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Volume IV, No. 7: July, 2014 - A Monthly Newsletter Summarizing Current CRPS/RSD Research
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"Attack of Overwhelm"

Hello, and welcome to this month's issue of the Newsletter, which each month brings you selections from the latest research results in the related fields of complex regional pain syndrome, reflex sympathetic dystrophy, and the pain components of such illnesses as cancer, peripheral neuropathy, phantom limb pain, diabetic neuropathy, certain types of headaches, etc.

This month's great selection is called "Attack of Overwhelm", by Gretta Hansing of Albany, NY; the small piece is colored pencil, just 8"x10". The artist writes: "The infectious bug of overwhelm whirling, stabbing, piercing every part of my body, pushing pain into as much of my body as it possibly can, growing, spreading, a torpedo of nerve pain."
Note: Every newsletter features a different image from the Pain Exhibit, "an educational, visual arts exhibit from artists with chronic pain with their art expressing some facet of the pain experience." (As always, please click on the image to see the full-sized original in a new tab/window.) We appreciate these images supplied by the artists at no charge.

graphic for 4th anniversaryThis issue starts the fourth year of continuous publication of this monthly newsletter! I'm very grateful to the many people who are subscribed to it and make suggestions as to how it might be improved; I had no idea it would become so popular, so quickly! I'll continue striving to put together selections from very recent research in a way that's enjoyable to read as well as being educational. As always, feedback of any kind is always welcome.

This month is a potpourri of topics, as occasionally happens, and touches on a number of important CRPS topics. Graded Motor Imagery is a technique that is rapidly gaining popularity as a technique for restoring the dysfunctional body perception we all suffer from, and seems to greatly accelerate progress against CRPS. Entries #1 (a 52 pg. collection of articles) and #2 (a quick, colorful 7 pg. flier) are both concerned with this new method. There are also two papers dealing with SCS - one deals with a new imaging technique called "magnetoencephalography" (#5); the other (#8) is a new, concise review of SCS and the state of the technique.

The ongoing epidemic of Rx opioid overdoses is partially addressed by a summary in J. Pain Res. (#4), which suggests increased security on written scripts, as well as other methods. At the same time, a psychiatric journal printed an editorial (#6) encouraging the development of cannabis-based medication for chronic pain. Speaking of diagnosis, two articles discuss the self-perceptual differences between those with CRPS and everyone else. Both #3 and #9 discuss the strange way that CRPS patients perceive their own bodies, especially those extremities or limbs afflicted by CRPS.

All CRPS folks know the terrible "sleep" that accompanies the disease. Part of this is due to the relentless, intense neuropathic pain (which tends to get worse at night) as well as the ongoing stimulation of the sympathetic ("fight or flight") nervous system. The National Academy of Sciences recently completed a huge study of the problem, which is reported in a 425-page BOOK (#10)! Another testament to the complexity of CRPS is a 40-pg diagnostic aid (#11), to help practitioners make an accurate diagnosis, and published by the "Best Doctors" Occupational Health [WC] Institute!

Earlier articles in this Newsletter have discussed how some drugs are metabolized at much different rates among individuals, depending on a genetically-determined collection of different metabolizing enzymes; the main consequence of differing metabolic speeds is the length of time the drug remains (and can be detected) in the body. The best-known example is methadone. #12 is a pdf chart of many dozens of drugs and the enzyme sub-type they interact with. The description contains links to the HTML version of the chart, as well as an abbreviated chart for clinical use.

Lastly, a retrospective study of 36 patients who had amputations between 2002 and 2012 to relieve CRPS pain (at a large teaching hospital in the Netherlands) made the surprising statement that, despite phantom limb pain developing in >70% of amputees, "amputation should not be ignored as a treatment option for long-standing therapy-resistant CRPS-I" (#13).

The PowerPoint presentation this month is called CRPS and Graded Motor Imagery (GMI) - an excellent, 73-slide presentation on how GMI is being used successfully in the UK to deal with CRPS. As you probably know, well-done PowerPoint slideshows are about the most painless way to learn technical material, and I select ones that I think are most relevant and also understandable for the diverse readership of this newsletter.

I hope this newsletter is useful to you. Remember that the site has an archive of all past newsletters, so you can look back to any issue since the first! In fact, here's a direct link. Thanks to a visitor suggestion, the PowerPoint presentations have also been archived, and can be accessed from the left menu throughout the site, or right here. Recall, too, that if you'd like to see one of the monthly PowerPoint slideshows but don't own the software, here's a very good, free, PowerPoint viewer link, courtesy of Microsoft. Incidentally, a few folks have let me know that, although they want to be able to see and enjoy the PowerPoint shows offered here each month, don't know how to use the information here to do this. If you're one of these, here's a very short, easy tutorial on how it's done.

Links to this and many other features from the site, especially brand-new articles on CRPS, are featured in our Facebook representation of the main site. Personally, I'm not much of a FB person, but this has proven to be a good idea, as it spreads the word about the site and what it has to offer. Please check it out (and please "Like" it!) occasionally; it's interesting to see what topics get the most attention and what other CRPS people have to say. You can find our FB page here! If you go there, please do "Like" us!

Please let me know if you have suggestions, corrections, effusive praise, or want to tell me anything else - just click here! I'm particularly interested in suggestions for new CRPS-related topics that I may not have covered or even touched on. Please don't feel weird about suggesting new ideas to me - I'm just one CRPS patient, and I'm grateful for any help in identifying new avenues of hope for our community.

Webmaster, Researcher, Writer, Editor, (& responsible for all errors).
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Excellent Powerpoint Presentation!
CRPS and Graded Motor Imagery
Please click above and "Like" us!!
A monthly feature! what are these?
For common medical abbreviations, like Dx, Rx, Tx, etc. please look here.
The most common ones are Rx = prescription; Dx = diagnosis; and Tx = treatment
Title of Article
1 It's All In Your Brain: Graded Motor Imagery
for Pain Modulation
view A very nice presentation on Graded Motor Imagery (GMI), one of the more promising techniques currently being investigated to restore the accurate body perception that's dysfunctional in most CRPS patients.
2 Graded Motor Imagery Flier view A great, multi-color flier on GMI that explains the process in lay language. At only 7 pages, it's a quick way to understand GMI and the reasons for the excitement.
3 Voices that may not otherwise be heard: a qualitative exploration into the perspectives of primary care patients living with chronic pain view A ground-breaking study whose purpose was to understand, as fully as possible, what chronic pain patients actually experience in their day-to-day lives. Several techniques were used, and the exercise seemed to give healthy people much more insight into what we must fight every second of every day.
4 Improving opioid prescription practices and reducing patient risk in the primary care setting view A very thorough analysis of the multimodal approach to treatment needed by CRPS patients. This piece is somewhat opiophobic, but otherwise is a good outline of the various Tx types that should be involved.
5 Restoration of Altered Somatosensory Cortical Representation With SCS Therapy in a Patient With CRPS: A Magnetoencephalography Case view "Magnetoencephalography" is a neural imaging technique that relies on the magnetic field produced by the brain's normal electrical activity (Wikipedia article). Like other, similar techniques, it is fast, painless, and produces results digitally and thus easily shared and transferred.
6 The use of cannabis for
management of chronic pain
view An unusual article format for a controversial topic, on which data are still being gathered. This is a 2-pg editorial in the journal General Hospital Psychiatry - an unusual place to find this topic, especially one that's so positive about cannabis!
7 Prevalence of Neuropathic Pain According to the IASP Grading System in Patients with
Chronic Non-Malignant Pain
view A team of researchers from Denmark studied 120 chronic pain patients, applying the new IASP (Internat. Assoc. for the Study of Pain) diagnostic criteria for neuropathic pain, and found that <20% were diagnosed with neuropathic pain. Very interesting article.
8 Spinal Cord Stimulation for
Intractable Chronic Pain
view A concise review of SCS and its status in treating severe neuropathic pain (NP). Several sources of NP were studied, including CRPS, failed back syndrome, diabetic neuropathy, abdominal pain, and angina. The most common complications - lead migration and infection - are now rare and controllable.
9 A Disturbance in Sensory Processing on the Affected Side of the Body Increases Limb Pain in Complex Regional Pain Syndrome view An elegant series of experiments showed that a disturbance in central somatosensory processing contributes to CRPS pain in a certain subset of CRPS patients. If these results are maintained in a larger group, the technique could be useful in diagnosing how far CRPS has progressed in a patient.
10 Sleep Disorders and Sleep Deprivation:
An Unmet Public Health Problem
view A huge study by the Nat'l. Acad. of Sciences is reported in this 425-pg book, which outlines the development of insomnia, why it happens, the current state of treatment, its shortcomings, what should be done to address the issue, and much more, in incredible detail. Awesomely complete.
11 Complex Regional Pain Syndrome - Clinical Pathway for Work-Related Injury view "This clinical pathway is intended to serve as an instructional aid. It is designed for clinicians treating work-injured patients with or at risk for the development CRPS". A 40-pg, detailed diagnostic aid that's quite unbiased and balanced, especially considering its source. Very refreshing!
12 Cytochrome P450 Drug Interactions Table (pdf) view From Indiana Univ.'s School of Medicine/Division of Clinical Pharmacology comes a page on Drug Interac-tions. This has links to the pdf table in HTML form, where every drug is hyperlinked to a unique data page; there's also an abbreviated table for clinical use. Great resource!
13 Informed Decision-Making Regarding
for CRPS Type I
view Although it's generally accepted that the amputation of a CRPS-afflicted limb doesn't help, the study reported here lays out criteria under which it may be helpful. "The aim of our research was to assist clinicians with task of providing evidence-based advice to patients who request amputation for CRPS-I."
Recent Changes to the Main Site
A new page has been added, called Drug Interactions. CRPS patients typically take many different drugs simultaneously, and I get many questions about possible drug interactions. This collection of sites should answer all of your questions.
Copyright ©2014 - T. Howard Black, Ph.D.
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