WELCOME TO PARC!
This page has news from 2006-9
FOR THE NEW YEAR
"Healing occurs in the
sacred space of calmness and confidence,
not amid the turmoil of fear, anger
Dharma Singh Halls MD
RIDE TO CONQUER
THE COMPLETED RIDE BLOG!
from the RIDE go to patient services and doctor education programs
at PARC as well as to McGill University for CRPS research.
Due to the efforts
of Dr Shulman and his RIDE TO CONQUER CRPS, PARC was able to donate
$5,000 towards CRPS research at McGill
CONJUNCTION WITH THE RIDE TO CONQUER CRPS:
Complex Regional Pain
Syndrome Type I (RSD):
New data from the
clinic and the laboratory.
A Pain Forum presentation of the MUHC Pain
DATE: Monday, 28 July 2008
TIME: 1:00-4:30 PM
PLACE: Livingston Hall Lounge (Room L6-500)
Montreal General Hospital
1:00-1:05 Welcoming remarks (Gary J. Bennett, PhD; McGill University)
1:05-1:45 CRPS-I: The clinical picture. (David L. Shulman, MD CCFP
FCFP DAAPM; Rothbart Pain Clinic, Toronto) RIDE TO CONQUER CRPS
1:45 -2:45 A new theory: Deep tissue microvascular pathology as
the cause of CRPS-I. (Terence J. Coderre, PhD; McGill University)
2:45-3:00 Health break
3:00-3:30 The role of the endothelins in CPIP pathology (Magali.
Millecamps, PhD, McGill University)
3:30-4:00 CRPS-I breakthroughs: New data from Boston and
Haifa (G. Bennett, PhD):
UPDATE AUG 2008:
Who says CRPS research is not important?!
IMPORTANT NEWS BULLETIN: New
research has found markers for CRPS. From Boston, a skin biopsy
can now detect distal nerve damage. From Haifa Israel, a saliva
test can measure high levels of LDH (lactate dehyrogenase), the
same substance found in heart attack victims and test also measure
high levels of albumin.
DUTCH RESEARCH: In
a database of 600,000 patients from 150 GPs in Holland, (only patients
who attend a doctor), the rate of occurrence has been established
as 26.2 in 100,000
is approximately 1 in
every 4,000 people.
In conjunction with
PAIN AWARENESS WEEK
W. J. CHINDEMI
ND DC DHANP
MD FRCS DAAPM
SAT. OCTOBER 31
Linhaven Hall (Linhaven
Home for the Aged)
403 Ontario Street
Lunch, displays, door
Draw for 2 tickets:
Toronto Maple Leafs vs Calgary Flames.
COST: $5.00 per person
Sponsored by Sanofi-Aventis
GUEST SPEAKERS' BIOS
DR R. ZACHARIAS MD
Dr Zacharias obtained his B.Sc from the University of Toronto in
1975. He obtained his Doctorate of Medicine from
the University of Western Ontario in 1980. He completed his residency
training in General Surgery at the University of Western Ontario
in 1985 and was the Senior Research fellow at the University of
Washington, Seattle Washington from 1985-1987.
He founded MedEmerg Inc in 1983 and served as its CEO and Chief
Medical Officer from 1983 to January 2009. MedEmerg was the largest
Emergency Room staffing company in Canada and was involved in Health
System Consulting in Canada and 14 countries internationally. Upon
graduation he worked as an Emergency Physician for 25 years and
since 2005 has works as a Pain Consultant at a
community based Chronic Pain Clinic in Mississauga, Ontario. He
became a Diplomate of the American Academy of Pain Management
in 2009. In addition to his consulting pain practice he
is the Medical Director of the Village of Erin Meadows, a 180 bed
LTC facility in Mississauga. While his pain practice is
diverse he has a special interest in the area of Persistent Pain
in Older Persons.
WAYNE CHINDEMI ND DC DHANP
Wayne graduated with a Chiropractic degree from the National University
of Health Sciences
in Illinois in 1980. He obtained a Naturopathic degree (ND)
from the National College of Naturopathic Medicine in Oregon
in 1986. He was an Instructor and Clinic Director between 1986-1987
with the Ontario College of Naturopathic Medicine in Toronto. He
completed a two year post graduate course and was awarded an Associate
Certification with the Hahnemann College of Homeopathy
in California in 1987-1989. He is a Diplomat of the Homeopathic
Academy of Naturopathic Physicians, (DHANP) and Board Certified
in Homeopathy in 1990.
Wayne has over 20 years' experience treating patients with many
types of illnesses.. His special interest is classical homeopathy.
Wayne has an active chiropractic and homeopathic practice at Bartlett
Natural Health in Grimsby, Ontario.
Our event was well attended and our speakers were excellent. We
thank Dr Zacharis and Dr Chindemi for taking part in NPAW. Both
received a NPAW Certificate of Appreciation and a piece of calligraphic
artwork donated by a local calligrapher. We were able to provide
the audience with a medical doctor and a naturopath who both treated
pain in different ways. We also had display tables for Yoga, Hypnosis,
Sanofi-Aventis, Chronic Pain Association, and PARC. Thanks to Cheryl
Gordon of Yoga Centre Niagara and Andrea Hebert of Hypnosis for
a Change. We thank the Canadian Pain Coaltion and Chronic Pain Assocation
of Canada for their support and for sending posters and materials.
Sanofi Aventis, our sponsor, helped fund a portion of the event
and sent everyone an informative Chronic Pain Booklet for patients.
Most of all we thank the Niagara Support Group volunteers,
(all have chronic pain), who were able to organize a successful
NPAW event in St. Catharines for the 5th year. You are the best!
To finda summary of the event, read the current
fall issue of the PARC PEARL FALL 2009.
US AT PARC.
412 Louth Street,
FIRST TUESDAY OF
PLEASE NOTE: We often have out of town
visitors. If you plan on travelling any distance,
please contact our office first and confirm
the next meeting date.
We discuss current issues in pain e.g. handling
medical treatment. We also have speakers, help attendees find
local resources and the group runs local events.
A long standing myth about support groups is that
they sit around and moan about everything. NOT SO! We are an active
group with much to offer everyone including any new members!
For details on future support group events, please
contact us at PARC.
PAST SUPPORT GROUP
for Chronic Pain"
FIRST: January 29, 2008
SECOND: Feb. 12, 2008
THIRD: Feb. 26, 2008.
FOURTH: March 25,
APRIL: 1, 2008.
April 29, 2008 cancelled
May 13, 2008.
May 20, 2008.
June 10, 2008.
June 24, 2008
Yoga will resume in
PLACE: Tangled Yoga,
25 Main Street, Port
Cowan, Certified Yoga teacher
WEAR: Loose comfortable
clothing and bring a positive attitude.
There is a small fee.
INTENSITY LASER THERAPY (LILT)"
PATRICK MADDALENA DC DIRECTOR
HEALTH AND WELLNESS Centre
JUNE 3, 2008
AM TO NOON
412 LOUTH ST.
Everyone is welcome. Admission is free.
Since seating is limited, please RSVP.
FOR CHRONIC PAIN"
STRESS MANAGEMENT, ALLERGIES)
Tucker RNCP EFT_ADV
DATE: Tuesday, April
This event was well attended and our speaker had
a great deal of information to share with us.
Should anyone wish to contact Judy please contact
us at PARC.
National Pain Awareness
Week across Canada, (Nov 3-8)
PARC and CPAC Niagara Support Group present:
WELL WITH CHRONIC PAIN"
For the first time in Niagara, two leading
experts talk about chronic pain in Canada
PAIN: THE SILENT EPIDEMIC"
Alcohol and Drug
Credit Valley Hospital
CPM Program Director
Canadian Pain Society 2005-7
IN PAIN RESEARCH"
DR MIKE SALTER
MD PhD FRSC
Chair In Neuroplasticity and Pain (Tier 1)
of Toronto Centre for the Study of Pain
Pain Society Distinguished Career Award
Head Program in Neurosciences and Mental Health
Hospital for Sick
Professor of Physiology
U of T
Home for the Aged
Please register early for this event as
space is limited.
Cost is $15 per person.
Refreshments, door prizes, displays. Free
parking. H accessible.
This event was well attended and the speakers were first rate.
Thanks to the Niagara Support Group for
making it run so smoothly. You are all fabulous!
Our thanks to The Positive Step, Accelerated
Health and Wellness, Linda Allen's Chocolates and Miguin for their
If you missed this event, plan to attend another
event of ours! Monitor this page.
PAIN AWARENESS WEEK (NPAW):
thanks to our great volunteers
whom our Nov. 10th event would not have been possible:
WARMEST THANKS to
speakers: Dr Shulman and Lisa Cardas.
OUR SPONSORS: CPM
Clinics, Aquasonix Therapy and Gait Maxx Foot Clinic.
Thanks to Gerry Hruby
of Aquasonix Therapy for donating items to the event.
AND MANAGING CHRONIC PAIN"
Dr. D. L.
MD CCFP FCFP
Pain Clinic, Toronto
DATE: Sat.Nov. 10
TIME: 1-4 PM
PLACE: CHRIST LUTHERAN
140 Russell Ave,
at Catherine St.
- Admission $10 with free hot/cold pack. Refreshments. Displays.
- Free parking at rear.
- Handicapped accessible. Elevator at left rear door.
- PARC members please RSVP to our office or e-mail us with number
in party and if H. assistance is needed.
Presented by PARC and CPAC Niagara support
thanks to the following people for
our June 2 CRPS SEMINAR a success!
Dr. D.L. Shulman,
Rothbart Pain Clinic, Toronto
RN, CPM Health Centres (MEI)
Aquasonix Therapy (Health Sonix Inc.)
CPM Health Centres
Dr. D. L.
MD CCFP FCFP
Pain Clinic, Toronto
MANAGEMENT PROGRAM FOR PATIENTS"
of Patient Services,
Saturday, June 2 at 1 PM
POCKET CARD with $10 admission.
Doors will open at 12:45 PM.
Sponsored by CPM Health
Centres Inc., Mississauga, Ont. Tel: 1 877 CPM PAIN
Sponsored by Health
Sonix Inc., Aquasonix Therapy, Mississauga, Ont. Tel: 1 877 622
CONGRATULATIONS TO FOR
The American organization FOR GRACE is dedicated
to promoting awareness of CRPS and women in pain.
Founder Cynthia Touissant's remarkable story
is in the March issue of Woman's Day Magazine.
To read the story go to FOR GRACE:
UPDATE: MARCH 20, 2007.
FOR GRACE has just posted some RSD/CRPS videos on YOU TUBE.
Way to go John and Cynthia!
WINTER ISSUE 2006
- REVIEW: November 8, St. Catharines with
Dr Bieman-Copland, Clinical Psychologist : "Mangling Chronic
- PARC NEWS: Spring Event
- The POWER OF ONE: Dr Copland
- Chicago RSD/CRPS Conference
- Pain Practitioner Vol 16 No 1: CRPS Special
- Physical Therapy
- Functional Restoration
- Personal Story: Life after DCS: by Bryant
To get your copy contact us at PARC.
- newsletter/research assistant
- small new or used copier
- new or used DLP (digital) projector
- sponsors for our Spring Event
Please contact PARC
for more details.
PAIN AWARENESS WEEK NOV. 5-11,2006.
Wed. November 8 at
Dr. Sherry Bieman-Copland,
Russell Ave. Community Center, Main Floor Russell
Avenue at Catherine St., St. Catharines
H accessible. Free parking. Raffle. Display Tables.
Sponsors: Aquasonix, Alternative Healing Therapy,
Dryan and Assoc.,
Pain Mgt. CANUSA (Laser Therapy), Holistic Therapies
Co-sponsored by CPAC and PARC.
Please contact PARC
for more details.
REGIONAL PAIN SYNDROME
G. Rhydderch, MD, FRCPC
H. Pollett, MD FRCPC, Director,
General Pain Clinic
T Kobrossi, DC, Toronto
DATE: June 18, 2006
3063 S. Service
TIME: 1 PM
OUR THANKS TO:
Dr and Mrs. G. Rhydderch, Hamilton Pain Clinic
Dr H. Pollett, Nova Scotia
Dr T Kobrossi, Toronto
Sharon, Bill and Aron Shore
Steve and Edna
Ken from Renew You Massage Therapy, Ancaster
Volunteers: Deanna, Bryan, Dee, Vickie, Margaret.
Renew You Massage Therapy, Ancaster
Bartlett Natural Health, Grimsby
Jane Lauermeier, ND, St. Catharines
Dr T Kobrossi, Toronto
Joan Gooderham, Golden Quill Studio, Ft. Erie
Tudor Creek House B&B, St. Catharines
You Send Me, Gift Shop, St. Catharines
Staples, St. Catharines
BRAND NEW! ONE OF A KIND! HOT OFF
The PARC CARD
is the size of a credit card easily
stored in a purse, wallet or pocket.
Text in part reads:
YOU HAVE BURNING PAIN?
IT LASTED LONGER THAN THE EXPECTED HEALING TIME?
TO SUSPECT CRPS...(quote)
TEXT: Signs and symptoms of RSD/CRPS.
Are you tired of explaining what RSD/CRPS is? Do your family and
friends understand? Does your doctor know about it? Does the ER
staff, specialist, local hospital, nurse, physiotherapist know?
Now there is no need to explain--let the Pocket Card do it for you.
Why not keep one in your wallet and carry
extras to educate your doctors?
Do you have patients recently diagnosed? Do you need cards for your
patients, nurses, hospital or clinic staff?
This sleek designed 4"x 3 3/8"pocket
card has current RSD/CRPS INFORMATION.
No other card like
it exists in all of Canada.
HOW CAN I GET A FREE
Sign up as a new member
or renew your membership with PARC. Please send your mailing address
and membership fee ($35 CDN for deluxe
or $25 CDN for newsletter only ) to
the address below. (Please note: US and International rates available
HOW CAN I GET CARDS ONLY?
To receive a quantity of
cards, please tell us how many you wish and include a donation inside
a self-addressed envelope sent to our mailing address:
PARC POCKET CARD
PO BOX 21026
ST. CATHARINES, ONTARIO
CANADA L2M 7X2
health care professionals and the public about CRPS is our mandate
Please contact PARC
for more details.
Autonomic Dysfunction and Spinal Cord Stimulation in
Complex Regional Pain Syndrome
Patients diagnosed with Complex Regional Pain Syndrome or Reflex
Sympathetic Dystrophy Syndrome are Needed
For a study investigating how the autonomous nervous system works
before Spinal Cord Stimulator Implant and after
· Participants must be Male or Female
· Between ages 18-65 years old
· Affected in one leg or arm
If interested please contact:
Laura Diedrich, MD
Or email: email@example.com
Please label the email: CRPS study
NOTE: PARC has inquired about Canadian patients.
They may be accepted into the study with certain conditions. If
interested, inquire to the above e-mail address.
McGill University, Montreal, Quebec.
Dr. Gary J. Bennett, well known American RSD researcher for
many years, has come to McGill to conduct research on CRPS/RSD.
PARC is wholeheartedly supporting this research and our team is
cheering him on! If you live in the Ontario or Quebec area, this
is your chance to help everyone with CRPS/RSD by being a research
We invite you to read about it here!
Toronto Star Date: Thursday, December 15, 2005
Chronic pain linked to spinal cord protein
Wind blowing on skin or touch of a shirt is extremely
Discovery will help sufferers rebuffed for lack of
ELAINE CAREY HEALTH REPORTER
Canadian scientists have discovered a protein that plays a
key role in causing debilitating, chronic pain that until now has
never been understood. "Some people can't wear shirts or they're
not able to go out because the touch of a breeze gives them lightning-like
pain," said Dr. Michael Salter, who heads the University of Toronto
Centre for the Study of Pain. "The worst part is that there's often
no physical sign that something's wrong. They're suffering intensely,
they get no relief from medications and their family and friends
don't understand." The discovery paves the way for developing new
ways of detecting and treating the chronic pain that affects thousands
of Canadians, says a study published yesterday in the scientific
journal Nature. Chronic or neuropathic pain is caused by nerve damage
brought on by an injury or illnesses such as cancer, HIV-AIDS or
diabetes, which causes changes in spinal cord cells called microglia.
"Once damaged, the scientists discovered that
microglia release a protein called brain-derived neurotrophic factor
which causes spinal neurons to send an abnormal signal to the pain-processing
networks in the brain. Microglia normally act to suppress pain signals
to the brain and spinal cord but the protein converts it into a
mechanism that amplifies them,"
said Salter, co-principal investigator with Dr. Yves De Koninck
of Laval University and a senior scientist at Sick Kids Hospital.
"One of the messages from this paper ... is that
after these kinds of injuries to nerves in your arm or leg or hand,
you can have changes in your spinal cord that can perpetuate pain
and actually intensify it long after the injury has healed," he
"This is an important discovery for the millions of Canadians
who suffer from debilitating chronic pain that cannot currently
be treated," said Michael Wilson, chair of NeuroScience Canada,
one of the funders of the research through the Brain Repair Program.
'If pain was spelled flu, it would already be considered an
epidemic in this country' Barry Ulmer, Chronic Pain Association
The discovery "represents an important shift that could soon
provide patients with effective treatments and allow them to be
active again in our society," Wilson said. Chronic pain is "a touchy
subject" because there are no obvious physical symptoms and sufferers
are often told they are making it up or faking it, Salter said.
Even strong painkillers don't suppress the pain because they work
on only some of the large pain-processing networks but not all of
them, he said. "Typically people with neuropathic pain get very
little pain relief from traditional painkillers like morphine or
Aspirin or acetaminophen," he said. For some people the pain is
so acute that even common events like wind blowing on the skin or
the touch of a shirt is extremely painful. When neuropathic pain
attacks children with cancer who are undergoing chemotherapy, the
pain is so excruciating the treatment has to be stopped.
The discovery of how microglia communicate with nerve cells
in the pain- processing networks should help in developing drugs
to treat it, Salter said. And it could lead to a diagnostic test
to identify it. "You could go and have a test and show your physician:
`Look, there really is something wrong with me,'" he said. That
is a bigger issue in the United States where many hronic pain sufferers
can't get any health care benefits.
Barry Ulmer, executive director of the Chronic Pain Association
of Canada, said the findings were encouraging but were still only
at the laboratory stage and "it's got a long way to go. "If pain
was spelled flu, it would already be considered an epidemic in this
country," said Ulmer, whose wife suffers from chronic pain. "Anything
that comes forward that takes away from the subjective nature of
pain is helpful," he said. "Most people are stigmatized because
of it. Anything positive that comes along has to be a bonus."
If you change the way you look at something Something you
look at will change.
SOURCE: Toronto Star 2005. Thanks
SUFFERING STOLE HER CHILDHOOD
Ravek, it was a spinning hockey puck that sent her life spiraling
in 1998. She was in Grade 5 and playing floor hockey when she was
struck in the leg.
she got home, her kneecap was twice its normal size. "The doctor
couldn't even touch me. As soon as he'd lay his hands on me, I'd
start yelling" Ravek says,
tests and scans on her knee found nothing.
had doctors saying it's all in my head, that I need psychiatric
help, "she recalls.
"I thought I was crazy. I started to believe what they were
months later she was diagnosed by a pediatric neurologist at CHEO.
But it could have come sooner. Four months earlier, her uncle an
anesthetist has suggested to Ravek's parents that it might be RSD.
The chronic neurological syndrome is characterized by severe burning
pain, pathological changes in bone and skin, tissue swelling and
extreme sensitivity to touch. But when they suggested that to another
doctor, he dismissed it.
just an exaggerated response to pain." Ravek recalls him saying,
"He is kind of threw his hands up in the air, brushing it off".
months later, after being struck, Ravek fell down a fight of concrete
stairs at school that left her with a shooting pain from head to
toe and throbbing that wouldn't quit.
the remainder of Grade 5, as well as a great deal of Grades 6,7,8
and had to repeat Grade 9.
had to leave school and I was teased relentlessly."
just the pain that kept me from school, it was the people There
are still people from my old school I can't see".
spread about what was wrong. Some said she was dying, others said
she was faking it.
supposed best friend once said:"I won't tell anyone if you're
faking it. Are you?"
she says that isolated feeling is imprinted on her, and left her
wary of trusting others....
said to be more painful than labour and Ravek describes it as a
"very intense toothache or migraine, but all over". Doctors
suspect Ravek may also have fibromyalgia.
things did get better for a short while. Once she was able to be
touched, she embraced alternative therapies, including Reiki, massage,
acupuncture, acupressure and creative visualization. She adopted
an organic diet and took up yoga. It allowed her to greatly reduced
were going very well until she developed endometriosis. Up until
then she had been at school almost every day and had taking up belly
dancing. but after laparoscopy in February 2004, Ravek didn't move
for a month.....Soon her depression crept back. She couldn't concentrate
and intense anxiety was setting in.
return saw her spiral downward physically and put her back to living
in her bedroom. She developed an anxiety disorder and an eating
her family being very close knit, Ravek withdrew and stopped talking
to her family. Last June, she was admitted to CHEO's psychiatric
ward in a deep depression.....Since then she has made progress.
For a long time her meds were locked in a safe, but she's reached
a point where she can now self-administer.
seven years but she says she's found great doctors that have helped
her cope with her pain. Today she uses OxyContin to control it,
but recently got off five medications.
still have a lot more but I know I need to be on these."
therapy is also helping her become close with her siblings.....Over
time she's also started talking more to her parents.
still hard," Ravek says. "You lose touch with people.
I'm trying to regain those relationships. I isolated myself so much
because of the depression. I didn't want to see anyone and didn't
want to do anything. It's not the same relationship but we're rebuilding".
Excerpt from Source:Ottawa Sun October 17,
NOTE: PARC has stayed in touch with this beautiful, courageous
teenager since she was diagnosed with CRPS. We hope that she continues
to improve. Special thanks to Ayala for promoting awareness of CRPS,
telling her story and making others aware of the myths of CRPS.
A combination of two drugs can selectively block pain-
sensing neurons in rats without impairing movement or other sensations
such as touch, according to a new study by National Institutes of
Health (NIH)-supported investigators. The finding suggests an improved
way to treat pain from childbirth and surgical procedures.
“It may also lead to new treatments
to help the millions of Americans who suffer from chronic pain.
The study used a combination of capsaicin -- the substance
that makes chili peppers hot -- and a drug called QX-314. This combination
exploits a characteristic unique to pain-sensing neurons, also called
nociceptors, in order to block their activity without impairing
signals from other cells. In contrast, most pain relievers used
for surgical rocedures block activity in all types of neurons. This
can cause numbness, paralysis and other nervous system disturbances.
"The Holy Grail in pain science is to eliminate pathologic
pain without impairing thinking, alertness, coordination, or other
vital functions of the nervous system.
This finding shows that a specific combination of two molecules
can block only pain- related neurons. It holds the promise of major
future breakthroughs for the millions of persons who suffer with
says Story C. Landis, Ph.D., director of the National Institute
of Neurological Disorders and Strokes at NIH.
Lidocaine, the most commonly used local anesthetic, relieves
pain by blocking electric currents in all nerve cells. Although
it is a lidocaine derivative, QX-314 alone cannot get through cell
membranes to block their electrical activity. That's where capsaicin
comes in. It opens large pores called TRPV1 channels -- found only
within the cell membrane of pain-sensing neurons. With these channels
propped open by capsaicin, QX-314 can pass through and selectively
block the cells' activity.
The research team, led by Clifford J. Woolf, M.D., Ph.D., (MGH)
and Bruce Bean, Ph.D. (Harvard), tested the combination of capsaicin
and QX-314 in neurons isolated n Petri dishes and found that :
it blocked pain-sensing neurons without affecting other nerve
cells. This study showed that the drugs could block pain without
impairing motor neurons that control movement.
The drug combination took half an hour to fully block pain
in the rats. However, once it began, the pain relief lasted for
several hours. "Current nerve blocks cause paralysis and total
numbness," Dr. Woolf says. "This new strategy could profoundly
change pain treatment in the perioperative setting." The treatment
tested in this study is unique in that it uses a type of ion channel
(TRPV1 channels) as an avenue to deliver medication. Ion channels
are pores in the cell membrane that control the flow of electrically
charged ions in and out of cells. "I'm not aware of any other
strategy that uses a channel within cells to deliver a drug to a
select set of cells," Dr. Woolf says.
"This project is a nice illustration of how research
trying to understand very basic biological principles can have practical
applications," says Dr. Bean. "Surgical pain is the obvious
first application "
Dr. Woolf says. However, similar therapies might eventually be useful
for treating chronic pain, he adds. Chronic pain continues for weeks,
months, or even years and can cause severe problems, and is often
resistant to standard medical treatments.
Bnshtok AM, Bean BP, Woolf CJ. "Inhibition of
nociceptors by TRPV1-mediated entry of impermeant sodium channel
blockers." Nature Oct.2007
Spots New Cause of Chronic Pain
WEDNESDAY, Jan. 25 (Health Day News) -- In a finding that could
alter pain treatment, British scientists have found that undamaged
nerve fibers, not injured ones, cause ongoing spontaneous pain.
The unexpected finding that may help in the development of new treatments
for back problems and other conditions that involve chronic pain.
Previous research into chronic pain focused on nerve fibers damaged
due to injury or illness, and largely overlooked intact nerve fibers.
"The cause of this ongoing pain and why it arises spontaneously
was not understood before," Sally Lawson, of the University of Bristol,
said in a prepared statement. "Now that we know the type of nerve
fibers involved, and especially that it is the undamaged nerve fibers
that cause this pain, we can examine them to find out what causes
them to continually send impulses to the brain. This should help
in the search for new analgesics that are effective for controlling
ongoing pain." The findings appear in the current issue of the Journal
of Neuroscience. Lawson and her colleagues identified nerve cells
called nociceptors (damage detectors) that, when activated by disease
or injury, send out electrical impulses that are sent to the brain.
The faster these undamaged nociceptors fire electrical impulses,
the stronger the ongoing pain. The firing of these nociceptors seems
to be caused by inflammation within the nerves or tissues, caused
by dying or degeneration of the injured nerve fibers within the
same nerve, the researchers said.
OF NERVE DAMAGE IN CRPS1
For immediate release: January 30, 2006
Study finds nerve damage in previously
mysterious chronic pain syndrome Reduction in small-fiber nerves
may underlie complex regional pain syndrome-I (reflex sympathetic
BOSTON – Researchers at Massachusetts General Hospital (MGH)
have found the first evidence of a physical abnormality underlying
the chronic pain condition called reflex sympathetic dystrophy or
complex regional pain syndrome-I (CRPS-I). In the February issue
of the journal Pain, they describe finding that skin affected by
CRPS-I pain appears to have lost some small-fiber nerve endings,
a change characteristic of other neuropathic pain syndromes
“This sort of small-fiber degeneration has been found in every
nerve pain condition ever studied, including postherpetic neuralgia
and neuropathies associated with diabetes and HIV infection,” says
Anne Louise Oaklander, MD, PhD, director of the MGH Nerve Injury
Unit, who led the study. “The nerve damage in those conditions has
been much more severe,
Complex regional pain syndrome is the current name for a baffling
condition first described in the 19th century in which some patients
are left with severe chronic pain and other symptoms – swelling,
excess sweating, change in skin color and temperature – after what
may be a fairly minor injury. The fact that patients’ pain severity
is out of proportion to the original injury is a hallmark of the
syndrome, and has led many to doubt whether patients’ symptoms are
caused by physical damage or by a psychological disorder. Pain not
associated with a known nerve injury has been called CRPS-I, while
symptoms following damage to a major nerve has been called CRPS-II.
Because small-fiber nerve endings transmit pain messages and
control skin color and temperature and because damage to those fibers
is associated with other painful disorders, the MGH research team
hypothesized that those fibers might also be involved with CRPS-I.
To investigate their theory they studied 18 CRPS-I patients and
7 control patients with similar chronic symptoms known to be caused
by arthritis. Small skin biopsies were taken under anesthesia from
the most painful area, from a pain-free area on the same limb and
from a corresponding unaffected area on the other side of the body.
The skin biopsies showed that, the density of small-fiber nerve
endings in CRPS-I patients was reduced from 25 to 30 percent in
the affected areas compared with unaffected areas. No nerve losses
were seen in samples from the control participants, suggesting that
the damage was specific to CRPS-I, not to pain in general. Tests
of sensory function performed in the same areas found that a light
touch or slight heat was more likely to be perceived as painful
in the affected areas of CRPS-I patients than in the unaffected
areas, also indicating abnormal neural function. “The fact that
CRPS-I now has an identified cause takes it out of the realm of
so-called ‘psychosomatic illness.’ One of the great frustrations
facing CRPS-I patients has been the lack of an explanation for their
symptoms. Many people are skeptical of their motivations, and some
physicians are reluctant to prescribe pain medications when the
cause of pain is unknown,” says Oaklander. “Our results suggest
that CRPS-I patients should be evaluated by neurologists who specialize
in nerve injury and be treated with medications or procedures that
have proven effective for other nerve-injury pain syndromes.” She
adds that the next research steps should investigate why some people
are left with CRPS after injuries that do not cause long-term problems
for most patients, determine the best way of diagnosing the syndrome
and evaluate potential treatments. “Investigations that identify
the causes of disease are only possible if patients are willing
to come to the lab and allow researchers to study them,” she adds.
“We are tremendously grateful to these CRPS patients, whose willingness
to let us study them – despite their chronic pain – allowed us to
make an important step in helping those who suffer from this condition.”
Oaklander is an assistant professor of Anesthesia and Neurology
at Harvard Medical School.
The study was supported by grants from The Mayday
Fund, the National Institute for Neurological Disorders and Stroke,
and the American Federation for Aging Research. Coauthors are Julia
Rissmiller, Lisa Gelman, Li Zheng, MD, PhD; Yuchiao Chang, PhD;
and Ralph Gott, all of the MGH. Massachusetts General Hospital,
established in 1811, is the original and largest teaching hospital
of Harvard Medical School.
Contact: Sue McGreevey (617) 724-2764
By Steven A. King,
June 2006, Vol. XXIII,
Of all the common pain syndromes, perhaps none is so misunderstood
by both physicians and patients as complex regional pain syndrome
(CRPS). Types I and II of CRPS are the current names for what
were previously called reflex sympathetic dystrophy (RSD) and
causalgia, respectively. Because of limited knowledge about these
disorders, patients who suffer what is frequently very severe
pain often have their condition misdiagnosed and do not receive
Although many physicians are still relatively unfamiliar with
these disorders, the first in-depth description was made over
140 years ago by the physician often considered the father of
American neurology, S. Weir Mitchell, and his colleagues, based
on their observations of soldiers wounded in the Civil War. They
noted that some soldiers who were wounded in the hand or foot
developed a burning pain that was exacerbated by touching the
affected body part. This syndrome was named causalgia, Greek for
Multiple similar conditions were described over the years and
received a variety of names, including post-traumatic injuries,
algodystrophy, and Sudeck atrophy. In 1953, John Bonica, one of
the pioneers in the study of pain, suggested that these disorders
be subsumed under “reflex sympathetic dystrophy.”
However, the validity of this term has been questioned frequently.
One of the major problems encountered in its use is the uncertainty
of the role of the sympathetic nervous system (SNS) in this disorder.
The fact that there is a great deal of variability in response
to sympathetic blocks suggests that in many patients, the pain
is not due to a disorder of the SNS.
Because of this and the general confusion over RSD and causalgia,
the International Association for the Study of Pain renamed these
syndromes in its classification of chronic pain.1 RSD became CRPS
type I and causalgia became CRPS type II. The diagnostic criteria
for CRPS are shown in the Table (see June 2006 Psychiatric Times,
page 9). The difference between types I and II is that in the
latter, there is evidence of a definable nerve lesion.
Two terms used to describe the pain, allodynia and hyperalgesia,
are notable in the criteria for both types of CRPS. Allodynia
is pain due to a stimulus that is not usually painful and is commonly
the most dramatic presenting symptom of these disorders. Patients
with this problem may wear loose-fitting clothing to limit the
amount of contact between it and the skin in the affected area.
In more severe cases, patients may complain that even having bedsheets
touching the body part can cause severe pain. In hyperalgesia,
a normally painful stimulus causes more discomfort than expected.
Both allodynia and hyperalgesia are covered by the more general
term “hyperesthesia,” an increased sensitivity to
The frequency of occurrence of CRPS is unclear. A recent study
of patients with fractures of the distal radius reported that
CRPS type I developed in 18%.(2) Another study of 162 soldiers
wounded in the Iraqi war who were seen in pain clinics reported
that 4.3% suffered CRPS type II and 1.9%, CRPS type I.(3) Based
on reports that patients with CRPS often see a number of physicians
before their condition is diagnosed correctly, it appears that
many cases are never diagnosed. Type I may especially go unrecognized
because of the absence of an identifiable peripheral nerve injury
and the usual relationship of the disorder to some form of trauma,
ranging from an accident-induced injury to surgery or diseases
that can cause pain, including myocardial infarction and post-herpetic
neuralgia. Since pain is an expected sequela of these events,
the possibility of CRPS may not be considered by health care providers
for lengthy periods.
Unfortunately, because many patients with CRPS appear “normal”
and because pain such as allodynia seems so bizarre and so foreign
to most laypeople and even some health care professionals, patients
may be mistakenly thought to be either exaggerating their pain
for secondary gain or even malingering. One of the saddest things
is that these patients may find their pain discounted by so many
others and may be stigmatized as falsifying their discomfort.
The cause of CRPS remains a mystery. A variety of physiologic
mechanisms have been proposed. The classic view that the pain
is due to hyperactivity of the SNS has been discounted, although
the SNS appears to be involved in some of the symptoms, most notably
the edema, blood flow, and sudomotor changes. Currently, CRPS
is believed to be due to a combination of peripheral and central
factors.(4) Among the peripheral mechanisms that have been proposed
are an inflammatory process, peripheral sensitization, and changes
in sodium channels. These processes may result in central changes,
including an exaggerated response to the peripheral input and
a reduction of descending inhibitory pathways.
Because the severity of the original trauma does not appear to
be correlated with these disorders, the significance of psychological
factors and the possibility that they may play an important role—if
not the major role—in the development of the pain have often
been the focus of attention. Despite this speculation, there have
never been consistent findings of a correlation between preexisting
mental disorders and the development of CRPS. However, it has
been proposed that there may be changes in the brain, most notably
in the primary sensory cortex, secondary to CRPS, and that these
can lead to a distorted body image.(5,6) What role these changes
may play in the pain and other symptoms of CRPS is still the subject
In my next column, I will address the diagnostic workup and treatment
Dr King is clinical professor of psychiatry at the New York University
School of Medicine.
1. Merskey H, Bogduk N, eds.Classification of Chronic Pain: Descriptions
of Chronic Pain Syndromes and Definitions of Pain Terms. 2nd ed.
Seattle: IASP Press; 1994.
2. Puchalski P, Zyluk A. Complex regional pain syndrome type 1
after fractures of the distal radius: a prospective study of the
role of psychological factors. J Hand Surg (Br). 2005;30:574-580.
3. Cohen SP, Griffith S, Larkin TM, et al. Presentation, diagnoses,
mechanisms of injury, and treatment of soldiers injured in Operation
Iraqi Freedom: an epidemiological study conducted At two military
pain management centers. Anesth Analg. 2005; 101:1098-1103.
4. McBride A, Atkins R. Complex regional pain syndrome. Curr Orthop.
5. Moseley GL. Distorted body image in complex regional pain syndrome.
6. Birklein F, Rowbotham MC. Does pain change the brain? Neurology.
retrains brain against phantom pain
January 13 2007 at 03:57PM
New York - A therapeutic approach called graded motor imagery reduces
the pain and disability in patients with phantom limb pain or complex
regional pain syndrome type 1 (CRPS1), according to a report in
the journal Neurology.
Findings such as these should make us all a bit more open minded
about pain, Dr G Lorimer Moseley from the University of Oxford,
UK, told Reuters Health. Graded motor imagery can be considered
a therapeutic tool, but should only be used "within a sound
clinical reasoning model."
Moseley notes that CRPS1 and phantom limb pain are classified as
pathologic pain syndromes, because the pain seems unrelated to the
underlying tissue damage. Therefore, the portion of the brain responsible
for the perception of brain appears to be a reasonable target for
treatment - to "train the brain."
The researchers investigated whether a 6-week program of graded
motor imagery would reduce pain and disability for a more general
population of CRPS1 patients and for patients with phantom limb
pain, and compared this approach to physiotherapy and usual care.
In the first phase of graded motor imagery, the patients assessed
images of their limbs in various positions for the degree of pain
they would expect to experience. In the next phase, they imagined
moving the limbs in a smooth, pain free manner. Finally, they actually
mimicked the movement.
At the end of the program, average pain (as measured on a 100-mm
visual analog scale) had decreased by 23.4 mm in the treatment group
and by 10.5 mm in the control group, Moseley reports.
The average scores on a specific task tailored to five patients
improved by 2.2 points on a 10-point scale in the graded motor imagery
group, compared with 0.6 points in the control group, the results
By the 6-month follow-up evaluation, the average decrease in pain
was still much greater for the graded motor imagery group (32.1
mm) than for the control group (11.6 mm), Moseley found.
"It is not a panacea by any means, and some patients don't
respond at all," Moseley said. He also advocates using graded
motor imagery with cognitive behavioural support and reassurance.
Moseley concludes: "Although evidence is emerging that treatments
such as graded motor imagery and sensory discrimination training
can be effective for pathologic pain, further studies are needed
to replicate the current data and elucidate the mechanisms involved."
SOURCE: Neurology, December 26, 2006.
The Day That Changed
My Life Forever
March 31, 2003 is a day that I will never forget, although
there are many
parts of that day that I can't remember. Parts that fade in and
out of my
memory, jumbled and unclear, but in focus and crystal clear. How
can that be
you ask? Well let me tell you a story about myself and explain.
My name is Connie and I am a 36 year old (soon to be 37) stay at
My husband Grant and I have been married for 17 years this summer
lived in Clifford for all of those years. We have two beautiful
Jessie who is going to be 16 this December, and Alisa who is turning
March 1st. Throughout our years together we have gone through many
both good and bad, like any normal family, but on that fateful March
some three years ago, our lives as we knew it, changed forever.
What is RSD?
RSD, is also known as Complex Regional Pain Syndrome. It is
a Chronic Pain Disease that is caused by a usually non traumatic
injury, such as stubbing your toe or something as simple as having
a sliver. Although in many cases
it is caused by an injury like mine, sustained in an accident, many
and others in everyday living. Surgery, fractures, stroke or heart
can also cause RSD. A normal injury like a sprained wrist that causes
undo amount of burning pain that just won't go away.
Color changes, swelling extreme reactions to cold and temperature
changes, limited range of motion in the limb affected by RSD. RSD
also causes tremors, weakness and muscle atrophy, limbic system
dysfunction, depression, memory loss, anxiety, hair, skin and nail
changes, and sweating. RSD/CRPS is a multi-system, multi symptom
disease characterized by chronic pain usually affecting one or more
limbs, but it can affect any part of the body. The blood supply
to the limb (hand, knee foot, hip shoulder) is affected.
When it progresses, the function of the limb may also become
impaired. If diagnosed early, it can be treated effectively. If
left untreated, it can spread to other parts of the body. There
is no single test to diagnose RSD. Many patients with RSD are left
undiagnosed for many months because of this and do not receive the
treatment that they need to recover fully from this disease.
Treatment consists of physical therapy, drugs, anti-depressants,
blocks (focal, sympathetic, epidural), spinal cord stimulator, nerve
stimulator, morphine pump. Many people with RSD need ongoing psychological
support and counseling. Learning to relax is a must for a person
afflicted with RSD.
Three years ago I was injured in a car accident on my way to
suffered many injuries. While most of my injuries healed, my left
refused to get better. It was swollen, cold to the touch, turned
caused me such intense pain that I was in agony most of the time.
Three weeks after my accident I started physiotherapy . My left
knee was hugely distorted and bent out of shape. I was unable to
apply any pressure on it and couldn't get it straight. Therapy was
pure torture as we tried to get my leg to straighten out. Many types
of treatments were used on my injuries. Acupuncture, ultra sound,
stretching, massage therapy, heat, shock wave therapy.
My physiotherapist tried every treatment available to her,
unfortunately it wasn't enough. RSD had become my closest enemy
for life. My life spiraled out of control as I tried to come to
grips with this disease. A touch, as simple as a light breeze on
my leg was enough to make me cry. Every day activities, that we
normally take for granted, became a task that took many hours for
me to complete. Vacuuming, laundry, dusting, these house hold chores
that would normally take a couple of hours to accomplish, were now
taking several days to be completed. Making dinner for Grant and
the girls was often overwhelming and had to be left until Grant
was home from work and able to do it. My life as I knew it was over.
While RSD had me in it's grips, I was struggling with my mental
fighting depression and that age old question of "Why Me?"
I hadn't done
anything to deserve this awful burning pain. Taking medication became
of my daily routine, and as I learned to walk with crutches, a walker
then a cane, I tried not to become dependant on pain killers which
never quite take the pain away. The medication was enough to take
off of the pain but it was always there. Grant and my girls became
friends and my pillars of strength, my shoulder to cry on when I
so badly and there were many days that I spent on the couch accomplishing
nothing but feeling sorry for myself as I lay in agony, trying not
Members of my family were very understanding, spending many
hours with me on
the phone, and in person trying to boost my spirits. My girls had
to grow up
very quickly as I was unable to work, do normal house hold daily
simply be a parent. I was unable to walk for more then a couple
at a time, sitting and standing was just as bad. My life became
trips to the
numerous Doctors and Specialists that were trying to treat me. Traveling
Hamilton General Hospital for Lumbar Sympathetic Nerve Blocks every
weeks was an ordeal that I undertook in an attempt to over come
the pain and
horror of RSD.
During the many months of treatments I had to look deep inside
decide what was important in my life and what I could do away with
attempt to make my life easier on myself and my family. In doing
so I was
able to find a new me and one that was much better suited to living
this disease. I knew that if I continued on as my old self , Grant
girls and myself would not survive.
I was able to find a person who was strong, a person who could
handle pain and someone who learned to laugh and love and enjoy
my life, such as it was. I became a nicer person, someone who was
able to talk to others and really listen. I became a lot more sympathetic
to others and their trials and tribulations. My strength and
faith in God became much stronger and is now a driving force in
my life. I
learned to love Grant and the girls for who they are and what they
for me and for each other. We became as a family, a much stronger
separate people forced to live in extreme conditions and we survived.
While our lives are not perfect and will never be perfect,
we have become a
strong happy healthy family, full of love, laughter, the spirit
of God and
each other. This disease has taught us to be compassionate, kind,
forgiving. Grant and the girls have learned not to take it personally
lash out at them in anger, they know it is not that I am angry with
but in so much pain that I can not handle it and must lash out at
something and they happen to be closest to me. While I am quick
to anger, I
am also quick to cry, quick to hurt and quick to feel sorry for
who may be suffering more then myself. I have had to learn to laugh,
myself and at the world.
While Grant and the girls laugh at me because my memory isn't
quite like it use to be and I am forgetting things that I shouldn't
be forgetting, I to have to laugh with them. While my disease makes
my life that much harder, it has also made me aware of what is important
and of how I want to live my life. I don't want to ever be the
person that I was before my accident; I am much more content with
and of what God has given me. I am truly thankful for all of the
small things in life that we take for granted and for all of the
big things that God has given me.
Family, Friends, Faith and Love.
Dealing with RSD and now also Rheumatoid Arthritis (which I
diagnosed with in April of 2005) two chronic pain diseases has made
stronger person, a person I like to think who is better suited to
life's challenges and everyday as I crawl out of bed, I accept those
challenges and look forward to what life has to offer. Living with
pain, memory loss, loss of being able to do every day activities,
comparison to the love and happiness that I have been given everyday
life since that fateful day in March, 2003.
Am I upset that I have to live in extreme immeasurable pain
every day for the rest of my life? Sure I am, I wouldn't be a
normal person if I wasn't, but I have learned to deal with it
and have decided that I am going to live my life to the fullest
and am not going to let RSD live my life for me.
While I am going to have many ups and downs and will spend
many hours on the couch in pain, I am very lucky as I know that
I will always have love and understanding and compassion from those
closest to me and those who mean the most to me. I will survive
and I will always have the pleasure of knowing that I have become
a better person because of RSD.
There may be a time in my life when I will not be able to walk
and will be forced to use a wheel chair, I will never have to worry
about parking in the very back of the parking lot as I now have
a parking sticker that lets me park right up front. We were also
lucky enough to get a hot tub in which I have spent hours and hours.
Hot water under a starry night sky is therapy in itself, throw in
a glass of wine, soft music and a soak in the hot tub with my husband
doesn't hurt any neither.
I want to take this time to thank Grant and my girls, and also
my friends and family who have stood by me. I want to thank everyone
who has helped us out in any way since my accident and fortunately
there is simply to many people to name. I can't thank you all enough
for caring enough about us to stand by us when others have walked
away. You are awesome and we love you! If you or someone you know,
think that you may have RSD there is help out there.
For more information please contact Helen Small who is president
which is a non-profit organization whose goal is to promote and
awareness of RSD in Canada. They are located in St.Catharines Ontario
she can be reached Monday to Thursday Evenings at 905-934-0261 or
by e-mail through the website at www.rsdcanada.org
Note: Connie has started an online support group about RSD.
If you are interested in learning more please visit the RSD Support
***Many thanks to Connie for taking the
time to write this awareness article.
Mail Tuesday October 24, 2006 p A19.
health care already exists when it comes to easing crushing pain....
many hospitals do not have pain clinics", says Dr Henry. "This
is a disgrace", he says.
Read the article and share your story of chronic
PAIN MANAGMENT AND RESEARCH Summer
2007 Vol 12 No. 2
copyright The Journal of the Canadian Pain Society
1. LaChapelle, Diane et al
ACCEPTANCE OF PAIN:IS IT WITHIN THE REALM OF POSSIBILITIES?
Univeristy of New Brunswick and Mount Saint Vincent University,
Within the past 10 years, cognitive behaviour pain management models
have moved beyond the traditional focus on coping strategies and
perceived control over pain, to incorporate mindfulness and acceptance
based approaches.Pain acceptance has been described as "giving
up the struggle within unyielding pain and learning to live a better
life." (McCracken 1998, p.22) Acceptance has since been found
to be associated with lower levels of pain, disability and psychological
distress. Little is know about how patients arrive at a state of
acceptance. Examination of the women's responses revealed acceptance
was a process of realizations and acknowledgements including: realizing
the pain was not normal and help was needed; receiving a diagnosis,
acknowledging there was no cure, and realizing they needed to redefine
normal. Diagnosis, social support, educating self and others, and
self care were factors that promoted acceptance. Struggling to retain
a pre-pain identity, negative impacts on relationships, others not
accepting, and the unspoken message that the pain was "all
in their head", were factors that hindered acceptance.
2. Noertjojo K MD MHSc MSc et al
AMPUTATION FOR COMPLEX REGIONAL PAIN SYNDROME AT THE WORKSAFEBC
Evidence Based Practice Group, Clinical Services. WorkSafe BC
CRPS type 1 and 2 are debilitating syndromes that have been recognized
perhaps in the 5th century BC as described in the story of Philocetes
written by Sophocles. Despite the lengthy history of these disorders,
the natural history and pathophysiology of CRPS 1 and 2 are still
unclear. As a result, the treatment of patients with these disorders
remains controversial and frequently ineffective. One of the most
drastic and dramatic surgical treatments occasionally considered
for these patients is amputation of the affected body part.
A systematic review of the literature identified 90 published papers.
Of these, 9 papers were relevant. The results of these papers will
be described and compared with the results of amputation among WorkSafe
BC claimants diagnosed with CRPS. The characteristics of the patients,
treatment prior to amputation, indication for amputation and outcomes
of the surgical procedures will be described.
CONCLUSION: Amputation is a rare and drastic surgical procedure
that is unlikely to be of benefit to patients with CRPS.
Poster abstracts: Canadian Pain Society conference May 23, 2007.