RSD tests?

[Lilly]

Hi,
I've got a question....is there a specific test they can do to dx RSD?
Or is the disease dx'd by symptoms only? Can it be proven?
Spring....I tried to PM you, but you have turned off your acceptance of pms.
Lilly

[Lilly]

Hi all....this got buried, so I'm just bumping it up
Lilly

[Sithie]

Lilly mine was proven with a QSART test, it is I think the only definitive test there is. Bone scans are often wrong as it will not show up there til very late.

http://www.coloradorehab.com/qsart.shtml

Hope this helps,
Sithie

[Spring]

Hi Lilly....Sorry, I have missed this post some how. And my PM's are working okay as far as I can tell. Or at least I was able to get all the PM's for the Bingo Game....who knows.

I hope you have been able to read the other thread that was just posted about RSD...I will bring it to the top so you can see it to. I am going to list some information about some of the things they are using to help diagnosis RSD.



RSD: Role of Bone Scans

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- Bone scan:
- generally considered sensitive but not specific;
- bone scans may help to r/o associated conditions such as a stress frx;
- Triphasic Bone Scan:
- may add higher degree of specificity;
- first stage is the radionucleotide arteriogram:
- increased uptake is suggestive of RSD;
- second stage is the blood pool stage:
- this is suggestive of RSD if there is diffuse increase in activity in the MCP and juxta articular regions of the digits;
- third stage is the delayed stage (typically 3-4 hours)
- is suggestive if there is diffuse assymetric uptake in radiocarpal, intercarpal, MCP and IP joint in the affected limb;
- third phase is the most important phase;


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Qsart Test for RSD

Mayo Clin Proc. 1996;71:524-525 © 1996 Mayo Foundation for Medical Education and Research

Letters
Reflex Sympathetic Dystrophy—Reply
In response: Editorials are intended for commentary on articles offering news that might influence understanding of a broad subject—by breakthrough…or by breakdown. Chelimsky and colleagues, who cast the news that the sweat test is 94% specific for “reflex sympathetic dystrophy” (RSD), oppose my editorial and the fact that it addressed RSD at large, rather than just their retrospective article. Some readers appreciated that my editorial made them aware of evidence that RSD is a magical concept; that patients with the label RSD remain undiagnosed pathophysiologically; that the gold standard “test” for “sympathetically maintained pain”—a subjective statement after a poorly placebo-controlled sympathetic block—is flawed; that experimental nerve trauma in animals could not be a model for the heterogeneous population of patients with organic, psychogenic, or malingering RSD; and that psychiatric somatization often determines a clinical profile of RSD.

Chelimsky and associates state that increased resting sweat output predicts the diagnosis of RSD with 94% specificity and 98% specificity when combined with an abnormal quantitative sudomotor axon reflex test result. Thus, the test result would very rarely be positive in patients without RSD. It is inconceivable that a pathologically heterogeneous population could express, with near absolute specificity, a physiologic anomaly of sweating amounting to an evidential, not a spurious, link. Besides, the same population of about 400 patients had been assessed by these investigators in 1991 as yielding negligible significance: “a mild correlation between clinical score and…resting sweat output (RSO) (p=0.05), but not quantitative sudomotor axon reflex test (QSART).”1 How could informed readers (the authors’ 1991 abstract is not cited in their 1995 article) accept validity of the newfound 94%?

Chelimsky and coworkers imply that I diminish the role of the experimental animal. While I respect, encourage, and perform animal research, I also argue that the specific animal model of nerve injury misrepresents patients with RSD.2 Nerve injury in animals cannot reflect psychosomatic pseudoneuropathy.3 The issue of animal models of human disease is truly “old hat,” and its Achilles’ heel is well illustrated in peer review: good and bad animal science exists.4

What disables the current material is not the term “RSD” with which the authors label those 400 patients but their assumption that these patients form a homogeneous population legitimately approachable for clinical scientific research. This misunderstanding has been acknowledged in the past: “I can’t define it [RSD], but I know it when I see it.”5 Indeed, in my opinion, the patients studied by Chelimsky and colleagues only had in common that they looked alike. It is refreshing that at least one of the authors seems to have been aware of that.

José L. Ochoa, D.Sc., M.D., Ph.D.


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Complex regional pain syndrome/RSD
Introduction
Complex regional pain syndrome (CRPS) is an uncommon, chronic condition that usually affects your arm or leg. Rarely, the disease can affect other parts of your body. You may experience intense burning or aching pain along with swelling, skin discoloration, altered temperature, abnormal sweating and hypersensitivity in the affected area.

The nature of complex regional pain syndrome is puzzling, and the cause isn't clearly understood.

Women are more likely to be affected by complex regional pain syndrome than men are. Although complex regional pain syndrome is most common in people between the ages of 40 and 60, it can occur at any age. Treatment for complex regional pain syndrome is most effective when started early in the course of the syndrome.

Signs and symptoms
The main symptom of complex regional pain syndrome is intense pain, often described as "burning." Additional signs and symptoms include:

Skin sensitivity.
Changes in skin temperature, color and texture. At times your skin may be sweaty; at other times it may be cold. Skin color can range from white and mottled to red or blue. Skin may become tender, thin or shiny in the affected area.
Changes in hair and nail growth.
Joint stiffness, swelling and damage.
Muscle spasms, weakness and loss (atrophy).
Decreased ability to move the affected body part.
Complex regional pain syndrome typically has three stages, though not everyone progresses through these phases at the same pace:

Stage 1. Severe pain develops in one of your limbs. Swelling, sensitivity to touch or to cold, and skin changes, such as drying or thinning, begin to appear. This stage usually lasts one to three months.
Stage 2. Changes to the color and texture of your skin become increasingly obvious, and the swelling spreads. You may begin to feel stiffness in your muscles and joints. This stage may last three to six months.
Stage 3. Severe damage is evident, such as limited movement in your affected limb, irreversible skin damage, muscle atrophy and contractures in nearby digits.
Causes
Complex regional pain syndrome occurs in two types with similar signs and symptoms, but different causes:

Type I. Previously known as reflex sympathetic dystrophy syndrome, this type occurs after an illness or injury that didn't directly damage the nerves in your affected limb. About 90 percent of people withcomplex regional pain syndrome have type I.
Type II. Once referred to as causalgia, this type follows a distinct nerve injury.
Many cases of complex regional pain syndrome occur after a forceful trauma to an arm or a leg, such as a gunshot wound or shrapnel blast. Other major and minor traumas — surgery, heart attacks, infections, fractures and even sprained ankles — also can lead to complex regional pain syndrome. It's not well understood why these injuries sometimes trigger complex regional pain syndrome.

The syndrome was first described after the U.S. Civil War when soldiers continued to report severe pain after their wounds had healed. It was often referred to as "hot pain" during that period.

When to seek medical advice
If you experience constant, severe pain that affects a single limb and makes touching or movement of that limb seem intolerable, see your doctor to determine the cause. It's important to treat complex regional pain syndrome early.

Screening and diagnosis
Your doctor may base a diagnosis of complex regional pain syndrome on:

Review of your medical history. The onset of complex regional pain syndrome symptoms can often be traced back to an accident, illness or injury.
Physical examination. An examination of your skin, muscles and joints may reveal information about the source of your tenderness and pain. There may be changes in the normal texture and color of your skin, and you may have problems with range of motion of one or more of your joints.
Bone scan. A radioactive substance injected into one of your veins permits viewing of your bones with a special camera. This procedure may show increased circulation to the joints in the affected area.
Sympathetic nervous system tests. These tests look for disturbances in your sympathetic nervous system. For example, thermography measures the skin temperature and blood flow of your affected and unaffected limbs. Other tests can measure the amount of sweat on both limbs. Dissimilar results can indicate complex regional pain syndrome.
X-rays. Loss of minerals from your bones may show up on an X-ray in later stages of the disease.
Magnetic resonance imaging (MRI). Images captured by an MRI device may show a number of tissue changes, such as skin thinning and muscle atrophy, that may help your doctor determine the stage of your disease.
Complications
If complex regional pain syndrome isn't diagnosed and treated at an early stage, the disease may progress to more disabling signs and symptoms. If you avoid moving an arm or a leg because of pain, or if you have trouble moving a limb because of stiffness, your skin and muscles may begin wasting (atrophy). You may also experience tightening of your muscles. This may lead to a condition in which your hand and fingers or your foot and toes contract into a fixed position.

The illness may also spread from its source to elsewhere in your body in these patterns:

Continuity type. The symptoms may migrate from the initial site of the pain — for example, from your hand to your shoulder, trunk and face — affecting a quadrant of your body.
Mirror-image type. The symptoms may spread from one limb to the opposite limb.
Independent type. Sometimes, the symptoms may leap to a distant part of your body.
Treatment
Dramatic improvement and even remission of complex regional pain syndrome is possible if treatment begins within a few months of your first symptoms. Treatment options include:

Medications. Doctors use various medications to treat the symptoms of complex regional pain syndrome. Over-the-counter nonsteroidal anti-inflammatory drugs (NSAIDs), such as aspirin, ibuprofen (Advil, Motrin, others) and naproxen sodium (Aleve), may ease pain and inflammation. In some cases, doctors may recommend prescription medications. For example, antidepressants such as amitriptyline and anticonvulsants such as gabapentin (Neurontin) are used to treat pain that originates from a damaged nerve (neuropathic pain). Corticosteroids, such as prednisone, may reduce inflammation.

Your doctor may suggest bone-loss medications, such as alendronate (Fosamax) and calcitonin (Miacalcin). Opioid medications may be another option. Taken in appropriate doses, they may provide acceptable control of pain. However, they may not be appropriate if you have a history of substance abuse or lung disease.

Some pain medications, such as COX-2 inhibitors (Celebrex), may increase your risk of heart attack and stroke. It's wise to discuss your individual risk profile with your doctor.

Applying heat and cold. Applying cold may relieve swelling and sweating. If the affected area is cool, applying heat may offer relief.
Capsaicin. This cream, made from the seeds of hot chili peppers, may relieve pain caused by nerve damage in early-stage complex regional pain syndrome. Your doctor may recommend applying the cream to the affected area several times daily. Capsaicin cream can be very irritating if rubbed on nonaffected parts of your body. Follow the application instructions carefully. You should be able to tell within a week whether the treatment is effective and tolerable.
Physical therapy. Gentle, guided exercising of the affected limbs may improve range of motion and strength. The earlier the disease is diagnosed, the more effective exercises may be.
Sympathetic nerve-blocking medication. Injection of an anesthetic to block pain fibers in your affected nerves may relieve pain in some people.
Transcutaneous electrical nerve stimulation (TENS). Chronic pain is sometimes eased by applying electrical impulses to nerve endings.
Biofeedback. In some cases, learning biofeedback techniques may help. In biofeedback, you learn to become more aware of your body so that you can relax your body and relieve pain.
Spinal cord stimulation. Your doctor inserts tiny electrodes along your spinal cord. A small electrical current delivered to the spinal cord sometimes results in pain relief.
Coping skills
Living with a chronic, painful condition can be challenging, especially when — as is often the case with complex regional pain syndrome — your friends and family don't believe you could be feeling as much pain as you describe. Share information from reliable sources about complex regional pain syndrome with those close to you to help them understand what you're experiencing.

Take care of your physical and mental health by following these suggestions:

Maintain normal daily activities as best you can.
Pace yourself and be sure to get the rest that you need.
Stay connected with friends and family.
Continue to pursue hobbies that you enjoy and are able to do.
If complex regional pain syndrome makes it difficult for you to do things you enjoy, ask your doctor about ways to get around the obstacles.

Keep in mind that your physical health can directly affect your mental health. Denial, anger and frustration are common with chronic illnesses.

At times, you may need more tools to deal with your emotions. Professionals such as therapists or behavioral psychologists may be able to help you put things in perspective. They can also teach you coping skills that may help you, including relaxation techniques.

Sometimes, joining a support group, where you can share experiences and feelings with other people, is a good approach. Ask your doctor what support groups are available in your community.


Lilly..Hope this helps you out. If not I will contuine looking for things to help your understand. And if you have any questions please just ask. I so hope this all makes some sense...I have been dealing with a awful flare up for the last few weeks. In fact can only focus through one eye tonight...the pain has the best of me. I was down in bed from 1:00pm yesterday till 7:30 am today. Sometimes the pain at times like that...there isn't anything I can but wait it out...and take my medications. Then today has just been the kind that you creep around the house....praying you don't stir something up within yourself to bring it back full force. I am sure you know what I am talking about. Since there is no reason to why with RSD that we have these major flare ups. I am just now praying tat I will be able to go to bed and sleep. I hope someday they will find a cure or atleast something to explain why some of this is happening to our bodies. Until then we will just have to stick together...and support each other. I will bump up the other post so you can see and read it too. Talk with you soon.

[Lilly]

THANKS ALL! Great info
Lilly

[Sithie]

On my QSART, I have absoluly no sweat output on that limb. Resting or while they are attepting to make it sweat.

Sithie

I think the key is to get in to and RSD specialist at least once.