Thursday, February 9, 2012

Ice and CRPS or ICE and RSD

I have been asked this question so many times that I have written about it a lot. So if you have read it here or elsewhere before, feel free to skip on over it :-D

The question is, Is it bad to apply ice pack to the CRPS (or RSD) affected area? (or even nearby)

Or, Is it bad to use the hot/cold contrast therapy in the CRPS affected area?
(hot/cold contrast therapy

I would definitely suggest you read our physical therapy section of the website, especially the article on Ice and CRPS,

one section of the article on Ice and CRPS, Dr Hooshmand states the case very well when he says;

"On the other hand repetitive application of ice freezes and coagulates the myelin (fatty tissue insulating large nerve fibers) exactly like ice freezes and solidifies melted butter. As the ice freezes the large nerve fibers, causing freeze damage to the myelinated nerves, the patient develops sensory loss and pain due to permanent damage to the large sensory nerve fibers.

This aggravates the RSD by adding sensory nerve pain of non-sympathetic origin to the initial thermal sensory pain of sympathetic origin. As a result, Ice provides total anesthesia and relief of pain for several minute the same way as the hand becomes numb being exposed to snowballs in the winter. However, a few hours after the cessation of ice exposure, the pain recurs with vengeance due to reactive enlargement of blood vessels after the constriction of blood vessels due to exposure to ice. This phenomenon causes excellent relief of pain with ice treatment followed by not only aggravation of pain, but damage to the nerve fibers adding sympathetic independent pain (SIP) to the original sympathetic mediated pain (SMP)."

If you need a refresher course on SIP and SMP (IMP as it is sometimes called) check out this article.

But pay particular attention to the words I put in bold letters in the quote above. So often I hear from patients who say, "But it feels better when I apply ice or run my hands under cold, ice-cold water for a few minutes", but they have to do it more and more often as the weeks and months roll on. And then hours later the pain is worse then ever.

The reason they have to do it more often and the reason the pain is worse than ever afterwards is both the same, are both the same. That is what Dr Hooshmand is saying above. The more you do these things, the more you are breaking down the protective myelin sheath that protects the nerve. Pretty soon there is no going back, the damage is permanent and the pain is no longer SMP, or localized, but SIP, or brain centered. This is where the pain-cycle gets in that stuck position and is nearly impossible to break. It is also where it seems the disease spreads.

We hear so many sad stories of patients whose use of ice precipitated their spread of their CRPS, from the one small area to not just further up that limb but also the opposite limb. It also seems to accelerate the timing of the disease through the stages if ice is used repeatedly.

Remember also that ice, even very cold water/temperature, can cause the blood vessels to constrict and/or spasm. This is one of the four main symptoms of CRPS (spasms in muscles and/or blood vessels). It can be very, very painful for your extremities; toes, fingers, feet, hands, nose, etc.

So please, be very cautious here. If your physical therapist insists on using ice, educate them. This is your life we are talking about, you are the boss, take control, take charge!

There are other articles on the net besides the one sited above too. I just think his is the best and probably was the first!


Keith Orsini

New Book for teens with CRPS / RSD

There is a new book written by teens and for teens with CRPS / RSDS, more commonly known as complex regional pain syndrome. We wanted to pass along their information so you could check it out and let us know what you thought of it!

It is co-written by Doctor Gillian.R. Lauder and Roslyn Massey, and it was illustrated by Shona Massey. Both Roslyn and Shona Massey are high school students. Doctor Lauder is a Pediatric Anesthesiologist with over 20 years of clinical experience.

You can read more about the book as well as order it by going to their website here!

According to their website;

"The principal aim of this book is to provide well-presented clear information for teenagers who develop CRPS. It is hoped that it will be used as a tool to aid the early recognition of CRPS and implement the necessary team approach to management. Medical terms have been explained in a way that can be easily understood. In an effort to make it even more useful, the authors asked a focus group of teenagers– which included those who have been treated for CRPS – to provide their feedback.

In Complex Regional Pain Syndrome (CRPS) Explained, teenagers can follow cartoons of Harold the alpha lion, who develops CRPS, and relays his journey from diagnosis to team management and recovery. With a clearer understanding of CRPS, teenagers will be able to take part in the decisions that affect their health and body.

Complex Regional Pain Syndrome (CRPS) Explained is referenced throughout and provides a list of other relevant books. In addition, an extensive list of contacts is provided to promote access to pain management clinics worldwide. Hence, although this book is specifically designed to cater to the needs of a teenager with CRPS, it will also serve as an extremely useful educational tool for families and healthcare professionals.

Let us know what you think of it!

Ketamine helpful for depression

According to a recent article, published on LiveScience,com ,

" Prozac and other treatments each improve conditions for only about 30 to 40 percent of the patient population, barely outperforming placebos; meanwhile, a single infusion of ketamine washes away the symptoms of 80 to 90 percent of patients who try it,"

That is amazing! The article is very interesting and it goes on to talk about how the Drs and researchers at Baylor, where the study is being conducted, believes the FDA may approved the drug as an antidepressant in as little as two years!

Still, much is needed to be learned as to how the drug works.

"Scientists understand how ketamine chemically affects the brain, but they don’t quite know why it alleviates depressive symptoms. According to Ken Robbins, a clinical professor of psychiatry at the University of Wisconsin-Madison, ketamine binds to portals in the brain called NMDA receptors; this prevents a chemical called glutamate from occupying the same spots. Because glutamate revs up the system and can cause cell damage, ketamine has a sedative effect by blocking it. Somehow, this causes euphoria.

"The hypotheses for why ketamine might be helping depression are in their infancy," Robbins said. Whatever the explanation, "it's a very different mechanism from that of other anti-depressants we now use. I think what we're seeing is there may be a whole other neurotransmitter system that plays a role in depression that we weren't aware of."

You can read the complete article here

The drug, which is addictive and must still be administered through an infusion, holds great promise and most of the readers here will remember has been used for years to treat CRPS. Perhaps if it is approved to treat depression it will open the door for treating CRPS patients as well, many of whom suffer from depression as a result of years of being in chronic pain.

Peace, Keith Orsini