On Sun, 21 Dec 2003 03:28:35 GMT, "CBI" <
[email protected]> wrote:
>
>
>"jake" <
[email protected]> wrote in message
news:[email protected]...
>> On Sat, 20 Dec 2003 19:29:27 GMT, "CBI" <
[email protected]> wrote:
>>
>> >
>> >
>> >"jake" <
[email protected]> wrote in message
news:[email protected]...
>> >>
>> >> >yet the dcotor does not insist the patient is not in pain...what do you do when pain cannot
>> >> >be "traced back to something concrete"?
>> >>
>> >> Iam not too sure in the USA where cash..lines of credit and insurance determine the type of
>> >> treatment if any.. but in the UK..where treatment is provided on the basis of clinical need..a
>> >> common procedure is to refer the patient to a Pain Clinic.
>> >
>> >Nice dodge. How about answering the question?
>>
>> dodge??
>>
>> what part of
>>
>> "Q. what do you do when pain cannot be "traced back to something concrete?
>>
>> A.a common procedure is to refer the patient to a Pain Clinic."
>>
>> do you not understand?
>
>Yes - you are apparently trying to maintain that ADHD is not real since there is no objective test
My point is that a syndrome inferred from observations is in an entirely different category from an
objective verifiable disease with tests and biological markers. attempts to conflate the two are
disingenious..
>yet pain is real despite the lack of an objective test. He asked you a question regarding this.
>Your answer is, in essence, "go ask someone else. "
nonsense.. bracketing the fact that the issue of pain was a red herring thrown in to divert from the
inappropriatness of the insulin analogy... the correct procedure is referral to paim management
clinic.. what do you recommend instead? self-diagnosis and handfuls of OTC painkillers?
>
>You made the claim. Now you answer the questions.
I made no claims.. I merely pointed out that the claim that ADHD was like diabetes was nonsense..
>How do you evaluate pain with no obvious cause?
unlike some in this forum who feel quite free to diagnose unmet strangers with ADHD and prescribe
drugs for them I would not have the hubris to even attempt to..
Nor would I coach people on things to say to their doctors to obtain Oxycontin or morphine
..for example ..in the same way that some coach unmet strangers on ways to obtain amphetamines
and ritalin..
>Specifically, how do you establish that it is real?
I do not..that is a matter for a neurologist..
The case of RSD alone shows how fraught with difficulties such a judgement is
Chronic Pain: Reflex Sympathetic Dystrophy Prevention and Management
http://www.rsdrx.com/Differential%20Diagnosis.htm
DISEASES MISTAKEN FOR RSD
1. Scleroderma. Thermography helps differentiate it from RSD. Thermography shows clearly the
delineated line of demarkation between cold fingers and warm palm of the hand in scleroderma.
This is in contrast to the glove type of cold extremity in RSD, a selective nerve involvement in
nerve root injures.
2. Occlusive peripheral arterial disease. Doppler ultrasound studies as well as absence of
peripheral pulse are helpful in differentiating this condition from RSD.
3. Spinal cord tumors, syringomelia, and contusion of spinal cord are almost invariably associated
with RSD. In so-called idiopathic RSD, the above conditions need to be ruled out.
4. Raynaud's syndrome (Raynaud, 1862) is vascular dysfunction of the extremities, which is usually
benign. This prognostic feature separates it from more severe forms of RSD.
The condition is a good example of the central origin of sympathetic dysfunction. The local
vasoconstrictor reflex that is absent in peripheral nerve damages such as diabetic neuropathy stays
intact in Raynaud's phenomenon. On the other hand,vasoconstrictive responses to sitting or standing
are increased in Raynaud's phenomenon.
In our experience with 26 consecutive cases of Raynaud's phenomenon, migraine headache was a
concomitant complication in 17 patients. This high incidence of migraine headaches also suggest a
central origin of the vascular dysfunction.
RSD MISTAKEN FOR OTHER DISEASES
One aspect of efferent dysfunction of RSD is spasm in the shoulder girdle muscles, pectoralis
muscles, and scalenus muscles. The latter group of muscles undergoing spasm cause the clinical
picture of thoracic outlet syndrome.
5. Thoracic outlet syndrome. As is the case with cervical disc herniation, cervical nerve roots
contusion, cervical spondylosis, and soft tissue injuries to the cervical spine region, RSD
patients are quite frequently diagnosed with thoracic outlet syndrome. Unnecessary surgery for
such patients is frought with disastrous results. Usually facial injury causes referred pain to
the C3 and C4 substantia gelatinosa gray matter of the spinal cord. This in turn causes spasm
over deltoid and scalenus muscles. The end result is not only TMJ disease, but shoulder-hand
syndrome and thoracic outlet syndrome.. the combination of any two of the above three conditions
produce disastrous results.
6. Entrapment neuropathies such as carpal tunnel syndrome and tardy ulnar palsy are frequently
mistaken diagnoses for RSD. Surgery in such cases is apt to aggravate the RSD, which has gone
undiagnosed.
7. Rotator cuff injury or tear of the shoulder. It is not unusual to see a patient suffering from
advanced RSD who has undergone multiple surgical procedures from the hand all the way to the
shoulder with mistaken diagnoses of carpal tunnel syndrome, tardy ulnar palsy, and rotator cuff
injury. Each one of the above surgical procedures cumulatively aggravates the RSD.
8. Knee injuries. It is not uncommon for the patient to sustain a blunt injury to the anterolateral
aspect of the knee. This can cause RSD with afferent (pain) and efferent (limitation of motion of
knee) complications. The arthroscopy done on such knee injury is "the straw that breaks the
camel's back" and causes severe aggravation of RSD.
>How does this differ from the diagnosis of ADHD (i.e why is one valid but the other isn't?)?
one is a medical problem..the other is not a medical problem but the medicalization of
social issues..