. It is usually a rare complication of the needle accidentally injuring the microscopic microvascular C-thermoreceptor sensory nerve. Lack of experience and severity of the trauma are not proven risk factors, and there are no known preventive measures. Accidental infiltration of chemical irritants can instigate the VP-CRPS, unless the injection is discontinued immediately. Early diagnosis and proper treatment provide significant pain relief. Multimodal treatment is essential. Surgical procedures, especially sympathectomy, may exacerbate the condition and lead to irreversible therapeutic failure.

and a link with a great artical(ABSTRACT) thank you, I feel we all help by sharing our info, by sharing we gain knowledge wich in turn helps us all. Vicc dear friend please do not leave this very important discussion no one is slamming you, we all want to know how you came up with your abstract? and to say all the docs who study this are wrong is not right, is the other issue I hope you return to the discussion it helps us all when we share.
Have a pain free day you all.oh the link here it is
http://www.ajpmonline.com/search/def...294.5805671296

Hi flippnout,


I know of 2 people who have RSD/CRPS as a result of a simple venepuncture prodecure for routine bloods.
I would have thought that this would constitute the diagnosis CRPS Type 2 as they were told that the pathology staff had in fact damaged the nerves in the cubital fossa and yet they both have been diagnosed as CRPS type 1
Is it any wonder there is such confusion amongst us.
I do know however that these people have had major improvements from stellate ganglion blocks and ketamine infusions, one having gone back to work with just a tiny patch of pain in the originalinjury site.
This is a disease seems to have it's very own agenda in each and every body it chooses as it's host.
Regards
Tayla

oops...have to try again

I am making a request for this discussion to remain *on topic* and *within the guidelines*, which means NO personal attacks or flame posts please.

This is not singling anyone out as it is evident that more than one person is becoming personal in their comments instead of keeping the debate objective

I have removed one post and I am about to edit others that are found to contain flame comments

I would greatly appreciate everyone's co-operation on this

We want to allow open debate and discussion here, but we simply cannot overlook the guidelines in doing so.

thank you
Cheri

Dear Chemar,

I have 3 son's that are very close the fights at times were unbelieveable. But they care about each other very much. Much Love, Roz

Roz

perhaps if you could read the MANY reports and VERY irate PMs we are receiving on all this you would understand that maybe others dont see this as you do

When violations of the guidelines are reported to us, we are obliged to act within those guidelines

I repeat, flames and personal attacks will not be permitted here.
Civil debate and discussion will



thank you
Cheri

ok
I am back from having to rush out to take care of a very important business thingy....

I really do want to post on a lighter note because I care, as does the whole admin/mod team, about all of you and for you to feel comfortable and honest in your posting here.

We are honestly not trying to restrict free speech here, even when it becomes a bit heated.

We stay out of most discussions, even tho they may get a bit heated at times.
We value exchange of ideas and information, and rely on you, the members, to apply your own knowledge and experiences, or research articles , etc to agree with or refute other comments posted.

That is healthy debate.
Disagreement while remaining objective rather than subjective in comments

When things take a personal turn, and posts are perceived as attacks or written in a flaming manner, and when we get reports and PMs, we discuss things on admin as much as possible and reach consensus, having looked at as many aspects and views as possible, and when we act, we act in accordance with the very reasonable guidelines that DocJohn has in place.

Those guidelines really arent harsh or restrictive...they are really just guidelines most of us apply to our everyday life....to be respectful of others and treat them as we would hope to be treated.

We really dont intervene a lot, and do try to allow a lot of leeway ( the guidelines are not written in stone )

but when other members of the board, report a post we have to look, evaluate, and act as admin decisions is made.


Of course we cant all be expected to agree, or even to like one another.
But it isnt unreasonable to expect to be treated respectfully by those who disagree with us.
We all have the right to be treated within the guidelines here, just as we have to abide by them.

This is a board filled with highly intellectual and also very caring members.
Let's see these debates reflect that.

with respect and care for all members here
Cheri

Tayla4me,
I hope you are ok today! along with everyone else out here
That is my point there is so much confusion of this horrible moster we all have here. There has to be a study done and try to come up with a conclusion to this, otherwise I feel some docs do not take this monster as being there instead you have some docs who say it is a junk diagnosis.
That is why it is COMPLEX REGIONAL PAIN SYNDROM too complex for me, that is why I trust my doc I have now. I say find a doc you trust and knows of RSD/CRPS and go from there, I'm sure we all agree there, if some of you do not have a good doc yet I hope you find one soon. Try going to your teaching hospitals connected to a Uni. thanks

Tayla,

One of your more recent posts piqued my curiosity so much that, even though I think it unlikely you will answer, I have to ask a question.

You wrote: ...when I read the research of many very learned people who have spent years developing the theory behind the cause of RSD/CRPS then I tend to find comfort from the consistancy from these people. It also makes good sense to my level of understanding.

Can you tell me which theory you agree with?

Do you agree with the one that claims that RSD results from a peripheral nerve injury?

Or do you agree with the theory that this disease is caused by damage to nerves in the sympathetic nervous system?

Or do you agree with the one that says RSD begins with a peripheral nerve injury that completely heals, leaving no symptoms, which are then assumed by the central nervous system?

Oh, yes, and if you think they all make some sense, can you explain how you find consistency between these three competing explanations of RSD?

(Added later) The reason I doubt you will answer this is that you have not yet answered an important question I asked earlier on this thread:

Since it appears to be widely accepted that CRPS-I (the overwhelming majority of RSD cases) is NOT caused by nerve damage, why do you insist that it is?

Please excuse my jumping in here, respectfully Vicc, and Tayla, I think it is more that they are nerves misbehaving - not performing normally in type I and we categorically don't know why. There is no black & white with any biological system.

I comment herein respectfully and this is probably a case of semantics and being pedantic on my part. I would think we are in the realms of hypotheses as in "a supposition made as a basis for reasoning, without assumption of its truth, or as a starting point for investigation" .....Concise Oxford Dictionary.....and to quote the dictionary again

" Theory: Supposition explaining something especially one based on principles independent of the phenomena etc.

Unfortunately, I think we are still at the hypothesis stage despite being aware of this incidious thing since the American Civil War. I fear CRPS has been studied in such small groups and work done on medical practice stats and opinion rather than collective studies that it is limited in its application of certainty. These doctors mean well but they don't have access to large numbers of patient and I might add that the researchers also mean well but they just don't have the numbers...as in size of sample. They are often using numbers like 50 participants.....very small samples. It is that fundamental.

So we come to the expectation of the impossible .....at this stage.....a theory is able to be proven with a degree of certainty whereas a null hypothesis can be disproved with a degree of certainty so an hypothesis can be confirmed with a reasonable statistical degree of certainty but the numbers don't appear to exist collectively.

As we don't KNOW all of the roles of the nervous system jigsaw puzzle and its interaction with the bodies’ systems this becomes quite curly.
In fact, that might get us as a group heading somewhere whereby we can try to influence the researchers were we to do it tactically on how we are most affected.

It's like the null hypothesis in stats. You say the opposite to that which you wish to prove & then prove it is wrong.....then you know the hypothesis proper (the theory) is correct within defined limits of certainty.
I'm not well enough by any stretch of the imagination to try to collate a meta-analysis along these lines.

The hypothesis that is out there that appears to give the most consistent little snippets of relief is that it is related to the nervous system. It must certainly include the nervous system as pain receptors are involved and certainly the higher order operants of the Higher order control of Autonomic functions.

I also think it curious that if nociceptive pain is relieved by opioids and the balance of pain source for many patients is nociceptive then they get a fantastic improvement in quality of life. I think there seems to be some confusion (I'm not sure that is the right word) with the Gate Control Theory and SCS has given such a degree of relief to so many patients - sadly, it didn't help me and yet opioids delivered intrathecally gives tremendous relief for some.

Those meds that quieten the nervous system whether they be anti-epileptics, tricyclic antidepressants have been a boon to many. Again...not I.

I am merely suggesting that if we were to, as patients, suggest the major irritants (stimulant) and the responses they cause us in large numbers we might actually get somewhere and work with the researchers to crack this nut.

The British and the Canadian RSD groups are great too.
We are a big group but if data could be combined worldwide before research is done rather than retrospectively reviewing small studies, a positive direction might be found for us all.

Very best wishes
Auberon