Free Downloads and More On CRPS Diagnostic Criteria (Woo Hoo!)

In the course of writing one blog post, here I am authoring another.

I just ran across a good article in the newly launched Wiley Online Library -- then discovered the offer of free downloads of most read and most cited articles from the journal Pain Medicine (The Official Journal of the American Academy of Pain Medicine and of the Faculty of Pain Medicine of the Australian and New Zealand College of Anaesthetists and of the International Spine Intervention Society).

Okay, it amounts to just a handful of articles, but some of them are quite good, especially those of the sort I often malign (but always read!) -- the dread review article.

So let us rejoice.
Amen, and amen!

From Volume 8, Number 4, 2007 -- more on diagnostic criteria in CRPS, just in case you haven't realized the importance of this issue by the fact that I have been droning on and on about it at every opportunity.  Anyway, this is a great foundational article about the discussion and helps to put the IASP criteria and the Budapest group's proposals in context.

Proposed New Diagnostic Criteria for Complex Regional Pain Syndrome

R. Norman Harden, MD, Stephen Bruehl, PhD, Michael Stanton-Hicks, MB, BS, DMSc, FRCA, ABPM, and Peter R. Wilson, MB, BS

Rehabilitation Institute of Chicago, Northwestern University, Chicago, Illinois;  Vanderbilt University School of Medicine, Nashville, Tennessee; Cleveland Clinic, Cleveland, Ohio; Mayo Clinic, Rochester, Minnesota, USA


ABSTRACT:  This topical update reports recent progress in the international effort to develop a more accurate and valid diagnostic criteria for complex regional pain syndrome (CRPS). The diagnostic entity of CRPS (published in the International Association for the Study of Pain’s Taxonomy monograph in 1994; International Association for the Study of Pain [IASP]) was intended to be descriptive, general, and not imply etiopathology, and had the potential to lead to improved clinical communication and greater generalizability across research samples. Unfortunately, realization of this potential has been limited by the fact that these criteria were based solely on consensus and utilization of the criteria in the literature has been sporadic at best. As a consequence, the full potential benefits of the IASP criteria have not been realized. Consensus-derived criteria that are not subsequently validated may lead to over- or underdiagnosis, and will reduce the ability to provide timely and optimal treatment. Results of validation studies to date suggest that the IASP/CRPS diagnostic criteria are adequately sensitive; however, both internal and external validation research suggests that utilization of these criteria causes problems of overdiagnosis due to poor specificity. This update summarizes the latest international consensus group’s action in Budapest, Hungary to approve and codify empirically validated, statistically derived revisions of the IASP criteria for CRPS.

Formerly Wiley Interscience, the Wiley Online Library just launched  -- as in *yesterday* -- and it's got some great new features plus a few things in The Realm of The Free (my favorite realm!):

Free access and access information.

Free abstracts and chapter summaries:  All journal abstracts and chapter summaries in books and reference works are free to all users of Wiley Online Library.


Free sample issues:
Each journal has a free sample issue that you can find from the left menu of any journal page.


Free supporting information:
Some articles include extra supporting information and this is available free to all users of the website. You can find supporting information in an extra tab from the abstract or article page.


Access icons:
Shows users in libraries what is free, what you or your institution has subscribed to and you can access.


Access information:
Clearly see why you might not be able to access an article, book, chapter or whole product and find out your options. [Booo!]

Proverbial Pain: I got your "evidence" right here...

I am having the proverbial hard time. I know, same old, same old! When pain becomes proverbial, that's bad. One feels extra superfluous when one's pain is superfluous. I tweeted last night -- yes, I tweet -- that suicide is my first thought now when I wake in the morning, and that sleep is my greatest waking desire.

Escapism, you know!

I am not threatening suicide, never fear. I am responsible for several lives and take that responsibility seriously. My own life may feel devalued (that word superfluous keeps popping into my linguistic centers) but I honor the integrity of those around me, and recognize the possibility that my wisdom is... impaired. And that, my friends, is to really say the LEAST.

My life: the split infinitive!

Are you familiar with the Aussie/Brit expression "pain in the proverbial"? Here's a great example from Australia Network's English Bites -- the discussion is about Ipswich toilets and the relative unavailability of women's toilets. [What can I say? It was the first result that popped up.]:

In Queensland, one local government has decided that there are not enough toilets for women. And it's going to do something to improve the situation.

WOMAN: ...[W]hen you're in a hurry, you got things to do and you've got to stand there for ten minutes and wait -- It's awful yeah.

WOMAN: If there's an urgent need you really are ah, in trouble.

PETRIA WALLACE: It's a universal pain in the proverbial. Women queuing for public toilets while men are out in a flash.

PAUL TULLY: Well look it's a bit small. You've got a couple of female toilets. The third one which is just for staff only. It's not very adequate compared with the male toilets next door with the couple of urinals and the regular toilet and there's times like when the movies finish when it's just jam packed.

PETRIA WALLACE: Councillor Paul Tully has made it his mission in life to rescue the women of Ipswich from time-wasting toilet queues.

For some reason, in the U.S.? People feel compelled to not leave their interlocuteurs hanging, worrying needlessly about just *what*, exactly, is the adjectival object. U. S. Americans will tell you, clearly, that the proverbial pain is in the ass, or some other quite definitive place.

An Indian living in Singapore wrote an entire blog post detailing the source of his dolorous dolour, his Pain in the Proverbial -- which he has renamed:

...the GART (or Gluteal Assault and Resultant Trauma) syndrome. It is better known as the pain in the proverbial, and no, I am not referring to anyone's spouse or children here. Many learned men of science have attributed reasons ranging from muscle problems, piriformis syndrome, sacroiliac joint restrictions and even sciatica to it. But as far as I am concerned, it is all thanks to the weight of my wallet.

Note the vocabulary, note the lack of the word ass.

Wait! I almost forgot why I logged in to Blogger. There has been another illustrious, earth-shattering, and completely unexpected contribution to the research into one of the major sources of my pain in the proverbial: CRPS.

I hope those of you who have CRPS/RSD will heed my advice and take a seat on your proverbial before I unveil the exciting news.

Okay... Are you ready?

I don't want to prolong your agony, so I am going to go straight to the masterful and shocking conclusion put forward by these researchers at Ziekenhuis Rivierenland, Tiel, in The Netherlands. You probably recognize a few of these names, especially Dr. Paul Zollinger, a Professor of Orthopedics who has published extensively on CRPS.

Indeed, it is from these folks, especially the CRPS I Task Force, that I expect important breakthroughs -- as they pursue the basic research so long ignored, especially in the area of inflammatory response.

Drum roll, please. Oh, the title of the article? It's very catchy: Evidence based guidelines for complex regional pain syndrome type 1.

Woo hoo! Can you handle more?

"The purpose of this study was to develop multidisciplinary guidelines for treatment of "
CRPS-I."

ohmygod! I'm getting the vapors from all this excitement.

Oh, I am the cruel one, aren't I, making you wait for the scintillating conclusion?
Well, I don't want to be known as any sort of impediment to progress, any kind of pain in the proverbial, so here it is:

"Based on the literature identified and the extent of evidence found for therapeutic interventions for CRPS-I, we conclude that further research is needed into each of the therapeutic modalities discussed in the guidelines. "