CRPS: Diagnosis and Prognosis

By: Traci Patterson, CH, CI and Owner, Advanced Pathways Hypnosis

As an individual that was diagnosed with CRPS (Complex Regional Pain Syndrome) I know there are a lot of questions about how patients are diagnosed and from there what is the prognosis for those patients.  I’ve put together some information to try to answer some questions that I’m asked quite often.

DIAGNOSIS

Currently there is no actual ‘one test’ that will give a definite positive diagnosis of Complex Regional Pain Syndrome (CRPS) aka Reflex Sympathetic Dystrophy (RSD).

Instead to receive a positive clinical diagnosis of CRPS/RSD, pain specialists and doctors use the current BUDAPEST CRITERIA 2004, which was brought out during the International Consensus Conference in 2004. This new diagnostic criteria takes over from the one from the International Association for the Study of Pain in 1994 (IASP 1994). The pain specialist or doctor will discuss with you your medical history, symptoms you may be having and any signs or changes. They also may do nerve conduction studies, EMG, MRI scan, x-rays, bones scans, and/or a thermal study.

If there is no known injury or illness that contributed to the problems then the doctors and specialists would carefully check to see if there is no other treatable condition that has been missed.

The BUDAPEST CRITERIA 2004 states that for there to be a clinical diagnosis of CRPS/ RSD certain criteria need to be reached.

These are:

  •  There needs to be lasting pain which is disproportionate to the initial injury or illness.
  • The patient also needs to be experiencing at least 3 out of 4 of certain categories listed below. If you are positive in any of these categories you need to tell the doctor / specialist that is treating you.

Specific Categories:

  1. SENSORY – This means that you describe symptoms of increased sensitivity or hypersensitivity on your limb
  1. VASOMOTOR– This is when you describe temperature differences in your limb and / or skin color changes and / or difference in your skin color between the limbs
  1. SUDOMOTOR / EDEMA – You describe edema and / or sweating changes and / or sweating asymmetry
  1. MOTOR / TROPHIC – Reports of decreased range of limb motion and / or abnormality of a muscle or nerve that effects or produces motion (including tremor, weakness, dystonia…) and / or trophic changes (includes changes in nails, hair, skin…)
  • You must ALSO show at least 1 sign observed by the doctor or specialist at your appointment, in 2 or more of the categories below:
  1. SENSORY– Evidence of hyperalgesia usually following a pinprick and / or allodynia (proof of pain to a light touch and / or deep somatic pressure and / or joint movement)
  1. VASOMOTOR – Proof of temperature change in 2 limbs or more and / or skin color changes
  1. SUDOMOTOR / EDEMA – Proof of swelling or edema and / or sweating changes and / or sweating asymmetry
  1. MOTOR / TROPHIC – Evidence of decreased range of motion and / or motor dysfunction (such as tremor, weakness, dystonia) and / or trophic changes (skin, hair, nails…)
  • If there is NO other diagnosis that could better explain the symptoms and signs observed during a physical examination, and you meet the above criteria then you will most likely be diagnosed with CRPS/RSD.

PROGNOSIS

If you receive early treatment following the injury or illness there is a little evidence or research to say that there is a fair chance of recovery or ‘remission’ as CRPS patients know it. It has not yet however been proven during clinical trials and studies concerning early treatment. However, the prognosis will be different for each sufferer as everyone is considered unique and their symptoms although they will have a common trait, will also vary.

Occasionally people are left with unrelenting, agonizing pain and irreparable changes regardless of what standard/traditional treatment is given to them.  I can’t stress enough, that more alternative and complementary treatment options need to be given to CRPS/RSD and chronic pain patients.  This is a starting point.  There are non-invasive treatment options currently available for CRPS patients at this time, but the hospitals and physicians are not utilizing them nor speaking to their patients about them.  Clinical/medical hypnosis/hypnotherapy has been shown to be effective in significantly reducing pain [I utilized clinical/medical hypnosis to get into remission, and I currently treat CRPS patients with clinical hypnosis and a multi-therapeutic approach to assist them in significantly reducing their pain and/or getting into remission.] and let’s not forget about Calmare Therapy.

More research is definitely require to help understand the actual causes of CRPS, how early treatment affects it, why it progresses in some people and not in others… The list is endless as to questions about CRPS – this needs to change.

In a recent study from 2014, Van Velzen, G.A.J. et al. (See below) concerning the quality of life, they concluded:

“We conclude that loss of QoL in CRPS patients is due mainly to reduced physical health. A comparison with data available from the literature shows that CRPS patients generally report poorer QoL than patients with other chronic pain conditions, particularly in the physical domains.”

(* QoL = Quality of Life)

Many children and teenagers who have been diagnosed tend to have a good recovery. According to Edward C.T.H. et al (See below for study details)

“The prognosis of childhood-onset CRPS I seems less favorable than usually reported, and is comparable to the prognosis of the adult-onset CRPS I in view of a decreased quality of life and a large relapse percentage (33%) at long-term follow-up.”

In another study by Finniss, D.G., et al. entitled ‘Complex Regional Pain Syndrome in children and adolescents’, (See below) it was said that:

“Early diagnosis, referral and appropriate intervention are essential in decreasing pain, suffering and resorting function for children and adolescents with CRPS.”

There is still more research to do to learn as much as we can about Complex Regional Pain Syndrome (CRPS) aka Reflex Sympathetic Dystrophy (RSD).  At this time there is no one specific test that can be done to diagnosis this condition.  The doctors and specialists are doing the best they can to confirm Complex Regional Pain Syndrome (CRPS) based upon the BUDAPEST CRITERIA 2004.  No, this is not perfect but it is aiding is the diagnosis and treatment of patients.

Research is slow when it comes to CRPS both in the US and in other countries.  There is some research that has shown that early diagnosis and early treatment will aid in the recovery and subsequent remission, but no clinical trials / studies have been completed to prove this.

I have personally experienced, treated and seen patients that have had CRPS from 1 years to 10+ years get into remission utilizing different non-invasive treatment options including clinical hypnosis.  We have to have studies done on all types of treatments, all stages of CRPS patients undergoing treatment and the efficacy of the treatments.  I think that the outcomes would be eye opening when it came to the money spent on Spinal Cord Stimulators and some of the other traditional treatments vs integrative and complementary treatments.

It seems that there is insufficient evidence in many areas of the condition that are unknown or understood by the health profession on a worldwide basis. This is something that has to change in order to increase the outcomes for CRPS patients.  That is the exact reason why Advanced Pathways Hypnosis is taking the steps to initiate data collection and a clinical study on the outcome of, “Clinical Hypnosis Utilizing a Multi-Therapeutic Approach with CRPS Patients”.  Please keep your eyes open in the near future for further information.

REFERRED TO RESEARCH / STUDIES / TRIALS

Breast Cancer: Published Study Shows Hypnosis Can Control Fatigue

By:  Traci Patterson, CH, CI – Owner, Advanced Pathways Hypnosis

Hypnosis can be used to control fatigue from radiotherapy for breast cancer according to a study published in the Journal of Clinical Oncology. People living with cancer and other diseases have been learning hypnosis at Advanced Pathways Hypnosis with Traci Patterson. Hypnosis is an evidence-based intervention to control fatigue in people undergoing radiotherapy for cancer.

Medical Hypnosis is noninvasive, has no adverse effects, and its beneficial effects persist long after the last intervention session. If you are living with cancer, an autoimmune disease, chronic pain or other illness, you too can learn hypnosis and create lasting benefits.

Randomized Controlled Trial of a Cognitive-Behavioral Therapy plus Hypnosis Intervention to Control Fatigue in Patients Undergoing Radiotherapy for Breast Cancer

Results: The CBTH group had significantly lower levels of fatigue (FACIT) at the end of radiotherapy (z, 6.73; P < .001), 4-week follow-up (z, 6.98; P < .001), and 6-month follow-up (z, 7.99; P < .001) assessments. Fatigue VAS scores were significantly lower in the CBTH group at the end of treatment (z, 5.81; P < .001) and at the 6-month follow-up (z, 4.56; P < .001), but not at the 4-week follow-up (P < .07). Muscle Weakness VAS scores were significantly lower in the CBTH group at the end of treatment (z, 9.30; P < .001) and at the 6-month follow-up (z, 3.10; P < .02), but not at the 4-week follow-up (P < .13).

Conclusion: The results support CBTH as an evidence-based intervention to control fatigue in patients undergoing radiotherapy for breast cancer. CBTH is noninvasive, has no adverse effects, and its beneficial effects persist long after the last intervention session. CBTH seems to be a candidate for future dissemination and implementation.

Here is a link if you would like to read the entire article: Randomized Controlled Trial of a Cognitive-Behavioral Therapy Plus Hypnosis Intervention to Control Fatigue in Patients Undergoing Radiotherapy for Breast Cancer

Advanced Pathways Hypnosis offers a caring environment, compassion, and excellent resources for noninvasive treatment options.  If you or a loved one is dealing with cancer please contact us to see how we can assist you to increase your energy, decrease pain, and more… all while working in conjunction with your current physicians.

www.AdvancedPathways.com  |  714-717-6633  |  Info@AdvancedPathways.com

PTSD: Facts, Signs and Treatment Options

By:  Traci Patterson, CH, CI – Owner, Advanced Pathways Hypnosis

Posttraumatic stress disorder (PTSD), once called shell shock or battle fatigue syndrome, is a serious condition that can develop after a person has experienced or witnessed a traumatic or terrifying event in which serious physical harm occurred or was threatened. PTSD is a lasting consequence of traumatic ordeals that cause intense fear, helplessness, or horror, such as a sexual or physical assault, the unexpected death of a loved one, an accident, war, or natural disaster. Families of victims can also develop PTSD, as can emergency personnel and rescue workers.

Sometimes these symptoms don’t surface for months or years after the event or returning from deployment. They may also come and go. If these problems won’t go away or are getting worse—or you feel like they are disrupting your daily life—you may have PTSD.

You feel on edge. Nightmares keep coming back. Sudden noises make you jump. You’re staying at home more and more, and isolating yourself from the outside world.  Could you have PTSD?

If you have experienced severe trauma or a life-threatening event, you may develop symptoms of posttraumatic stress, commonly known as posttraumatic stress disorder, PTSD, shell shock, or combat stress. Maybe you felt like your life or the lives of others were in danger, or that you had no control over what was happening. You may have witnessed people being injured or dying, or you may have been physically harmed yourself.

Some of the most common symptoms of PTSD include recurring memories or nightmares of the event(s), sleeplessness, loss of interest, or feeling numb, anger, and irritability, but there are many ways PTSD can impact your everyday life.

Some factors can increase the likelihood of a traumatic event leading to PTSD, such as:

  • The intensity of the trauma
  • Being hurt or losing a loved one
  • Being physically close to the traumatic event
  • Feeling you were not in control
  • Having a lack of support after the event

Most people who experience a traumatic event will have reactions that may include shock, anger, nervousness, fear, and even guilt. These reactions are common; and for most people, they go away over time. For a person with PTSD, however, these feelings continue and even increase, becoming so strong that they keep the person from living a normal life. People with PTSD have symptoms for longer than one month and cannot function as well as before the event occurred.

What Are the Symptoms of PTSD?

Symptoms of PTSD most often begin within three months of the event. In some cases, however, they do not begin until years later. The severity and duration of the illness vary. Some people recover within six months, while others suffer much longer.

Symptoms of PTSD often are grouped into three main categories, including:

  • Reliving: People with PTSD repeatedly relive the ordeal through thoughts and memories of the trauma. These may include flashbacks, hallucinations, and nightmares. They also may feel great distress when certain things remind them of the trauma, such as the anniversary date of the event.
  • Avoiding: The person may avoid people, places, thoughts, or situations that may remind him or her of the trauma. This can lead to feelings of detachment and isolation from family and friends, as well as a loss of interest in activities that the person once enjoyed.
  • Increased Emotions: These include excessive emotions; problems relating to others, including feeling or showing affection; difficulty falling or staying asleep; irritability; outbursts of anger; difficulty concentrating; and being “jumpy” or easily startled. The person may also suffer physical symptoms, such as increased blood pressure and heart rate, rapid breathing, muscle tension, nausea, and diarrhea.

Young children with PTSD may suffer from delayed development in areas such as toilet training, motor skills, and language.

Who Gets PTSD?

Everyone reacts to traumatic events differently. Each person is unique in his or her ability to manage fear and stress and to cope with the threat posed by a traumatic event or situation. For that reason, not everyone who experiences or witnesses a trauma will develop PTSD. Further, the type of help and support a person receives from friends, family members and professionals following the trauma may influence the development of PTSD or the severity of symptoms.

PTSD was first brought to the attention of the medical community by war veterans, hence the names shell shock and battle fatigue syndrome. However, PTSD can occur in anyone who has experienced a traumatic event. People who have been abused as children or who have been repeatedly exposed to life-threatening situations are at greater risk for developing PTSD. Victims of trauma related to physical and sexual assault face the greatest risk for PTSD.  Chronic pain patients that have been through numerous procedures, surgeries and have dealt with immense pain for years face the risk for developing PTSD.

What are the signs of PTSD?

A wide variety of symptoms may be signs you are experiencing PTSD:

  • Feeling upset by things that remind you of what happened
  • Having nightmares, vivid memories, or flashbacks of the event that make you feel like it’s happening all over again
  • Feeling emotionally cut off from others
  • Feeling numb or losing interest in things you used to care about
  • Becoming depressed
  • Thinking that you are always in danger
  • Feeling anxious, jittery, or irritated
  • Experiencing a sense of panic that something bad is about to happen
  • Having difficulty sleeping
  • Having trouble keeping your mind on one thing
  • Having a hard time relating to and getting along with your spouse, family, or friends

It’s not just the symptoms of PTSD but also how you may react to them that can disrupt your life. You may:

  • Frequently avoid places or things that remind you of what happened
  • Consistent drinking or use of drugs to numb your feelings
  • Consider harming yourself or others
  • Start working all the time to occupy your mind
  • Pull away from other people and become isolated

What is the treatment for PTSD?

If you have PTSD, it doesn’t mean you just have to live with it. In recent years, researchers from around the world have dramatically increased our understanding of what causes PTSD and how to treat it.

Traditional medicine will state there are two types of treatment that have been shown to be effective for treating PTSD: counseling and medication. Professional counseling can help you understand your thoughts and discover ways to cope with your feelings. Medications, called selective serotonin reuptake inhibitors, are used to help you feel less worried or sad.

Unfortunately, many people that undergo these two types of treatment are still left with signs and symptoms of PTSD.

I recently read an article about some new research where they were utilizing MRT (Magnet Resonance Therapy) to help treat PTSD.  Yes, it is a drug-free and non-invasive treatment option, but at the same time every treatment it exposing the patient to radiation.  The treatment protocol is daily 30 minutes treatment for up to two months. What a tradeoff, radiation exposure for possible relief of PTSD.

The other option is also a drug-free, non-invasive treatment protocol that involves clinical hypnosis with a multi-therapeutic approach.  This combination works with the neuroplasticity of the brain, the physiology of the body and mixes that with hypnosis to give patients a scientifically designed program to meet their personal needs.  Our approach empowers the patient to take charge of their health, life, to open up new pathways and create a more succinct, healthy and successful future.

You may need to work with your doctor or counselor and try different types of treatment before finding the one that’s best for dealing with your PTSD symptoms.

What can I do if I think I have PTSD?

In addition to getting treatment, you can adjust your lifestyle to help relieve PTSD symptoms. For example, talking with other Veterans or individuals who have experienced trauma can help you connect with and trust others, exercising can help reduce physical tension, and volunteering can help you reconnect with your community. You also can let your friends and family know when certain places or activities make you uncomfortable.

Your close friends and family may be the first to notice that you’re having a tough time. Turn to them when you are ready to talk. It can be helpful to share what you’re experiencing, and they may be able to provide support and help you find treatment that is right for you.

Take the Next Step – Connect:

Whether you just returned from a deployment, you’ve been home for 40 years, or you’re dealing with PTSD from chronic pain – it’s never too late to get professional treatment or support for PTSD. Receiving counseling or treatment as soon as possible can keep your symptoms from getting worse.

You can also consider connecting with:

  • Your family doctor: Ask if your doctor has experience treating PTSD or can refer you to someone who does
  • A mental health professional, such as a therapist
  • Your local VA Medical Center or Vet Center: VA specializes in the care and treatment of Veterans
  • A spiritual or religious advisor
  • Advanced Pathways Hypnosis

If you or a loved one is living with PTSD and traditional treatments have not helped please consider contacting Advanced Pathways Hypnosis.  We offer a drug-free, non-invasive treatment option that is scientifically designed.  Advanced Pathways utilizes a multi-therapeutic approach based on breakthrough research from leading academic institutions to ensure the best result for our patients.

Contact us today at (714) 717-6633 for a FREE confidential telephone consultation, or contact us via email at: Info@AdvancedPathways.com.