Term Paper: History of Rsd

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[. . .] In RSD/CRPS, the sympathetic nervous system functions abnormally. It fires, with pain and swelling responses when the body does not reactively require it. In a sense therefore, one might also implicate the failure of the parasympathetic nervous system in bringing the body back to normal function. (Blumberg et al., 1997).

Progress of the Disease

CRPS Type 1 progresses in four stages. These are Dysfunction, Dystrophy, Atrophy, and Irreversible Failure of the Immune System. Because of the complexity and problems with misdiagnosis, many research panels have decided to avoid the process of staging. The disorder has been considered too complex to categorize. Incorrect categorization leads to significant problems for patients. Though RSD does not itself cause death, one has to be cautious of the problems with failure of the immune system and secondary effects.

Dysfunction or Stage I: This stage is also called early RSDS. Here, the pain is severe. But it is limited to the sight of injury. Patients often describe the pain to be of a burning and aching type. This pain often causes quality of life issues and emotional distress. A temperature reading often indicate that the local region where the pain is at either a higher or lower temperature than the rest of the body by up to one degree. Swelling is seen in the area of pain. Stage 1 is often characterized by abnormal hair or nail growth. Some changes in the bone mass or bone structure are also seen as a result of bone scans. This stage is also marked by muscle cramps. The skins color of the afflicted area changes from red to blue; the temperature changes from hot to cold. Stage 1 is marked by increases sweating. This is the best stage for treatment and complete recovery from RSDS. Unfortunately, depending upon the severity of the pain and associated symptoms, patients tend to ignore it or medical professional treat the pain as caused by other ailments, often prescribing incorrect treatment. It was mentioned earlier of the suggestion of eliminating suggestion. This is because of the variation in time associated with this stage. Typically, from the onset of the symptoms, the stage of dysfunction lasts for three months. In some however, it might last for shorter durations. In others, Stage 1 might last for several years. Research has shown that some patients never progress beyond this stage.

Dystrophy or Stage 2: This stage is also called the established stage. This stage is marked by increased severity of pain. The pain starts spreading at this stage, as does the swelling. The swelling also changes in character. The edematous tissue becomes indurate. In other words, it becomes hard to the touch, progressing from the soft swelling of the dysfunction stages. The excess growth of hair and nails is now replaced by falling hair and breakdown in nail-tissue giving rise to brittleness and cracks.

The dehydration from excess sweating causes dryness that it noticeable in the hands and palms. This is the stage when osteoporosis sets in. Bone scans or radiographs at this point are usually positive. Due to inactivity and reticence to move because of the pain, muscle tissue begins to waste away. The atrophy also extends to the skin and subcutaneous tissue. Once again, the severity and length of this stage are in dispute. In most patients however, the stage of dystrophy lasts between three months to a year.

Atrophy or Stage 3: The pain is still there and it is still severe. Occasionally, the pain diminishes but it is present. The pain also spreads to the entire limb. The spreading of the pain is also more significant. Studies have shown that the pain not only spreads proximally and laterally, there is a mirror affliction on the symmetrically opposite side of the body -- in some cases. (Maleki et al., 2000). The skin of the afflicted area becomes thin and shiny. This stage however, is marked by a lack of edema. Skin flare-ups and other problems occur spontaneously. Bone demineralization occurs. Muscle tissue is also often irreversibly damaged. Because of the progressive destruction of non-bony tissue such as muscles, ligaments and tendons, joint motion becomes severely restricted. Such joint motions are called contractures. In the atrophy stage, a small percentage of patients have generalized RSD. This means that it affects the entire body.

Stage Four: The fourth stage is when the disease becomes chronic enough and it is serious enough that the patient develops disturbance of immune system, hypertension, chest pain, stroke, and heart attack, and is at higher risk than the general population for high blood pressure and cancer. In the fourth stage, there is a high mortality due to suicide from secondary and psychosomatic effects. (Parillo, 2001).

Complications of the disease

Complications from RSD can be significant and widespread. Some of the complications have already been mentioned in the discussion on the stages of the progression of the disease. Like any other illness, patients with RSD/CRPS, often suffer from depression and anxiety. Skin, muscle, and bone atrophy (wasting) are possible complications of the syndrome. Atrophy may occur because of reduced function of the limb.

One of the problems in assigning a complication to RSDS as opposed to other factors is that it is hard to distinguish them. The sympathetic nervous system is so widespread in its functionality that a complication from RSD might be ascribed to another condition, and vice versa. A comprehensive study of over one thousand patients was undertaken to identify how predisposition to RSDS complications were different if the patient had no predisposition to RSDS. The data was collected over twelve years in the outpatient clinic.

The progress of the disorder in every patient was documented in detail. The researchers identified severe complications of chronic edema, impaired muscle function or dystonia, which are movement disorders in which sustained muscle contractions cause twisting and repetitive movements or abnormal postures. Dystonias are involuntary and sometimes painful, may affect a single muscle; a group of muscles such as those in the arms, legs, or neck; or the entire body.

Some of the patients showed dystonias, others showed myoclonus (a brief, sudden, singular, shock-like muscle contraction), and others showed both. Typically, complications affect the extremities and in a large number of cases, the lower extremities. (van Hilten et al., 2001).

One of the salient conclusions of this work was that patients whose RSD symptoms showed decrease in local temperature (of the affliction) were at greater risk for developing severe complications or symptoms that were resistant to therapy.

Occasionally, complications arise from severe misdiagnosis or mistreatment or also the lack of knowledge. These include the beliefs that RSD is rare, or that it does not occur in children or that the pain being not related to an injury will go away in a few months if the patient merely guts it out.

Sometimes, the pain forces the doctor to use a cast, which further complicates the symptoms and hastens the onset of atrophy. All treatment modalities are not exhaustively used.

While physical therapy is often called for to treat pain and ensure that muscles are adequately used, aggressive physical therapy without proper medical supervisions often makes the symptoms worse.

Prevalence of the disease

No demographic is really immune from the diseases. RSD affects several million people annually with varying levels of severity.

Children also develop the disease and have the best chance of treatment working. Both men and women suffer from RSD, but there is a statistically significant greater chance of women complaining of the symptoms. (Mailis & Wade, 1994). People between the ages of forty and sixty are those most afflicted, though there are no defined age barriers.

According to the federal agency monitoring this disorder, National Institute of Neurological Disorders and Strokes (NINDS), between two to five percent of peripheral nerve injury patients complain of RSD symptoms. The prevalence of symptoms is greater in hemiplegics or those that are paralyzed on one side of the body with between twelve and twenty-one percent of the people presenting. The NINDS also indicates that between one and two percent of people with bone fractures report signs RSD either while healing or even after their fractures have completely healed. (NINDS, 2004).

A study by Allen and co-workers of 134 patients might be considered as fairly typical for this disease -- in terms of epidemiology.

The median age was slightly higher than forty-one years of age.

The age range of this cohort was from eighteen to seventy-one years. Also the average time before the evaluation was approximately thirty months. This means that most patients were well into the second stage of RSD. Seventy percent of the patients were female. A large percentage was Caucasian and fewer were of African-Americans, Asians, Hispanic and Middle Easter. With race and other demographics, of course, are confounding factors of injury and occupational stress. Sprains, post-surgical symptoms and fractures were the most common injuries. Crush injuries were relatively rate. Other injuries were associated with veni-punctures, lacerations and spinal cord… [END OF PREVIEW]

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