Another CRPS Review Article -- Oh, and Jose Ochoa is A Turd!

Here's another one of those much-touted but essentially useless "review" articles. I know I am being super-crabby, but I figure *someone* was about to perish for lack of publications...

And yet, I reproduce the abstract and necessary link information here because...

[Hmm]

Well, because perhaps you, Dear Reader, are looking for just the type of global view that this article provides. I know that were you to rely on a summary article on CRPS from a decade ago, there would be scads of misinformation and some very tired opinions {blocks:blocks:blocks}. The work on inflammatory processes, alone, has dated such reviews and some foundational research has effectively silenced assholes like Ochoa.*

I suppose I ought to summon more basic human kindness, also, given that the authors' expected audience is one of cardiovascular specialists. Though I've not met anyone with CRPS whose disease began after a heart attack, I've read that this is not all that uncommon. It's not something I can wrap my mind around -- this involvement of internal organs.

{don'twannathinkaboutitdon'twannathinkaboutitdon'twannathinkaboutit}

Complex Regional Pain Syndrome: State of the Art Update
Current Treatment Options in Cardiovascular Medicine
ISSN 1092-8464 (Print) 1534-3189 (Online)
Authors: Patrick Henson, DO; Stephen Bruehl, PhD (Vanderbilt UMC)

Although the pathophysiology of complex regional pain syndrome (CRPS) is not fully understood, it appears to reflect multiple interacting mechanisms. In addition to altered autonomic function, a role for inflammatory mechanisms and altered somatosensory and motor function in the brain is increasingly suggested. Several possible risk factors for development of CRPS, including genetic factors, have been identified. Few treatments have been proven effective for CRPS in well-designed clinical trials. However, recent work suggests that bisphosphonates may be useful in CRPS management and that the N-methyl-d-aspartate receptor antagonist ketamine significantly reduces CRPS pain when administered topically or intravenously at subanesthetic dosages. Extended use of ketamine at anesthetic dosages (“ketamine coma”) remains a controversial and unproven treatment for CRPS. Spinal cord stimulation may be effective for reducing pain in approximately two thirds of CRPS patients not responding to other treatments, but its efficacy appears to diminish over time.

*Ugh. It's been a long while since I gave José L. Ochoa even the beginnings of a thought... The man is a turd. Yes, that's my considered -- and, believe it or not, quite reserved -- opinion. You cannot imagine the emotional pain someone like him causes to the newly-diagnosed who are out grazing among the available literature. He has made a living testifying against hundreds of people in workman's compensation cases and owes his soul to the insurance industry.

Some of you are going to pooh-pooh this woman's resistance to having her hand blown on by Dr. Ochoa. I can tell you that the pain from such a stimulus can be severe and may also launch a pain cycle that can last hours.

As for his "explanation"? You really don't want me to go there...






Addendum 3/22/2010 -- The citation below is from an appeal decision which, in part, deals with the "expert testimony" of Dr. Ochoa. The Third Circuit Court of Appeal found that his conclusions about "RSD" were not reliable or scientifically sound, and excluded his testimony.
I am only slightly nervous that Dr. Ochoa considers negative opinions about his capabilities to be "slander."

From: STATE OF LOUISIANA
COURT OF APPEAL, THIRD CIRCUIT
CA 08-1289
JANELL ERNST
VERSUS
DR. FLYNN A. TAYLOR, ET AL.

The trial court is granted broad discretion in determining who should or should
not testify as an expert. Cheairs v. State ex rel. Dep’t. of Transp. and Dev., 03-680
(La. 12/3/03), 861 So.2d 536. It is within the trial court’s discretion to decide if an
expert is qualified and competent to testify in specialized areas, and its decision will
not be overturned absent an abuse of discretion. Id. Louisiana Code of Evidence Article 702 provides for the admission of expert testimony “[i]f scientific, technical, or other specialized knowledge will assist the trier of fact to understand the evidence or to determine a fact in issue, a witness qualified as an expert by knowledge, skill, experience, training, or education, may testify thereto in the form of an opinion or otherwise.”

Expert testimony, like any other form of evidence, must be
relevant; it is subject to the La.Code Evid. art. 403 balance whereby its
probative value is weighed against the “danger of unfair prejudice,
confusion of the issues, or misleading the jury, or by considerations of
undue delay, or waste of time.” If its probative value is substantially
outweighed by these factors, the otherwise relevant evidence is
inadmissible.

McPherson v. Lake Area Med. Ctr., 99-1876, p. 8 (La.App. 3 Cir. 5/24/00), 767 So.2d
102, 107, writ denied, 00-1928 (La. 9/29/00), 770 So.2d 353.

The following four-part inquiry should be used in evaluating whether expert
testimony should be admitted:

(1) whether the witness is qualified to express an expert opinion, (2)
whether the facts upon which the expert relies are the same type as are
relied upon by other experts in the field, (3) whether in reaching his
conclusion the expert used well-founded methodology, and (4) assuming
the expert’s testimony passes these tests, whether the testimony’s
potential for unfair prejudice substantially outweighs its probative value
under the relevant rules.
Id. (quoting Adams v. Chevron, U.S.A., Inc., 589 So.2d 1219, 1223 (La.App. 4 Cir.
1991), writ denied, 592 So.2d 414, 415 (La.1992).

It is clear that Dr. Ochoa was called to testify that the diagnosis of RSD is no
longer an accepted diagnosis in the medical community, and therefore, Ms. Ernst
cannot be suffering with RSD.

Dr. Ochoa admitted that he never examined Ms. Ernst. He only reviewed her medical records. Dr. Ochoa explained that since the 1990’s the new nomenclature for RSD is complex regional pain syndrome I (CRPS I). CRPS II is a separate condition that exists when there is a definite nerve injury. He testified that CRPS I is a diagnosis when the patient complains of pain following an injury associated with moderate sensory phenomena. There might be changes in color and
temperature. There is no nerve injury, and the cause is unknown.

Dr. Ochoa testified that he had never diagnosed CRPS I because CRPS I is not a diagnosis.

There is no doubt that Dr. Ochoa is well-educated and trained. He obtained his
medical degree in Chile where he was born and raised. He studied for eight years at
the Institute of Neurology in London. He then came to Dartmouth Medical School
in New Hampshire where he ran the nerve and muscle clinic for ten years. Dr. Ochoa
then moved to the University of Wisconsin to teach neurology. He is presently at the
Good Samaritan Hospital in Portland, Oregon, and associated with the Oregon Health
& Science University. He has been in Oregon for twenty-one years. He has
published about 150 peer-reviewed articles and chapters in books used in teaching.
He now practices specialized neurology dealing with nerve disease, pain, abnormal
sensation, and sympathetic dysfunction.

However, Dr. Ochoa has not taken the neurology board certification examination and is not board certified in any field. Dr. Ochoa’s bias was called into question in the traversal of his qualifications.

He has testified in hundreds of cases. Only two of the cases in which he testified in
court were on behalf of the plaintiff. He admitted that most of his cases over the past
fifteen years had been sent to him by the defense. Approximately ninety-five percent
of the cases dealt with RSD.

However, it was also clear from his testimony that he offered no basis or other
scientific support for his conclusion that RSD was no longer a valid diagnosis other
than his own testing and his testimony that there were many doctors who supported
his conclusion. Dr. Ochoa did agree that there are physicians who disagree with the
position he has taken regarding RSD. However, Dr. Ochoa testified that any
physician who believed that RSD was a valid diagnosis was not a preeminent
physician.

Dr. Ochoa was also questioned about cases in other states in which the
courts have acknowledged that Dr. Ochoa had a reputation as being hired to refute
RSD claims. In regard to these questions, he opined that he had been slandered.

Dr. Ochoa could not offer any medical evidence, other than his own personal
studies, for his theories that RSD was no longer a viable diagnosis. No studies by
other doctors were offered in support of his conclusion that RSD is no longer a valid
diagnosis. Dr. Ochoa admitted that there were many medical books that recognized
that RSD, or CRPS, is a disabling condition. There was no evidence or testimony
offered to indicate that Dr. Ochoa’s conclusion is reliable or scientifically based.
Therefore, we find that the trial court erred in not excluding Dr. Ochoa’s testimony.
Accordingly, in conducting our de novo review, we will not consider the testimonies
of Drs. XXXXX or Ochoa.