ABDOMINAL MUSCLES
The flat, bandlike muscles on the front of the trunk that are attached to the pelvis below and the rib cage above.
ACETYLCHOLINE
A neurotransmitter that slows heart rate; it is controlled by the parasympathetic nervous system.
ACUTE PAIN
What was the worst pain you can remember? Was it the time you scratched the cornea of your eye? Was it a kidney stone? Childbirth? Rare is the person who has not experienced some beyond-belief episode of pain and misery. Mercifully, relief finally came. Your eye healed, the stone passed, the baby was born.
In each of these cases, pain flared up in response to a known cause. Doctors call that kind of pain ACUTE PAIN. It is a normal sensation triggered in the nervous system to alert you to possible injury and the need to take care of yourself.
ACUTE PHASE/STAGE
Typically what is described as the First Stage of CRPS.
Stage one is called the acute stage and can last one to three months.
Some characteristics are warmth, coolness, burning pain, edema, increased sensitivity to touch, increased pain, accelerated hair/nail growth, tenderness or stiffness in the joint, spasms, limited mobility, some bony changes may be visible on X-Ray, abnormal amount of pain for the injury. In this stage there is decreased sympathetic activity. For the patient, she, typically a she, may feel as if their limb is on fire and is amazed when it actually feels cool to the touch (this is due to the lack of blood flow to the extremities).
Read more about the Stages of CRPS here.
ADDICTION
Characterized by loss of control over opioid use and continued use of despite negative consequences; typically a psychiatric diagnosis. Is also used to refer to alcohol, many other drugs, habits, etc.
This is very different from “Dependence” and “Tolerance”.
People who take a class of drugs called opioids for a long period of time may develop tolerance and even physical dependence.This does not mean, however, that a person is addicted. In general, the chance of addiction is very small when narcotics are used under proper medical supervision.
Some medications used to treat pain can be addictive. Addiction is different from physical dependence or tolerance, however. In cases of physical dependence, withdrawal symptoms occur when a substance suddenly is stopped. Tolerance occurs when the initial dose of a substance loses its effectiveness over time. Addiction and physical dependence often occur together.
See additional terms in this section; Tolerance, Dependence and/or read the article Addiction, Dependence, or Tolerance.
ALENDRONATE
A drug that slows bone resorption. As Fosamax, has FDA approval for postmenopausal women with bone loss or osteoporotic fractures and for prevention of osteoporosis.
ALLODYNIA
Extreme pain is produced by stimuli that do not normally induce pain (such as touch, pressure, warmth). This hypersensitivity is a large part of the RSD equation and explains why something as simple as the touch of clothing, sheets, a breeze, or the light touch of another person, can cause extreme pain. What other stimuli could produce pain? Some examples might include vibrations from riding in a car, a passing thunderstorm, the loud noises produced by a crowd of people, organ/piano music at your church, your dog brushing up against your affected limb, the hum of a hair-dryer, the loud rhythms of a passing cars stereo, a crying baby at the grocery store, etc.
The next time that you are in a mall sit down and close your eyes (hopefully you are near a chair). Listen for a few minutes to the myriad of noises around you and think what you would feel like if most of those noises caused you pain; how that would affect your life.
The term allodynia was originally introduced to separate from hyperalgesia and hyperesthesia, the conditions seen in patients with lesions of the nervous system where touch, light pressure, or moderate cold or warmth evoke pain when applied to apparently normal skin.
AMYGDALA
A part of the brain’s limbic system involved in memory and emotion.
ANALGESIA
Absence of pain in response to stimulation which would normally be painful. As with allodynia, the stimulus is defined by its usual subjective effects.
ANESTHESIA DOLOROSA
Pain in an area or region which is anesthetic.
ANTI-INFLAMMATORY
Agents that reduce inflammation without directly antagonizing the agent that caused it.
ANTIDEPRESSANTS
Pharmaceutical agents used to treat clinical depression. See our RSD TREATMENTS section for more information.
ANTIOXIDANTS
Vitamins such as C and E that inhibit oxygen-based free radicals.
ATROPHY
A wasting of a normal developed organ or tissue due to degeneration of cells. This may be due to disease, aging or undernutrition.
AUTOIMMUNE DISEASE
Disorders in which the body mounts a destructive immune response against its own tissues.
AUTONOMIC NERVOUS SYSTEM
The part of the nervous system responsible for the control of bodily functions that are not consciously directed; including heartbeat, intestinal movements, sweating, etc.
AUTONOMIC TESTING
The Autonomic Test is usually a series of Seven Tests conducted while monitoring your blood pressure and heart rate. They consist of; Tilt Table Test, Deep Breathing Test, Valsalva Maneuver, Thermoregulatory Sweat Test, Quantitative Sweat Axon Reflex Test, Resting Sweat Output Test, Limb Volume Displacement. What are they looking for? They are trying to determine if your Autonomic Nervous System is functioning correctly and if not, where is it malfunctioning? The University Hospitals of Cleveland has an excellent explanation of Autonomic Testing.
AXON
The part of the neuron that transmits a signal to the next cell.
BASIL GANGLIA
Clusters of neurons deep in the brain that play an important role in movement.
BI-POLAR DISORDER
A mood disorder that commonly begins with depression and is characterized by at least one period of elation sometime during the course of the illness.
BONE SCAN OR BONE DENSITY SCAN
A test, also called Tri-Phasic Bone Scan, sometimes used to check for the presence of damage caused by CRPS to the bones. It will usually show an increased uptake but not always.
As with many other tests used for CRPS, it should not be used as a sole diagnostic tool as it CAN show the presence of CRPS but doesn‘t ALWAYS detect it, depending on the stage the patient is in, other medical issues going on with the patient etc..
It is best used as a baseline from which the Dr can compare future bone scans to to determine progress of bone/density loss.
SEE ALSO THREE- PHASE OR TRI-PHASIC BONE SCAN
BONE SCAN – Part Two
Should Bone Scans, or Tri-phasic Bone scans as they are sometimes called, be used in diagnosing CRPS? Are they a useful tool? Are they a definitive test? Can they be used to absolutely rule in or out CRPS? The answer is no, they cannot be used to absolutely rule out a diagnosis of CRPS. They can sometimes show a diagnosis but they can also be incorrect in up to 50-55% of cases! There currently does not exist an accurate test to rule in our out the diagnosis of CRPS, other than the skill of a trained and experienced physician doing a clinical examination of the patient. The physician can use tools such as x-rays, bone scans, blood-work, strength tests, medical history, and physical examination in combination to help him make the diagnosis but none of these by themselves is enough to stand alone as a diagnositic tool. Here is some information on the Bone Scan as provided by Doctors Gilbert W. Lee and Paul M. Weeks in a study the published in the Journal of Hand Surgery in January of 1994.
Received 27 January 1994; accepted 27 September 1994. Available online 14 December 2006.
“Three-phase bone scintigraphy is used often to diagnose reflex sympathetic dystrophy of the hand. This study presents an analysis of the literature relating three-phase bone scanning to reflex sympathetic dystrophy in the upper extremity. The data show a wide variability in scintigraphic accuracy in patients with clinically obvious reflex sympathetic dystrophy. The results of bone scintigraphy correlate best with the clinical diagnosis of reflex sympathetic dystrophy within the first 20–26 weeks of onset. Even then, the sensitivity in the most recent series approximates 50%. After 26 weeks, there is a poor correlation between three-phase bone scanning and reflex sympathetic dystrophy. Consequently, three-phase bone scintigraphy should not be used as a major criterion in diagnosing reflex sympathetic dystrophy. The diagnosis of reflex sympathetic dystrophy remains a clinical diagnosis made by an experienced hand surgeon”
Yet there are still Doctors who use this test as a way to rule in or out an CRPS diagnosis. As Doctor Hooshang Hooshmand once noted, “If I have a heart attack and they tell me that they are going to do a test that has 55% chance of diagnosing my heart attack, obviously I’m not going to consent to such a test.” There are many reasons why bone scans are not accurate, from the spreading of CRPS to the changes in bone circulation that take place during the different stages of CRPS, and diseases that mimic CRPS like arthritis. Now bone scans can be helpful in ruling out some things when considering the diagnosis of CRPS; things like stress fractures. The tri-phasic bone scan in particular;
- 1st stage is radionucleotide arterigram: increase uptake is suggestive of CRPS
- 2nd stage is the blood pool stage: increase activity in the juxta-articular region is suggestive of CRPS
- 3rd stage is delayed stage (3-4 hr ) it is suggestive if there is diffuse asymmetric uptake in the small joints of affected limb
Another tool often used is “bone densitometry. Recent studies have shown that reduction in bone density, as measured by radiographic scoring system and single photon absorpitometry , was greater and more prolonged after fracture complicated with RSD than fracture without RSD ( Bickerstaff DR, Charlesworth D, Kanis JA).
Some other things to note; Findings on the bone scan depend to a great extent on the stage of the disease and the age of the patient. The studies done so far on CRPS using bone scans have shown a much greater incidence of lower-extremity CRPS in teens than in adults. Most studies show an average of 30% of lower-extremity CRPS patients had normal scans. So having said that, do bone scans have a role in the diagnosis or treatment of CRPS? The answer is yes and no. The scans can be useful but they should not be used as the sole diagnostic tool. A diagnosis of CRPS should be a clinical one. The bone scan is just one of the many things that the Doctor can factor into that diagnosis but by no means should it be the determining factor. Other factors should include; the physical symptoms presented by the patient (burning, aching, stabbing, allodynia (sensitivity to touch), tingling, shooting, etc.); motor dysfunction in the form of muscle spasm, fatigue, weakness, tremor, and constriction of blood vessels; inflammation, swelling, shiny red skin, rash, etc; insomnia/emotional disturbance (changes in the limbic system of the brain, short-term memory loss, concentration difficulties, etc.) See CRPS – signs and symptoms
Bone scans are also sometimes helpful in tracking the progress of your CRPS. When a bone scan is taken on a yearly basis it can track the progression of the disease in some patients. Studies are being done now to determine how successful this idea is. Osteoporosis and osteoarthritis are fairly common for CRPS patients. In 2005, the RSDSA (our fellow national RSD organization) published an article by Dr Angel Malis-Gagnon which discussed the role of bone scans in CRPS.
At the end of the article it stated “In my view, the value of a three-phase bone scan in the diagnosis of CRPS is very limited. A three-phase bone scan neither makes nor excludes the diagnosis of CRPS by itself. I always teach my students: “Never treat a test result, treat the patient.” In other words, a pathognomonic “CRPS bone scan” can confirm a diagnosis of CRPS only when my patient has the clinical signs and symptoms of CRPS. ” How are bone scans used in the diagnosis and treatment of CRPS?
See also the article by Doctor Hooshang Hooshmand regarding the role of Bone scans in CRPS;
BONE SCAN PUZZLE
BRAIN STEM
The brain structure that is the major communication route between the brain, spinal cord, and peripheral nerves’ controls heart rate, breathing and other vital functions.
CALCIUM CHANNEL BLOCKER
Drugs that dilate the coronary arteries and increase blood flow through the coronary arteries; useful for angina and blood-pressure reduction.
CASE CONTROL STUDY
An epidemiologic study that examines selected patients who have a defined disease (cases) with persons without the disease (controls).
CASE DEFINITION
In the example of CRPS, a combination of symptoms, signs, and physiologic characteristics that serve to distinguish a case of CRPS from other disease states.
CAT SCAN – COMPUTERIZED TOMOGRAPHY (CT)
A diagnostic technique in which x-rays are taken in many different directions, and the resulting data are synthesized by a computer to generate cross-sectional and other images of the body.
CATHETER
A hollow, flexible tube that is used to add or remove fluid from the body; commonly inserted into the bladder through the urethra to empty urine after surgery.
CAUDA EQUINA
The bundle of nerve roots in the lumbar spine that come from the end of the spinal cord and proceed to the lower part of the trunk and the lower extremities.
CAUSALGIA
Severe burning pain, sometimes divided into major and minor CAUSALGIA. Latin for “Burning Pain”, original name for RSD, coined by Dr Weir Mitchell. (see “ORIGINS of CRPS”) Now known as CRPS Type II
CFIDS
Chronic Fatigue and Immune Dysfunction Syndrome – A synonym for chronic fatigue syndrome used by some patients and physicians. It should be stressed, however, that no immune dysfunction or aberration has been persuasively linked to chronic fatigue syndrome.
CHRONIC
Of long duration, denoting a disease of slow progress and long continuance.(sometimes with chronic conditions, physicians consider if they last longer than 6 mo. they are chronic, rather than ‘acute‘)
CHRONIC FATIGUE & IMMUNE DYSFUNCTION SYNDROME
A synonym for chronic fatigue syndrome used by some patients and physicians. It should be stressed, however, that no immune dysfunction or aberration has been persuasively linked to chronic fatigue syndrome.
CHRONIC PAIN
Chronic pain is different. Chronic pain persists. Fiendishly, uselessly, pain signals keep firing the nervous systems for weeks, months, even years. There may have been an initial mishap- a sprained back, a serious infection, from which you‘ve long since recovered.
There may be an ongoing cause for the pain- arthritis, cancer, ear infection. This kind of pain is called CHRONIC BENIGN PAIN or CHRONIC NON-MALIGNANT PAIN. But some people suffer chronic pain in absence of any past injury or evidence of body damage. This kind of pain is called CHRONIC MALIGNANT PAIN. Whatever the cause may be, chronic pain is REAL, UNREMITTING, AND DEMORALIZING.
COMPRESSION FRACTURE
The collapse of a bone, most often a vertebra.
CONNECTIVE TISSUE
The supporting tissues of the body, such as tendons, ligaments, bone, and cartilage.
CONNECTIVE TISSUE DISORDER
A variety of inflammatory diseases of connective tissue, the most common of which is rheumatoid arthritis. Much, if not all, of this disease is now attributed to autoimmune processes.
CONTROL
A device used to verify or regulate a scientific experiment or study. A case-control study serves as a useful example. Since patients with a specific illness are examined for various characteristics, a group of healthy individuals who otherwise have as much in common with the patients as possible must be examined in parallel for the same characteristics.
CROHN’S DISEASE
A chronic inflammatory condition of the small or large intestine; associated with abdominal pain, diarrhea, fever, and weight loss.
CYANOTIC
A blue or dusky color due to decreased oxygen in blood or decreased blood flow. Many CRPS patients have limbs that change color, from dark blue, cyanotic, to an almost cadaver-looking color. The colors can change throughout the day depending on the severity of the pain, temperature, barometric pressure, stress-levels, etc. The use of ice or hot/cold contrast baths can increase the color changes seen in CRPs patients because ice generally constricts the blood vessels.
DEGENERATIVE DISC DISEASE — LUMBAR
DEGENERATIVE DISC DISEASE – CERVICAL
DEGENERATIVE SPONDYLOLISTHESIS
Spondylolisthesis caused by erosion of the facet joints over time.
DEPENDENCE
There’s an important difference between opioid dependence and opioid addiction. Anyone who takes opioid drugs for more than a few weeks will develop tolerance and some physical dependence on the drug. Usually, these people are on stable, generally lower doses of medication. If they stop suddenly, they have withdrawal symptoms (usually mild). The symptoms go away, the person is “detoxed,” and they go on with life. They don’t seek further chances to use the drug.
People who take a class of drugs called opioids for a long period of time may develop tolerance and even physical dependence.This does not mean, however, that a person is addicted. In general, the chance of addiction is very small when narcotics are used under proper medical supervision.
See additional terms in this section; Addiction, Tolerance.
DEPRESSION
A neurotic or psychotic condition marked by an inability to concentrate, insomnia, and feelings of dejection and guilt. Most RSD patients have depression as a result of the changes in the limbic system from the RSD. Some Psychiatrists have it backwards and think the depression comes first.
DIASTOLIC BLOOD PRESSURE
The lower of two numbers in a blood-pressure reading and a reflection of pressure in the arteries when the heart is relaxed.
DISKECTOMY
The surgical removal of all or part of an intervertebral disk.
DISKITIS
Inflammation of an intervertebral disk.
DOPAMINE
A neurotransmitter that enables people to move normally and smoothly; made by special cells in the substantia nigra and stored in the caudate nucleus and the putamen.
Dopamine stimulates the heart and increases blood flow to the organs.
DOPAMINE AGONIST
A drug that tricks the brain into thinking it has more dopamine than it really does.
DOPAMINE PRECURSOR
An amino acid that the brain transforms into dopamine.
DOUBLE-BLIND STUDY
A RESEARCH TOOL WHEN STUDYING NEW TREATMENTS/DRUGS. DOUBLE BLIND MEANS THAT NEITHER THE DR. NOR THE PATIENT KNOWS WHO IS GETTING A PLACEBO AND WHO IS GETTING THE REAL THING. ACCORDING TO DR. SNYDER IF ANYONE TELLS YOU ABOUT A NEW “MIRACLE CURE” FOR RSD, ASK THEM TO SEND YOU THE RESULTS OF THEIR DOUBLE BLIND STUDY. IF INSTEAD THEY SIMPLY SEND YOU PATIENT REMARKS, THEN ASK WHY.
DRY EYE SYNDROME
An irritating syndrome usually caused by a decrease in tear production. A very common symptom of CRPS patients along with dry mouth.
DYSESTHESIA
An unpleasant abnormal sensation, whether spontaneous or evoked. Special cases of dysesthesia include hyperalgesia and allodynia. A dysesthesia should always be unpleasant and a paresthesia should not be unpleasant. It should always be specified whether the sensations are spontaneous or evoked.
DYSPEPSIA
A condition equivalent to indigestion; characterized by upper abdominal pain following meals that may be accompanied by bloating, nausea, vomiting, a sense of fullness, and general discomfort.
DYSTROPHY
Progressive deterioration.
EDEMA
Fluid build-up in the body‘s tissue.
ELECTROCARDIOGRAM
A graphic record of the electrical activity within the heart that is responsible for its contraction and relaxation.
EMG
A series of diagnostic procedures in which electrical activity in muscles is measured to determine whether the nerve pathway from the spine is intact.
How is it performed?
For an EMG, a needle electrode is inserted through the skin into the muscle. The electrical activity detected by this electrode is displayed on an oscilloscope, and may be heard through a speaker.
After placement of the electrodes, you may be asked to contract the muscle (for example, by bending your arm). The presence, size, and shape of the wave form — the action potential — produced on the oscilloscope provide information about the ability of the muscle to respond when the nerves are stimulated.
Is it painful?
Speaking from personal experience and as someone who has talked to thousands of other CRPS patients who have undergone this procedure? Yes.
For a typical CRPS patient? When they perform it in the CRPS-affected area, yes. If you have full body or systemic CRPS it can be very painful especially if your CRPS is in flare. This isn’t said to scare you but to prepare you.
You must prepare yourself ahead of time. Take whatever medications you are due to take. If you practice relaxation techniques, do that, most of all, if while the test is being performed it causes undue pain STOP IT!
Ultimately it is your body. Do not subject yourself to more pain. The test is trying to determine if your nerve pathways are intact. If you have CRPS those nerve pathways are damaged and/or hyperactive and so sending electricity through them can cause them to react in more pain.
ENDORPHINES
Natural morphine-like substances produced in the body.
EPINEPHRINE
A chemical that can act as either a neurotransmitter or a hormone; it constricts blood vessels and increases heart rate; also called adrenaline.
ETIOLOGY
History or cause of the disease in question.
FACET JOINTS
The superior and inferior paired joints located on the back side of each vertebra and connecting its posterior elements to those of the vertebrae above and below.
Sometimes this is an area used for an injection for pain.
FIBROMYALGIA
Also known as myofascial pain syndrome and fibromyositis. A group of common rheumatoid disorders (not involving the joints) characterized by achy pain, tenderness, and stiffness of muscles.Also involving very painful tender spots, notably by the shoulder, knee, ankle, etc.
SEE OUR FIBROMYALGIA SECTION or Fibromyalgia or CRPS?
FIBRO FATIGUE – Sometimes described as Fibro Fog the exhaustion that accompanies Fibromyalgia can often be debilitating. It can include depression, insomnia, and other symptoms. It is most often described by Fibro patients as the most difficult of all the symptoms to deal with and nearly impossible to control. There are some supplements that some patients have reported having helped them. Click on the link “Fibro Fog” to learn more.
FIBROSIS
Thickening and scarring of connective tissue
FLOATERS
Tiny clusters of protein or cells that drift through the vitreous humor and appear as black specks across the visual field; most commonly benign, but may precede retinal complications. Check out this amazing video!
FLUOROSCOPY
A diagnostic procedure in which x-rays that have passed through the body are projected onto a screen, providing a continuous image of the body‘s internal structures. Patients SHOULD request a Fluoroscope be used when getting a Nerve Block, and nowadays they almost always are used.
GASTROESOPPHAGEAL REFLUX DISEASE (GERD)
A condition in which food and acid flow back into the esophagus from the stomach, often causing heartburn and sometimes damaging the esophagus.
HEART FAILURE
A condition in which the heart loses its ability to efficiently pump blood throughout the body.
HERNIATED DISK
Displacement of some portion of the disk out of its normal location.
HIPPOCAMPUS
The part of the brain’s limbic system that is involved in learning, memory, and emotion.
HOT / COLD CONTRAST BATH THERAPY
This can sometimes be called Therapeutic Contrasting, but whichever name it goes by the procedure is basically the same. It is the process whereby you are quickly changing the tissue temperature from hot to cold and back again, repeatedly. This is usually done by immersing the limb or even the entire body, using hot and cold water. How is this different from the usual method of applying heat or ice? By applying both in rapid succession it is an exaggerated form of both but it is typically done with water because it is more practical. Hot/Cold Contrast Therapy could be done with Ice/ and hot water, or Heat and cold water, depending on what part of the body is affected though.
Care must be taken with patients who have sensitivity to ice, high blood pressure, circulatory problems, where there are open sores, skin sensitivity, or CRPS, For a good description of Hot/Cold Contrast Therapy, CLICK HERE
For more on why Hot/Cold Contrast Therapy and/or the application of Ice can be harmful to some CRPS patients CLICK HERE.
HYPER DIFFERENCES
The implications of some of the above definitions may be summarized for convenience as follows;
Allodynia: lowered threshold: stimulus and response mode differ
Hyperalgesia: increased response: stimulus and response mode are the same
Hyperpathia: raised threshold: stimulus and response mode may be the increased response: same or different
Hypoalgesia: raised threshold: stimulus and response mode are the same lowered response.
HYPERESTHESIA
Increased sensitivity to stimulation, excluding the special senses. Hyperesthesia may refer to various modes of cutaneous sensibility including touch and thermal sensation without pain, as well as to pain. The word is used to indicate both diminished threshold to any stimulus and an increased response to stimuli that are normally recognized.
(note) Allodynia is suggested for pain after stimulation which is not normally painful. Hyperesthesia includes both allodynia and hyperalges
HYPERHYDROSIS
Excessive sweating.
HYPERPATHIA
A painful syndrome characterized by an abnormally painful reaction to a stimulus, especially a repetitive stimulus, as well as an increased threshold.
HYPNOSIS
The use of Hypnosis in the treatment of CRPS is somewhat controversial and has had mixed results. Some of this stems from the fact that CRPS patients are wary of any treatment that might possibly insinuate the pain is in your head and that reported positive results have been few and far between. Because of the recent work by Dr Flemming though, some of these ideas need to be re-considered. He has had some very positive results but cautions that if done incorrectly, it can cause more harm than good.
IATROGENIC
Related to an abnormal state or condition produced in a patient through inadvertant or erroneous treatment.
IBD – IBS – INFLAMMATORY BOWEL DISEASE
A generic term for ulcerative colitis and Crohn’s disease.
ICE – Using ice on CRPS patients – Click here to read more.
IDIOPATHIC
Without a known cause.
IMAGING TESTS
Any of a variety of methods for observing the internal anatomy of the body, ranging from simple x-rays to complex three-dimensional scanning techniques using nuclear magnetic resonance, positron emission, and other techniques.
IMMUNE SUPPRESSANTS
Agents that block or restrict the activity of one or more components of the immune system, usually leading to increased susceptibility to infectious disease.
INFLAMMATORY RESPONSE/FLARE RESPONSE
Irritation of the involved extremity, which may include localized heat, swelling, redness, pain, and limited movement.
INSOMNIA
Inability to sleep even in the absence of external impediments, during the period when sleep should normally occur; (a common symptom of CRPS).
INTERVERTEBRAL DISK
One of the small, energy-absorbing cushions located between the vertebrae of the spine.
INTERVERTEBRAL FORAMEN
One of the two narrow spaces between adjacent vertebrae (one on each side), through which nerve roots pass.
INTRACTABLE
resistant to treatment.
IRRITABLE BOWEL SYNDROME – IBS
IBS – A functional disorder that typically involves a range of symptoms that include intermittent abdominal pain and bloating accompanied by diarrhea, constipation, or alternating episodes of both.
LABILE HYPERTENSION
Blood pressure that fluctuates far beyond what is normal.
LAMINA
One of the two thin, platelike parts of each vertebra that join in the midline and form the base of the spinous process of that vertebra.
LAMINECTOMY
An operation in which all or a portion of one or both laminae is removed to gain access to the spinal canal or to decompress the spinal cord and nerve roots.
LIMBIC SYSTEM
An area of the brain containing the amygdala, the hippocampus, and the basal ganglia; involved in emotion, memory, and certain aspects of movement.
This is an area that is specifically affected by RSD. RSD causes changes in the limbic system that results in problems with short-term memory and concentration as well as feelings of irritation and frustration on the part of the patient, among other things.
LUMBAR PUNCTURE
A procedure in which a hollow needle is inserted into the lower part of the spinal canal to withdraw cerebrospinal fluid for testing. It can also be used to inject medication into the lower spine or Lumbar Region. For more information click on the link provided. This is also known as a Spinal Tap.
LUMBAR SPINE
The five lowermost mobile vertebrae of the spine. Here is a YouTube video of Dr Corenman reading an MRI of a normal, healthy lumbar spine. I thought some of you might like to see a healthy one for a change!
LUMBAR STENOSIS
Spinal stenosis in the lumbar area.
LYME DISEASE
A tick-transmitted inflammatory disorder that begins with a characteristic skin rash, and may be followed weeks to months later by neurologic, cardiac, or joint abnormalities.
LYMPH NODES
Secondary immune organs distributed at discrete locations throughout the body. These organs play a central role in the activation and trafficking of immune lymphocytes in the body.
MALAISE
A feeling of general discomfort or uneasiness, an out-of-sorts feeling, often the first indication of an infection or other disease.
MRI – MAGNETIC RESONANCE IMAGINING
A diagnostic technique in which radio waves generated in a strong magnetic field are used to provide information about the hydrogen atoms in different tissues within the body; a computer uses this information to produce images of the tissues in many different planes. Here is a YouTube video showing a typical MRI scan.
MULTIPLE SCLEROSIS
A slowly progressive central nervous system disease characterized by disseminated patches of demyelination in the brain and spinal cord.
MYELIN SHEATH – tissue surrounding the nerve fibers in the brain, spinal cord, and optic nerves, a fatty substance. This is called the Myelin Sheath. It protects the nerve. It insulates the nerves and helps them send electrical signals that control movement, speech, and other functions. When myelin is destroyed, scar tissue forms, and nerve messages are not transmitted properly. How can it be destroyed? Over-use of ice; hot and cold contrast therapy; sometimes even the new desensitization therapy can destroy the myelin sheath.
MYELOGRAPHY
A diagnostic technique in which x-rays are taken of the spine after a contrast medium has been injected into the space within the sheath that surrounds the spinal cord and the cauda equina, enabling a radiologist to see distortions in the shape of the space (produced by a herniated disk, a tumor, a fracture, spinal stenosis, or the like).
NARCOTICS
This is a very controversial topic. There are two different groups of Narcotics; the first are Morphine Agonists (such as Morphine and Demoral) and the second are Morphine Antagonists (such as Stadol and Ultram). The controversy surrounds which are better for treating RSD-type pain and which are detrimental. However, many patients could not survive a day without the strength of these Class IV Type Medications, they are literally life savers for a great many patients.
There are some issues surrounding Addiction, Tolerance, and Dependence. For more information regarding these topics, look for them in this section.
NERVE CONDUCTION STUDY
(See EMG) An electromyogram (EMG) measures the electrical activity of muscles at rest and during contraction. Nerve conduction studies measure how well and how fast the nerves can send electrical signals. Nerves control the muscles in the body by electrical signals (impulses), and these impulses make the muscles react in specific ways. Nerve and muscle disorders cause the muscles to react in abnormal ways.
NEURALGIA
Pain in the distribution of a nerve or nerves.
NEURITIS
Inflammation of a nerve or nerves.
NEUROLOGIST
A medical doctor trained to diagnose and treat disorders of the brain and other aspects of the nervous system.
NEUROPATHY
A disturbance of function or pathological change in a nerve: in one nerve, mononeuropathy; in several nerves, mononeuropathy multiplex; if diffuse and bilateral, polyneuropathy.
NEUROTRANSMITTER
A chemical released by neurons at a synapse to transmit information to other nerve cells.
NEUROVASCULAR
The effect nerves have on vessel function and the supply of blood to the tissues of the upper extremities.
NOREPINEPHRINE
A neurotransmitter that constricts blood vessels; its release is stimulated by the sympathetic nervous system.
OBSTRUCTIVE SLEEP APNEA
A disorder characterized by heavy snoring and interrupted breathing during sleep; often associated with obesity; a risk factor for stroke.
OCCIPITAL LOBE
One of the four major subdivisions of the two hemisphere of the cerebral cortex; plays a role in visual perception.
OCCIPITAL NERVE BLOCK
An injection of medication, usually Marcaine or Lidocaine, into the occipital nerve, right at the back of the head. This procedure, while painful, is a huge help for those who suffer from migraines.
OPIOID INTOXICATION
When an individual uses a sufficient amount of an opioid, they will get “high” from the drug. Some people, however, have negative experiences when they use an opioid. When too much of an opioid is taken, an individual can overdose.
OPIOIDS
“Opioids are a class of drugs that include both natural and synthetic substances. The natural opioids (referred to as opiates) include opium and morphine. Heroin, the most abused opioid, is synthesized from opium. Other synthetics (only made in laboratories) and commonly prescribed for pain, such as cough suppressants, or as anti-diarrhea agents, include codeine, oxycodone (OxyContin), meperidine (Demerol), fentanyl (Sublimaze), hydromorphone (Dilaudid), methadone, and propoxyphene (Darvon). Heroin is usually injected, either intravenously (into a vein) or subcutaneously (under the skin), but can be smoked or used intranasally (i.e., “snorted”). Other opioids are either injected or taken orally.” (from www.minddisorders.com )
There are some issues surrounding Addiction, Tolerance, and Dependence. For more information regarding these topics, look for them in this section.
OSTEOPATH
A doctor who has training analogous to that of an M.D. and may use medicine and surgery in addition to manipulation therapy to treat disease.
OSTEOPHYTE
A bony outgrowth, or spur, on the margin of a joint or intervertebral disk. (not an argument between Osteopaths)
OSTEOPOROSIS
A degenerative disease that decreases the density of bone, leaving it vulnerable to fracture. Radiologyinfo.org has more information.
OSTEOPOROSIS TYPE 1
Primary osteoporosis in which bone loss is due to estrogen decline associated with menopause.
OSTEOPOROSIS TYPE 2
Primary osteoporosis where bone loss is due to aging.
OSTEOPOROSIS, SECONDARY
Bone loss associated with an identifiable medical condition, tratment with certain drugs, or immobility.
PAIN
An unpleasant sensory and emotional experience associated with actual or potential tissue damage, or described in terms of such damage.
PAIN THRESHOLD
The least experience of pain which a subject can recognize.
PARASYMPATHETIC NERVOUS SYSTEM
One of two branches of the autonomic nervous system; it is involved in the regulation of digestion, circulation, voiding, and other bodily functions.
PATHOGENISIS
The mode of origin of any tissues.
PATHOPHYSIOLOGY
Derangement of function seen in disease.
PERCUTANEOUS DISKECTOMY
the removal of part of an intervertebral disk by means of a narrow probe inserted through the skin and muscle of the back.
PERIPHERY
The part of the body away from the center
PHYSIATRIST
A medical doctor trained as a rehabilitation specialist.
PLACEBO
a. Medicine. A substance containing no medication and prescribed or given to reinforce a patient‘s expectation to get well. b. An inactive substance or preparation used as a control in an experiment or test to determine the effectiveness of a medicinal drug.
PLACEBO EFFECT
Improvement in one‘s condition that occurs as the result of having been treated but cannot be attributed to the treatment used.
POSTMENOPAUSAL OSTEOPOROSIS
Bone loss resulting from the deficiency of estrogen associated with menopause; sometimes called Type 1 osteoporosis.
PRIMARY OSTEOPOROSIS
Bone loss that doesn’t result from an identifiable pathological process.
PROCESS
Any one of several bony projections from each vertebra, some of which mesh with similar structures on the vertebrae immediately above and below.
QUANTATIVE COMPUTED TOMOGRAPHY (QCT)
A modification of computed tomography that provides measurement of bone mass as well as an image.
RADIO FREQUENCY ABLATION – RFA
Radio Frequency Ablation is yet another name for sympathectomy, not recommend by most Doctors for treatment of CRPS. In this method the nerve is burned.
In one of his famous RSD “Puzzles” Doctor Hooshang Hooshmand wrote,
“RSD (CRPS) is not a surgical disease. The trauma of surgery only aggravates the condition.The most traumatic of all invasive treatments is Radio frequency nerve ablation and block. It is done with a heat generating Radio frequency electrode causing a boiling hot temperature at the target area which coagulates, destroys and kills the nerve fibers and nerve cells.
Because the Radio frequency damage causes high temperature in the adjacent areas of the target, it also destroys the adjacent normal nerves causing a much larger lesion and scar formation with spread and aggravation of pain in a permanent fashion. ”
You can read more about SYMPATHECTOMIES by scrolling down in this MEDICAL TERMS section.
RAYNAUDS PHENOMENON
Spasm of the arteries of the toes or fingers with paleness and numbness of the fingers
RECEPTORS
Structures on the outside of a cell membrane that permit attachment of specific chemicals.
REFLEX
An involuntary response to a stimulus by the nervous system affecting muscle, bone, vessels, skin, and so forth.
RHEUMATOLOGIST
A medical doctor trained to diagnose and treat disorders of the joints and other parts of the musculoskeletal system.
RHIZOTOMY
Surgical destruction of nerve roots and also of nerves (such as those around intervertebral joints) in order to relieve pain. Another version of a sympathectomy.
SCIATICA
Pain along the course of the sciatic nerve (from the buttock, down the back and side of the leg, and into the foot and toes), often due to a herniated disk.
SCOLIOSIS
An abnormal lateral curvature of the spine.
SIP or SYMPATHETICALLY INDEPENDENT PAIN
sympathetically independent pain (SIP)
As CRPS progresses, more and more of the pain becomes Independently mediated, that is, it becomes centered or generated in the brain.
This explains why localized pain reduction techniques (i.e. sympathetic blocks, creams etc.) no longer work after the first few months of onset of CRPS. SEE SMP or SIP? What is the Difference?
SLEEP APNEA
A group of potentially lethal disorders in which breathing recurrently stops during sleep for long enough to cause measurable blood deoxygenation.
SMP or SYMPATHETICALLY MAINTAINED PAIN
SMP makes up the majority of the pain in the beginning of the CRPS
This type of pain is very responsive to local pain reduction efforts, most notably sympathetic nerve blocks.
As your CRPS progresses, the SMP is gradually replaced by SIP, or Sympathetically Independent that is brain-centered/generated.
This is why blocks usually work best in the early stages of RSD. Once your pain becomes IMP it is much harder to affect/reduce it.
Also see “SMP AND SIP, WHAT IS THE DIFFERENCE?”
SNS OR SYMPATHETIC NERVOUS SYSTEM
One half of the Autonomic Nervous System, Involuntary control over sympathetic functions like vasoconstriction of blood vessels of the skin, and so forth,
ALSO one of two divisions of the autonomic nervous system (the other is the parasympathetic) having fibers leaving the central nervous system via a chain of ganglia close to the spinal cord.
SPINAL FUSION
Joining two or more vertebrae with a bone graft in order to eliminate motion and relieve pain.
SPINAL STENOSIS
A reduction in the size of the spinal canal, which may result in compression of the spinal cord or nerve roots.
SPINAL TAP
See lumbar puncture.
SPONDYLOLISTHESIS
Forward displacement of a vertebra in relation to the vertebra immediately below.
SPREADING OF CRPS
According to a national study done on 809 RSD Patients, it was found that RSD spreads in 75-80% of cases, with only 8% of these cases becomming full body or systemic. Most spreading wrist to hand, hand to shoulder,foot to knee for instance, and in some cases to opposite limbs. In rarer cases to eyes, ears, etc.
CRPS can spread in any stage and of course you can have symptoms from more than one stage at one time.
SUBACUTE
A zone between acute and chronic, denoting the course of a disease.
SUBSTANCE P
An undecapeptide present in the intestine where it induces contraction of the intestine and dilation of blood vessels; it is also present in a number of neuronal pathways in the brain and in primary sensory fibers of peripheral nerves, and may be a neurotransmitter associated with transmissions of pain impulses.
SYMPATHETIC NERVOUS SYSTEM
One of two divisions of the autonomic nervous system; it prepares the body for action by raising blood pressure and elevating heart and breathing rate.
SYMPATHECTOMY
Surgical sympathectomy. The use of this operation that destroys some of the nerves is controversial. Some experts think it is unwarranted and makes CRPS worse; others report a favorable outcome. Sympathectomy should be used only in individuals whose pain is dramatically relieved (although temporarily) by sympathetic nerve blocks. It also can reduce excess sweating. (WebMD )
This same definition is repeated almost verbatim on numerous other websites such as NIH. They can be called surgical sympathectomies, chemical sympathectomies, they can say we are going to “burn the nerve”, “freeze the nerve”, or a few other slight variations. The bottom line is that the nerve will be severed with the hope that it will no longer be able to conduct the false pain signals to the brain that are the hallmark of CRPS, (see diagram). Most CRPS Drs. stopped performing these types of procedures back around 2003 when they figured out that CRPS was simply finding new pathways around the severed nerve and in some cases, the CRPS even got worse.
Also see an article by Dr Hooshmand HERE.
SYNAPSE
The tiny gap between an axon terminal that sends a chemical signal and the neuron that receives it.
SYNDROME
A collection of signs and symptoms that together create a distinct picture for the Health Professional to help define a particular disorder.
The higher of two numbers in a blood-pressure reading and a reflection of pressure in the arteries when the heart contracts.
TEMPORAL LOBE
One of the four major subdivisions of the two hemispheres of the cerebral cortex; plays a role in hearing, long-term memory, and behavior.
TENS – TRANSCUTANEOUS ELECTRICAL NERVE STIMULATION
Use of low-voltage electrical current to provide pain-suppressing stimulation. Normally only effective for CRPS patients early on in the disease when most of their pain is Sympathetically-mediated.
THERMAL PARATHESIA
Transitory, unpleasant sensations of heat or cold in certain body regions.
THERMOGRAPHY
A test designed to determine heat differences between different parts of the body, (i.e. comparing the temperature difference between two feet). Sometimes used to confirm diagnosis of RSDS but results are dubious if more than one extremity is involved, i.e. both feet or both hands.
This test can provide useful information but should NOT be used as a litmus test for CRPS since only in certain Stages of this disease there may be no significant showing on a thermogram. Best used as a test to determine progression of CRPS over time.
THYROID
A two-lobed structure located in front of and on either side of the trachea, producing the hormone thryoxin; of or relating to the thyroid gland.
OPIOD TOLERANCE
A reduction in response to a given dose of drug after repeated administration. This is very different from “addiction” and “dependence”.
People who take a class of drugs called opioids for a long period of time may develop tolerance and even physical dependence.This does not mean, however, that a person is addicted. In general, the chance of addiction is very small when narcotics are used under proper medical supervision.
Some medications used to treat pain can be addictive. Addiction is different from physical dependence or tolerance, however. In cases of physical dependence, withdrawal symptoms occur when a substance suddenly is stopped. Tolerance occurs when the initial dose of a substance loses its effectiveness over time. Addiction and physical dependence often occur together.
See additional terms in this section; Addiction, Dependence.
TRANS ISCHEMIC ATTACKS, TIA
A TIA is when the nerves clamp down on the veins and shut off the blood flow to the heart, brain and anything else it feels like doing.
TRANSVERSE PROCESS
The winglike projection on each side of a vertebra, to which muscles and ligaments are attached and, in the chest area, the ribs are connected.
TRI-PHASIC BONE SCAN – THREE PHASE BONE SCAN
BONE SCAN
Here is some information I put together regarding tri-phasic, or three-phase, bone scans and related information in response to some questions posted in one of our forums. Remember, we are not medicl professionals but simply fellow patients and loved ones. Never start, stop, or change what you are doing with your Doctor based on what you read on the internet but rather, share what you learn with your Doctor and together formulate the best plan possible for your current and future care.
What is a bone scan and can it be used to diagnose CRPS?
First, we should define what a bone scan is.
A bone scan is a nuclear scanning test that identifies new areas of bone growth or breakdown. It can be done to evaluate damage to the bones, detect cancer that has spread (metastasized) to the bones, and monitor conditions that can affect the bones (including infection and trauma). A bone scan can often detect a problem days to months earlier than a regular X-ray test.
For a bone scan, typically, a radioactive tracer substance is injected into a vein in the arm. The tracer then travels through the bloodstream and into the bones. Areas that absorb little or no amount of tracer appear as dark or “cold” spots, which may indicate a lack of blood supply to the bone (bone infarction) or the presence of certain types of cancer. Areas of rapid bone growth or repair absorb increased amounts of the tracer and show up as bright or “hot” spots in the pictures. Hot spots may indicate the presence of a tumor, a fracture, or an infection.
A bone scan may be done on the entire body or just a part of it. (WebMD)
Second, we have to differentiate between bone scans and x-rays and their use, from a practical sense, concerning CRPS patients.
Do X-rays have a use in diagnosing CRPS patients? Different Doctors will have different answers here. X-rays CAN show patchy thinning, or osteoporosis, in some patients. This is not always indicative of CRPS of course and if a patient is believed to have CRPS the appearance of osteoporosis on x-rays is not always a confirmation but it is an indicator. An x-ray is not something that is typically used to diagnose CRPS, but it can be one of many pieces of information gathered. Typically Doctors prefer the more informative bone scan.
Is a bone-scan a way to diagnose CRPS?
Some Doctors will use this method to diagnose CRPS but according to a study done a number of years ago by Doctors Lee and Weeks in the Journal of Hand Surgery, it is only accurate in diagnosing CRPS 55% of the time! You can find links below to a number of articles where the number quoted is even lower and/or where Doctors do not recommend the use of tri-phasic bone scans to rule in/out CRPS because of the inaccuracy of the method.
Yet there are still Doctors who use this test as a way to rule in or out an RSD diagnosis. As Doctor Hooshang Hooshmand once noted, “If I have a heart attack and they tell me that they are going to do a test that has 55% chance of diagnosing my heart attack, obviously I’m not going to consent to such a test.”
There are many reasons why bone scans are not accurate, from the spreading of CRPS to the changes in bone circulation that take place during the different stages of CRPS, and diseases that mimic CRPS like arthritis.
Now bone scans can be helpful in ruling out some things when considering the diagnosis of CRPS; things like stress fractures. The tri-phasic bone scan in particular;