There are infinite reveries & numberless extravagancies that pass through both[wise and foolish minds].
Thursday, February 19, 2009
The 4 Stages of RSD
What RSD/CRPS looks like in some- These pics are of my right foot in 2007.
The Four Stages Of RSD/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).
Stage two is called the Dystrophic Stage and can last three to six months.
Pain is constant, as in stage one, and throbbing, burning, aching, crushing in nature and is exacerbated by any stimuli. The affected limb may still be edematous, cool, cyanotic (discolored), or mottled (different shades). Nails are brittle and ridged. Pain and stiffness persists. Muscle wasting may begin.
Patient usually starts experiencing short-term memory problems, as well as increased pain from noises and/or vibrations, and other changes in the limbic system; these include the inability to concentrate, find the right word when speaking. X-Rays may reveal signs of osteoporosis. Patients may start to repeat themselves.
Some Doctors will try and use tools such as x-rays, Bone Scans, thermograms, and others during Stage 2 and Stage 3 to confirm a diagnosis of RSDS. **Understand that while these tests MAY show the presence of RSD, they are rarely conclusive and they should not be used as the sole determining factor in whether a patient does or does not have RSD. The only positive way of diagnosing RSD/CRPS is a physical exam by a Doctor knowlegeable in RSDS.** These other tests should only be used as one of many tools to aid in that diagnosis. They are also useful in tracking the progress of the disease over the course of the time.
Stage three is called the atrophic stage and can last an unlimited amount of time. Pain as usual is typically constant but can increase or decrease, depending on the person, and the RSDS may spread to other parts of the body. At this stage irreversible tissue damage may occur. Skin becomes cool, thin, and shiny.
Contraction of the extremity may occur as well as atrophy of the limb (decreased joint movement). Skin atrophies (wasting away) and loss of movement or mobility may also occur. X-Rays may show marked demineralization and increased osteoporosis.
At this stage many RSD patients are not likely to be effectively treated with blocks as the percentage of SIP (Sympathetically Independent Pain) is now much greater than the percentage of SMP (Sympathetically Mediated Pain), meaning the majority of the pain signals are now originating in the brain and not at the original RSD site where a local block would help.
Pumps are usually discussed at this stage but there are other treatments available and more are coming all the time.
Most patients will never advance to Stage 4.
In this Fourth Stage, RSD is resistant to many forms of treatment and many Physicians would now recommend a Pump or a DCS/SCS. However, there are a great many problems associated with the use of SCS units for RSD patients, even though they work well for other pain problems.
Also in this stage there is an involvement of the inner organs.
Please do not allow any Doctor to amputate the affected limb unless it is a medical necessity due to gangrene or the like. While it is infrequent, there are some uneducated Doctors out there who are performing amputations in an effort to eliminate the RSD pain. This is not only barbaric it is ineffective. It not only does not work but it also in most cases will exacerbate the RSD and increase the spread rate.
Always ask to speak to a Doctor's other patients before undergoing any type of implant or surgical procedure. Educate yourself on the internet. Talk to other patients. In the end, YOU are most responsible for what happens to your body. It is the only body you get, so treat it with the utmost care. You deserve first class care always!
THE PROBLEMS WITH STAGES
While being able to divide patients into neatly defined stages is seen as a plus by some diseases, it has always presented a problem for Doctors who are trying to make a diagnosis, and for patients who are trying to understand it, for the following reasons:
- Most patients have symptoms from multiple stages at the same time making a definitive diagnosis difficult.
- Stage 1 and Stage 2 are so brief, sometimes less than a few months total, and very few patients are diagnosed within those first few months
- Depending on which Type of CRPS you develop you may not develop many of the symptoms listed for each of the stages, again making for a confusing diagnosis.
- Some patients may never advance to Stage 3 and only a very few patients will advance to Stage 4.
- It may be difficult to determine your stage due to the combination and/or lack of symptoms.
- A better benchmark of where your RSD/CRPS is may be mapping your percentages of SMP and IMP over a period of months. Like diseases such as MS, RSD is a progressive disease, meaning it advances over time. Placing a patient into a clearly defined Stage with a highly fluid disease like RSD just doesn't make medical sense, as we are learning.
- Please note that not all Doctors agree on the existence of a Fourth Stage and is considered end stage 3.