Talk:Complex regional pain syndrome

smoking study of 53 people is not indicative of anything

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Why is it stated that type 2 is more severe than type 1?
This statement needs better verification. The user that edited that in also stated that type 2 tends to feature harder to control symptoms(what symptoms?), which the source doesn't state. The source used has another picture of the McGill Pain Scale which includes RSD/CRPS instead of just causalgia. These words are just synonyms for the most painful condition know to medicine, the only difference is that type 2 is caused by an obvious nerve injury. Second paragraph under "What is complex regional pain syndrome?" http://www.ninds.nih.gov/disorders/reflex_sympathetic_dystrophy/detail_reflex_sympathetic_dystrophy.htm (if anything is wrong about policy or format of this contribution, please tell me. I am new to editing wikipedia and am just a patient trying to advocate for my disease(RSD), and to provide factual information about CRPS type 1 and 2.) OpioidsAreGod&#39;sGift (talk) 17:15, 8 December 2015 (UTC)

Why isn't acupuncture listed as treatment?
I'm not talking about normal acupuncture, but Chinese scalp acupuncture. It's been proven to work. Heck, the US military used it.

http://www.ncbi.nlm.nih.gov/pubmed/23113454 — Preceding unsigned comment added by 173.27.220.213 (talk) 04:07, 8 November 2014 (UTC)

Sympathic nervous system
There is one section that spends some time talking about the autonomic nervous system as if it's a major player, "...the autonomic (think automatic, like blood pressure regulation or breathing or sweating) nervous system can go haywire...". I don't think this is accurate and should be edited.War (talk) 07:48, 30 November 2011 (UTC)

Is
Isn't the ICD-10 code of this supposed to be G56.4 (see List_of_ICD-10_codes) rather than under "other bone disorders" as it is? Causalgia redirects to here.... not knowing much about medicine I'll leave it as it is but someone please feel free to edit or reply to this!

Edit: Forget that, shall we? Didn't read the article ;)

Nippoo 12:36, 13 December 2005 (UTC)


 * Causalgia and Reflex sympathetic dystrophy are subtypes of complex regional pain syndrome. I'm going to put in a redirect here, and move most of this stuff over to a complex regional pain syndrome pageZyryab 20:15, 8 February 2006 (UTC)

Occupational therapy is also one of the main treatments —Preceding unsigned comment added by 24.29.217.64 (talk) 18:16, 6 February 2008 (UTC)

RSD Research
The first RSD CRPS research and clinical practice center was established by Hooshang Hooshmand; his book "Chronic Pain :RSD Prevention and Management"(1993) was the first book published dedicated to RSD exclusively. —Preceding unsigned comment added by 128.220.205.89 (talk) 22:34, 24 July 2008 (UTC)


 * Hello all I am family doc has studied Travell Myofascial issues for a while. I noticed the this article has no reference to the myofascial component to RSD. This component is misunderstood and is very treatable with myofascial therapy! Who would do add this valuable information? Ref: Travell and Simon's Myofascial Pain and Dysfunction (2nd Edition), by David G. Simons, Janet G. Travell,  Lois S. Simons,  Janet Travell, Hardcover, 1664 Pages, Published 1999, ISBN-10: 0683307711, ISBN-13: 978-0683307719. Srodrigu (talk) 01:44, 17 March 2013 (UTC)


 * You can add any information yourself. Be sure to include this and other literature citations in reliable journals or periodicals establishing this claim, or your edit is liable to be deleted as original research, which is not allowed. David Spector (talk) 18:59, 24 March 2013 (UTC)

some more about RSD
Reflex Sympathetic Dystrophy, RSD, is a syndrome characterized by chronic pain, tenderness, and vasomotor instability usually in a distal extremity. Lack of recognition, familiarity and a simple diagnostic test has often delayed diagnosis and proper management. There are three basic stages to RSD.1-6 The first stage usually occurs after a trauma, whether chemical, physical or mechanical. Sometimes the trauma is a minor one. Symptoms can include pain, hyperesthesia, local edema, muscle spasm, stiffness, limited mobility, vasospasms, burning pain, and hyperhydrosis. This stage is often called "sympathetic maintained pain" (SMP). The sympathetics react to the minor trauma causing what is usually a temporary vasoconstriction of the area's small vessels. This is a normal protective mechanism. For reasons poorly understood, the sympathetic reflex arc sometimes does not stop. This is an abnormal response.

In stages two and three the symptoms worsen, and dystrophic changes occur to the hair, skin, and nails. By stage three the pain is intractable, there is marked muscle atrophy, flexor tendon contractures, edema, and bone deossification (Sudeck's atrophy). By this stage the syndrome can truly be classified reflex sympathetic dystrophy syndrome (RSDS).

In the first stage, which is usually overlooked or misdiagnosed, the patient presents with chronic pain that just will not subside, with temperature changes in the hands (cold). The coldness of the extremity can easily be detected by thermography scanning. Thermography has been labeled by the Anesthesiology Department at Texas Tech University as the prime diagnostic criteria in the diagnosis of sympathetic hyperactivity in RSD and SMP.3

The pathophysiology, though poorly understood, seems to be that as trauma occurs, sympathetic afferent fibers are stimulated by local nociceptors and mechanoreceptors. A patient injured her foot, which was painful, cyanotic, cold, swollen, and hyperesthetic. Radiographs were normal, but a bone scan was positive for traumatic synovitis. A thermogram disclosed a 2o drop in temperature consistent with RSD stage one. (Fig. 1) This information is relayed to the internuncial pool at the cord level and spreads. It then stimulates efferent sympathetic stimulation causing vasospasm, myospasm, decreased thermal emission at the skin, and sometimes dystrophic changes.1-6

The thermographic findings should show a Delta T or temperature difference from right to left of at least 2oC. The criterion for nerve fiber irritation is 1oC. The normal variation from right to left in numerous studies has been shown not to exceed a few tenths of a degree. The findings are usually hypothermic and are regional. It does not follow a peripheral nerve or dermatomal pattern, but affects many surfaces of the limb. It will usually give the appearance of global nerve levels, but is actually sympathetic hyperactivity or SMP pain.

Figure 2A and 2B shows lower extremity hypothermia compatible with sympathetic hyperreflexia in a runner secondary to ankle sprain. In both cases the Delta T is greater than 3o. The possible reason for regional hypothermia and the appearance of multiple nerve level involvement is that at the spinal level one preganglionic fiber will synapse with about 100 postganglionic carrying sympathetic efferents. This will give the widespread involvement of thermal change.

If stage one, which is usually the stage in which the patient is in your office, is not recognized and then properly treated, it can and often will progress to the later severe debilitating and usually irreversible stage three RSD. By this stage, conservative care will no longer be appropriate and medical treatment such as sympathectomy and blocks are usually performed. The goal is to recognize this syndrome early on, while chiropractic treatment can have a positive effect, and while these patients are still being treated in your office. It is of utmost importance to break the sympathetic reflex via physiotherapy, exercise, manipulation, and mobilization in stage one RSD.8,9 Thermography is the diagnostic test of choice for RSD.1-9 Thermography has been demonstrated to be a highly specific and sensitive test for the diagnosis and management of RSD.2,5 Furthermore, utilizing thermography in combination with cold stress tests (autonomic challenge) has further enhanced the utility of thermography as a diagnostic aid in RSD.2,7,11,12 When a patient has chronic pain that is resistant to treatment, refer for a thermography scan to rule out RSD or SMP. If, in fact, it is afflicting the patient, you can alter your treatment approach. RSD/SMP can begin very soon after trauma. Be suspicious when the patient complains of burning, throbbing pain; coldness of extremity; hyperhydrosis; allodynia; and hyperpathia (pain and discomfort in response to just gentle touch and even moving hair follicles).

Treatment of RSD is dependent upon early recognition, and treatment is best delivered in a multidisciplinary approach utilizing physiotherapy, manipulation, exercise, and mobilization of the joint involved, as well as sympathetic blocks/injections.8,9,13 Usually a pain-management specialist such as a neurologist, physiatrist or anesthesiologist could be consulted. Since RSD can progress to stage two or three despite aggressive efforts to inhibit progression, it is best to have other medical professionals cotreating/observing the patient.

In a study by Dietz et al., on the treatment of RSD in children, published in Clinical Orthopedics and Related Research, noninvasive, nonpharmacologic management consisting of mobilization and massage was found to be effective. In another study by Duncan et al., manipulation with sympathetic blocks was also shown to be effective.8,9 In a case study published in Chiropractic Technique, a child with foot RSD secondary to ankle sprain was treated successfully by manual adjustive procedures.

It is important that the doctor of chiropractic be aware of RSD The most common symptoms are chronic pain, especially of a burning nature, allodynia hyperpathia, cold extremity, and hyperhydrosis. Thermography is considered by many in the chiropractic and medical communities to be the test of choice in early diagnosis since thermography is a window to the sympathetic nervous system. —Preceding unsigned comment added by 218.248.67.81 (talk) 18:58, 23 October 2008 (UTC)

RSD or CRPS
these are the same disease they just keepgiving it new names Reflex Sympathetic Dystrophy and Complex Regional Pain Syndrome are the same disease affecting the sympathetic nervous system I am not a doctot but I am in a wheel chair due its way of moving to opposing joints and it is not an orthopedic disease it is neurologic and because it is different in every victim there are no longer stages. The onlything they can do for you after it goes into it's incurable stage is pain medicine or death. Both unfortunately are not fun.It is rated I believe 42 on the pain index that is the same as last stage of cancer. It was discovered during the civil war and 75% of the people that live with outragous unperdictable disease are women. They are not sure why or how it happens but most people see at least 10 doctors before they are diagnoised by then they are treated by doctors that refuse to admit they are not GOD and they don't think that a sprained ankle that has been the size of a baseball bat should see a neurologist. The saddest part about this disease is that most doctors don't have the foggest idea what they are dealing with and end up pushing their patients into the incurable disease. The Sympathic Nervous System affects every major organ of the body the largest being the skin. Unforntunately this is a first hand account, I am now in a wheel chair can;t be touched.no sex drive, it changed the acidity of my saliva and ate not only the enamel of my teeth it ate the roots and the teeth under 5 crowns. Lovely. I have aged 30 years in the last ten years and I run a fever on aspirin 2 every 4 hours because I only sweat through my head. I am always cleans except for certain areas but when I over look taking my meds I look like it is raining on my head. My doctor could not believe that my skin had lost all my pores so he got the best mosterizer that could be perscribed and did a test. it went into his skin but it just sat on the top of mine, he has known me for 26 years he said I appeared to be morfing into a reptile or alien. I laugh because I cried for the first two years and all it did was make my eyes puffy and make me hurt worse which I didn't think could happen worse pain.Oh I forgot it stops your REM rapid eye movement no more dreams.you hurt to be touched and people have no idea how a loud noise can hurt you. So I went from a very healthy middle aged woman with a grown daughter to a suicidal cripple.I wouldnt kill myself, it is selfish. My daughter would have to live with that. it is bad enough to watch me deteriate. I have come to terms with my politicaly incorrect view of my self. I figure it is karma from a past life I must have been a man, sorry, you can sit and cry or you can try to keep as much of your body healthy that you can. My body is very broken from this disease I haven't had to shave my legs since 1999 but my brain is fine.My life is painful. nothing stops the pain. I have gotten use to people bathing me. And I am better with a joy stick on my wheel chair than I ever was with pac man. At one point on my right large toe I had 8 toe nails growing one after another very odd. But this disease is odd and there is no real research being done. I live in Alaska a bad place to get sick. Drs dont seem to want to move here. we have I believe 3 neurologis but it was too late to fix me by the time they figured out what was wrong with me. I am told I am one of the rare people suffering with horible disease that I wouldn't wish on my worse enemy I am positive. oh and funny. If you know someone with this disease don't think they are drug addicts or they are crazy. there are some good websites. RSD Hope and the goverment medical site on pain. and there is one more in CA that is pretty good. If you are suffering remember what doesnt kill you makes you stronger. Also a doctor in Florida told my sister that it is a disease that doesn't kill you it just makes you want to die. 5:50am Alaska time. bed time for me. Good luck to all that have this disease. And don't listen to the people that say negative things to you and yes we are alone our friends well friend is used losely were never our friends. Be kind to yourselves become an advocate tell everyone. maybe they will find a cure. —Preceding unsigned comment added by 74.61.126.17 (talk) 13:57, 18 March 2009 (UTC)

TITLE CHANGE
What should be done is to have a page for RSD that redirects you to the CRPS wiki page. — Preceding unsigned comment added by Hutch0024 (talk • contribs) 05:22, 15 May 2013 (UTC)

The title for this needs to be changed to RSD (Reflex Sympathetic Dystrophy). It may be officially CRPS, but it is still commonly known by doctors and patients alike as RSD.

Pearberr13 (talk) 12:55, 24 March 2009 (UTC)
 * Since there are two types of CRPS, and RSD is only one of them, this does not make sense. If the article was named after one of the two types, it would unduly exclude the other from view. ` The Talking Sock talk contribs 02:28, 6 May 2009 (UTC)


 * Thing is, many practitioners just use RSD, even when causalgia is the more appropriate term; to them, causalgia is a subtype of RSD, or a synonym, and CRPS might be meaningless. After all, the nomenclature was chosen fairly arbitrarily. Furthermore, since the only difference between type I and type II CRPS is nerve damage, one might easily characterize causalgia as a subtype of RSD. Not that I agree the article should be called RSD- the term should certainly redirect to CRPS as it currently does. &mdash;/M endaliv /2¢/Δ's/ 20:19, 19 September 2009 (UTC)

This is not necessary. There is currently a redirect page for RSD/CRPS. That should suffice. There is also a disambiguation page for CRPS. David Spector (talk) 19:05, 24 March 2013 (UTC)

Ketamine / NMDA overemphasized
It seems that a single author added a disproportionate amount of info about the role of NMDA in CRPS. The field of CRPS research is much broader, including the inflammatory/immune response. —Preceding unsigned comment added by 146.151.117.224 (talk) 23:09, 26 October 2009 (UTC)

Oral ketamine is miracle for my severe CRPS pain. constant burning pain drops 3-4 levels after taking — Preceding unsigned comment added by 76.171.20.101 (talk) 08:12, 14 March 2016 (UTC)

Section on Patient Experience?
It is inarguable that CRPS has a particular kind of patient experience, which is somewhat outstanding. Not to give too much voice to the rant-style comments that show up on the discussion page, but would it be completely inappropriate to include a section within the article giving some information on the experiences of patients suffering with CRPS? For instance, there are relatively few conditions which are as well documented for which patients routinely feel accused (if not persecuted) for being 'drug abusers'. There are also relatively few medical conditions for which a significant fraction of the treatment is the use of chemotherapeutic agents that are considered recreational (and exceptionally illegal) drugs by the general population. It is impossible (and false) to posit any professional disconnection of the medical practitioner from that broader society, and I suspect that most patients who are refractive to treatment by (for instance) sympathetic blocks, etc, who are on a regimen including opiates, have been urged by more than one pain specialist to consider the surgical implantation of a spinal cord stimulator, generally persistently and against vocal opposition from the patients. It seems highly relevant to include some (if small) amount of mention of such issues within the article. If nothing else, this is most certainly a component of the experience of a patient with the condition, and that information could be valuable to a support provider, such as a family member. Gaedheal (talk) 23:24, 16 November 2009 (UTC)


 * IMO a "Patient Experience" section would be inappropriate in an encyclopedic entry as it is completely variable and subjective. 99.185.96.217 (talk) 02:06, 18 February 2010 (UTC)

I agree a patient experience section would be inappropriate in an encyclopedia, however, under treatment it might be reasonable to mention that there are lots of forums and support groups available for patients to discuss this condition? Speaking as a med student, this is valuable to patients and providers especially when purely 'medical' options are exhausted. Corduroy pillows making headlines (talk) 13:50, 14 May 2018 (UTC)

With 18 years of patient experience, both good and bad medical intervention, general ignorance, and prejudice concerning rsd/crps. I would be inclined to open a dialogue with anyone who sincerely feels that patient imput/response is integral to understanding what little knowledge we have into the pathology of this devastating disease. Sixtysgirl70 (talk) 19:12, 2 July 2018 (UTC)

Does it only occur in limbs?
This page seems to imply, but not state, that CRPS occurs only, or at least predominately, in limbs. I have severe chronic pain in my spine, and this was diagnose twice as CPRS (but many more times as a plethora of other conditions). Can CRPS occur anywhere in the body, and if so what proportion of patients present with such? I think providing such information would be very useful for patients such as myself.

You are right that CRPS is "predominantly" distal, but that's not the same as "exclusively". The trouble is, as far as I can find in the literature, proximal cases are rare, so rare that they're only mentioned as a possibility but not studied. Like you I have a spinal case (RSD) which reacts enough in the same way as the distal case to make the diagnosis convincing. However there are enough differences to make it difficult to connect to any of the common literature on RSD. For example, temperature differences and edema don't work the same, so the discussion becomes especially difficult when trying to cite helpful information. Is there anyone reading this, with sufficient background in neurology or access to more obscure legit literature, to add even a paragraph on RSD in the trunk?RichardCDunn (talk) 04:02, 28 January 2014 (UTC

In response to the question "What percentage of CRPS Patients present with trunk involvement?" CRPS does not appear to be a name that appropriately defines the disorder. Yes, it may be that most cases of this disorder are identified with patients that present with a distal limb being the problem but this may be due to the fact that many doctors don't recognize the diagnosis until or unless it presents as such. The underlying mechanisms of this disorder have been misunderstood for so many years. It was originally thought that CRPS was more of a syndrome or a conglomeration of symptoms than a definable disorder because the medical profession lacked a clear understanding of the possible original patient presentations as well as the progression or stages and how they would be defined. We are not sure how many patients,who actually have CRPS, are not given the diagnoses due to inconsistencies in the definition. How can we then possibly conclude how many present with trunk involvement?Because of this lack of knowledge, I believe it is not possible to conclude what portion of the patient population present in this manner. One of the weaknesses of our medical field is it is limited by the Western School of philosophy or education shall we say. Where the body is parted into units based on its primary function. Then doctors are educated on a particular specialty. This leaves many doctors with an incomplete understanding of the integration of these functions. Humans are not a mere sum of their individual parts. We are much more complex. When our society comes to understand this maybe our definition will become a more workable tool our doctors can use.....and the answer to your question will becoming statistically reliable.http://www.ncbi.nlm.nih.gov/pubmed/12725849#

Yes it can have a systemic part, basically any system that is controlled by nerves can be affected; heart/circulation, gastrointestinal, temperature, breathing, immune system, skin, just to name a few of the autonomic nervous systems that can be adversely affected by rsd. There is also a large emotional impact that can often get overlooked. Sixtysgirl70 (talk) 18:53, 2 July 2018 (UTC)

Reference
48 & 49 are referencing to the same document —Preceding unsigned comment added by 139.80.119.152 (talk) 05:47, 12 July 2010 (UTC)

Electrodiagnostic Testing
Under the section for "Electrodiagnostic testing" I presently see the following: "EMG (Electromyography testing) should not be done for the diagnosis of CRPS I or II. It is extremely painful for patients suffering from CRPS and may even be considered unethical and cruel. This is just wrong. The EMG/NCS may be the only way to identify underlying nerve injury or alternative diagnoses"

However, when attempting to edit, all that appears is: "===Electrodiagnostic testing=== EMG (Electromyography testing) is not diagnostic for CRPS I or II, although it may be useful in the identification of any underlying nerve injury."

The first statements above ("EMG (Electromyography testing) should not be done for the diagnosis of CRPS I or II. It is extremely painful for patients suffering from CRPS and may even be considered unethical and cruel. This is just wrong") are inaccurate, charged & sensationalized, and should be removed. Many diagnostic tests involve some degree of risk or discomfort (eg. CT scans involve exposure to a significant amount of radiation, and bone scans involve even more exposure). EMG and NCS certainly involve some discomfort (needles are involved in EMG, and NCS involves shocks that are similar to a rubber bland snapping on the skin). As long as the patient is aware of the risks of the procedure, the fact that it will involve some discomfort (thorough "informed consent" is obtained) then there is nothing unethical or cruel about the procedure itself. Although allodynia is often a hallmark of CRPS, not all patients experience it, let alone to a degree where it contraindicates a 20 minute electrodiagnostic study that will yield useful information.

I have added/suggested the following:

Electromyography (EMG) and Nerve Conduction Studies (NCS) are very important ancillary tests in CRPS because they are among the most reliable methods of detecting nerve injury. They can be used as one of the primary methods of distinguishing between CRPS I & II, which differ based on whether there is evidence of actual nerve damage. EMG & NCS are also among the best tests for ruling in or out alternative diagnoses. The definition of CRPS relies on having no alternate diagnosis that can account for the patient's symptoms (ie. it is a "diagnosis of exclusion"). This is very important to emphasize, because otherwise patients can be given a wrong diagnosis of CRPS when they actually have a treatable condition that better accounts for their symptoms. An example is severe Carpal Tunnel Syndrome, which can often present very similar to CRPS, but can be corrected with surgery. — Preceding unsigned comment added by 70.64.20.106 (talk) 00:16, 7 December 2011 (UTC)

Clarification requested
In order to be sure that the Portuguese title was translated correctly, I need to know whether complex is related to pain or to syndrome: I suppose it's a "complex syndrome", right? Thanks for any help. capmo (talk) 22:24, 26 August 2012 (UTC)
 * I do not know the answer for sure, but I do not understand how the pain itself can be characterized as more or less &#8220;complex,&#8221; and the syndrome may involve the interaction of many different physiological processes, so I think that it is the syndrome that is &#8220;complex.&#8221; 71.178.188.47 15:42, 15 February 2013 (UTC)

Guanethedene
The first paper saying Guanethedene was useless against RSD was published in 1993 in the US and 7 further studies confirmed this. It was not until May this year that the Royal College of Physcians published a paper saying the same thing. This is just one of many examples I could give you showing why my campaign is vital. One more is that in June last year I recieved an e-mail saying my specialist was trying to raise funds to send me to Germany for the 5 day Ketamine coma, that was 18 months after I had read that Germany had banned it due to a number of Patients not coming out of the coma and at least one death. I am working with two of the top American Sites to turn November 2013 into International RSD Awareness Month, currently only America has a National Awareness Month. Please spare 5 1/2 mins to watch this video but be aware you may find some of the images disturbing. http://www.youtube.com/watch?v=MviVcjWZDts it is vital that you watch it to the end If you are newly diagnosed I strongly suggest you do not watch it. If you live in the UK please sign http://epetitions.direct.gov.uk/petitions/31344 E-mail the link to your MP asking why since being informed on 30/10/2010 David Cameron, Nick Clegg and The DOH have refused to do anything about the situation If you live in another Country can you start your own petition and send the link to your own Politicians If you are willing to commit to spending 15mins a day for 4 weeks then 15mins a week to help spread this then please e-mail me (e-mail address removed) Kevin

I moved this from the article to the talk page. However, Kevin, the article only should have encyclopedic facts, and the talk page should only have discussions about the article. For campaigning you need to go somewhere else. Lova Falk    talk   10:43, 3 November 2012 (UTC)

Vitamin C
The current version of this article says that "Daily vitamin C has been shown to reduce the chance for the occurrence of CRPS after an injury, leading to calls for greater awareness, especially in the emergency room setting. In two placebo-controlled randomized clinical trials Zollinger et al. showed that patients who took 500 mg of vitimin C daily after a wrist fracture were less likely to incur the problem." The change.org petition is evidence of calls for greater awareness, but I would like to add a citation to more WP:MEDRS. This article, for example, reviews 4 clinical trials, and originally I wanted to simply insert a &lt;ref&gt; citation &lt;/ref&gt; to this study after “...has been shown to reduce the change for the occurrence of CRPS after an injury,” but then I realized that I lack the requisite scientific knowledge to determine whether the study actually supports the assertion as written. Therefore, I shall leave the citation here on the talk page and let others decide what to do with it. 71.178.188.47 (talk) 15:33, 15 February 2013 (UTC)

Type two is different than type one in several ways
Regardless of the following challenge on change and reversion, the very first sentence of the page needs to be fixed. It states, "Complex regional pain syndrome (CRPS), formerly reflex sympathetic dystrophy (RSD) or "causalgia",…" Thie "or" part is misleading in the extreme--it implies that RSD and causalgia are two names for the same thing. In fact, RSD is CRPS-I (CRPS type 1) but causalgia is CRPS-II. This is made clear a little bit down in the text, but let's not get off on the wrong foot.RichardCDunn (talk) 04:12, 28 January 2014 (UTC)

An earlier edit of this article has been reverted for the wrong reason. The editor Grapestomper9 noted that when a person with type2 with say a head or face injury causing the pain is faced with a new injury such as a herniated disc, the herniated disc should be dealt with either surgically or with adequate painkillers, whichever the case merits. Another editor has stated that surgery is not a good idea for people wit CRPS. Well, type 2 is different. In the above example, a tye 2 patient with head or face pain suddenly confronted with a herniated (Low Back) disc should do whatever is necessary to alleviate the pain of the new nerve injury. The edit in question would only apply to type 1 where the whoe body is at rish for becoming painful. In type one, surgery is someting to be avoided, not type 2 when it is for something other than the source of type 2 pain.50.174.89.101 (talk) 08:00, 8 October 2013 (UTC) As there has been no opposition to this suggestion for reversion to the original Grapestomper addition, I think the reversion should be reverted back to the original Grapestomper edit.50.174.89.101 (talk) 09:08, 25 October 2013 (UTC)
 * The revert won't be happening, since this IP has been used by blocked user Dunkmack9, and Grapestomper9 is one of his socks. In fact the IP you are using has been used by Dunkmack9 in the past, so you are in fact socking right now. -- Diannaa (talk) 23:48, 25 October 2013 (UTC)

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Help - Reflex neurovascular dystrophy needs sources and/or to be merged
Can people who know about complex regional pain syndrome please edit reflex neurovascular dystrophy? I can't find any reliable sources via Google. Thank you. 12.180.133.18 (talk) 03:04, 12 September 2015 (UTC)

UK guideline - RCP
ISBN 978-1-86016-480-4 (2012). "Concise" but 84 pages. JFW &#124; T@lk  17:32, 26 November 2015 (UTC)

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Mirror box, tactile discrimination training and graded motor imagery are types of physical and occupational therapy
Therapy section was edited in the past and it is now unclear that the treatments above are part of physical therapy — Preceding unsigned comment added by 2605:E000:841A:B000:85F9:D07:BA0D:6C5 (talk) 21:27, 2 November 2017 (UTC)

Proposing Edit to Treatment Description in Box
I am proposing a change to the treatment description within the boxed section.

Current description: “Physical therapy (more effective with early diagnosis); medications (e.g., anticonvulsants, opioids, muscle relaxers, etc.); sympathetic nerve blockade; ketamine infusions; lidocaine infusions; implantable pharmaceuticals; amputation”

Edit would read: “Exercises (under the guidance of a physical therapist); medications (see list); sympathetic nerve blockade (largely historical); implantable pharmaceuticals; amputation”

Rational:

Physical therapy is a profession, not a treatment. Additionally, these treatments have show limited supportive evidence and warrants further discussion.

Opoids also need careful discussion and should not be prominently featured.

The IASP changed the name from RSD to CRPS because it feels that the evidence is clear that the sympathetic nervous system is not involved. Unecomeditor1 (talk) 14:08, 22 November 2023 (UTC)

Proposing Edit to move a paragraph from Signs and Symptoms Section
I am suggesting that the first paragraph of the "Signs and Symptoms" section should be moved to another section. The paragraph reads as follows:

"Clinical features of CRPS have been found to be inflammation resulting from the release of certain pro-inflammatory chemical signals from surrounding nerve cells; hypersensitization of pain receptors; dysfunction of local vasoconstriction and vasodilation; and maladaptive neuroplasticity."

These are not clinical features. This is current speculation about pathophysiology and etiology, and should be moved to the appropriate section. Unecomeditor1 (talk) 20:13, 1 December 2023 (UTC)


 * Where would you propose it be moved? Perhaps the "Cause" section? Kimen8 (talk) 20:36, 1 December 2023 (UTC)
 * I suggest it be moved to pathophysiology. Looking at that section, I see that these considerations are already addressed there. So it could simply be deleted in the "symptoms" section. Unecomeditor1 (talk) 21:47, 1 December 2023 (UTC)
 * That seems reasonable. Those listed features are not symptoms, but are they also not "signs"? Kimen8 (talk) 21:52, 1 December 2023 (UTC)
 * While inflammation and hypersensitivity are processes noted in CRPS, they are not specific only to CRPS. Many disease processes involve inflammation and hypersensitivity, therefore, they are not signs specific to CRPS.
 * The discussion still needs to be mentioned, but it belongs in the pathophysiology section. Unecomeditor1 (talk) 00:08, 2 December 2023 (UTC)

Removal of Paragraph from "Signs and Symptoms"
Discussing the removal of the following paragraph, as it seems irrelevant in a distracting way.

"Symptoms may change over time, and they can vary from person to person. The more dynamic symptoms (especially vascular aspects (edema, temperature) and the location of pain) can change numerous times each day."

What is the purpose or benefit of emphasizing changes? Unecomeditor1 (talk) 16:23, 8 December 2023 (UTC)

Discussion of Edit to final paragraph of "Signs and Symptoms"
The paragraph was edited because a key aspect that characterizes CRPS is the absence of experimental data. Unecomeditor1 (talk) 16:32, 8 December 2023 (UTC)


 * Can you explain how this source you used in this edit is relevant? For reference, you changed
 * "Patients may develop burning pain and allodynia in either form of CRPS. Both forms of the syndrome are also characterized by autonomic dysfunction, which presents with temperature changes (usually localized, but can be global), cyanosis, and/or edema." to "Other findings are aspects of disuse including swelling, stiffness (limited range of motion), and disuse related changes to the skin (temperature, color) and bones (disuse osteoporosis)." The reference you added has no mention of CRPS and it's not clear how the change (or source) is relevant. Kimen8 (talk) 17:21, 15 December 2023 (UTC)

Removal of Two Images
I am proposing the removal of the two images located beneath the table summarizing CRPS. They are not a good representation of CRSP and are frightening. Unecomeditor1 (talk) 16:07, 15 December 2023 (UTC)

Using the word "association" instead of "cause" for CRPS
Since there is no measurable pathophysiology that corresponds with illness described as CRPS, we should avoid the words of cause and effect or of etiology. We should only speak of associations. Unecomeditor1 (talk) 22:49, 17 December 2023 (UTC)


 * This is patently false; even a cursory Google search yields articles published in well-regarded peer-reviewed journals with “CRPS” and “pathophysiology” in the shared title. Please be cautious in your use of pathophysiology. Furthermore, the link between "measurable" and "cause" that you're suggesting is misleading. J E F-T (talk) 05:28, 3 January 2024 (UTC)
 * The condition is still a syndrome with no measurable pathophysiology. If you have evidence of experimentally verifiable pathophysiology, that would be of interest to me.  I study this and similar conditions and this would be new to me. Unecomeditor1 (talk) 16:12, 3 January 2024 (UTC)
 * Easily accessible reviews of CRPS-I and -II pathophysiology are abundant. If you're looking for diagnostic biomarkers available for clinical use as evidence of "experimentally verifiable pathophysiology," CRPS, like many other conditions of the nervous system (e.g., MDD, bipolar disorder, PD, ASD, or ADHD), is unfortunately without one as of January 2024. If you're looking for reviews of CRPS pathophysiology as measured in experimental settings, please read the following recent articles:
 * 1. Syndrome: A Comprehensive Review. J Pain Res. 2023;Volume 16:3061-3073. doi:10.2147/JPR.S423733
 * 2. Birklein F, Ajit SK, Goebel A, Perez RSGM, Sommer C. Complex regional pain syndrome — phenotypic characteristics and potential biomarkers. Nat Rev Neurol. 2018;14(5):272-284. doi:10.1038/nrneurol.2018.20
 * 3. Cuhadar U, Gentry C, Vastani N, et al. Autoantibodies produce pain in complex regional pain syndrome by sensitizing nociceptors. Pain. 2019;160(12):2855-2865. doi:10.1097/j.pain.0000000000001662
 * 4. Marinus J, Moseley GL, Birklein F, et al. Clinical features and pathophysiology of complex regional pain syndrome. Lancet Neurol. 2011;10(7):637-648. doi:10.1016/S1474-4422(11)70106-5
 * 5. Lloyd ECO, Dempsey B, Romero L. Complex Regional Pain Syndrome. Am Fam Physician. 2021;104(1):49-55.
 * 6. David Clark J, Tawfik VL, Tajerian M, Kingery WS. Autoinflammatory and autoimmune contributions to complex regional pain syndrome. Mol Pain. 2018;14:1744806918799127. doi:10.1177/1744806918799127
 * 7. Scheuren PS, De Schoenmacker I, Rosner J, Brunner F, Curt A, Hubli M. Pain-autonomic measures reveal nociceptive sensitization in complex regional pain syndrome. Eur J Pain Lond Engl. 2023;27(1):72-85. doi:10.1002/ejp.2040 J E F-T (talk) 00:25, 4 January 2024 (UTC)
 * Thanks. That is helpful.  Our sense is that those studies are speculations and early investigations rather than solid evidence. Among experts, it is widely agreed that CRPS is still a syndrome.  We'll get to work on a systematic review of the available evidence regarding pathophysiology. Unecomeditor1 (talk) 15:03, 5 January 2024 (UTC)

Speculation regarding subtype pain intensities
Stating that type II is more painful than type I may not be accurate. Most "knowledge" regarding CRPS is speculative because the absence of experimental verification makes it difficult to address with scientific experiments. I'm not aware of any evidence that supports the contention that proposed subtypes vary in mean pain intensity. Unecomeditor1 (talk) 22:57, 17 December 2023 (UTC)

AMPS claim unsourced
CRPS, especially type II, is not commonly referred to as a form of AMPS in the literature. CRPS may have some overlap with AMPS in symptomatology, but the pathophysiologies are not synonymous enough to classify CRPS as a type of AMPS. The causal mechanisms of the CRPS types differ; lumping them under AMPS as one condition is inaccurately representing them as such. Furthermore, no reference to a peer-reviewed source was provided to make the claim in the introduction. J E F-T (talk) 05:21, 3 January 2024 (UTC)