We use cookies to improve our service and to tailor our content and advertising to you. More infoClose You can manage your cookie settings via your browser at any time. To learn more about how we use cookies, please see our cookies policyClose
Rapid responses are electronic letters to the editor. They enable our users to debate issues raised in articles published on thebmj.com. Although a selection of rapid responses will be included online and in print as readers' letters, their first appearance online means that they are published articles. If you need the url (web address) of an individual response, perhaps for citation purposes, simply click on the response headline and copy the url from the browser window. Letters are indexed in PubMed.
The photographs of the case in the Minerva column refer to a
diagnosis of chronic regional pain syndrome. The diagnosis should read
"Complex Regional Pain Syndrome". Although there are bone changes
associated with the syndrome, they are not pathognomic, and three-phase
bone scans are no longer considered necessary for the diagnois of this
syndrome, as their high specificity is matched by a very low sensitivity,
which gets lower as the disease progresses. The diagnosis is made purely
upon clinical grounds. The important point in this syndrome is that early
and agressive therapy with physiotherapy and good analgesia is essential
to obtain a good outcome. (Progress in Pain Research and Management Volume
32 DRPS: Current Diagnosis and Therapy Wilson PR Stanton-Hicks M, Harden
RN eds IASP Press Seattle 2005)
Murphy and colleagues describe osteopenia which is commonly
associated with disuse.
Burke describes self-induced hand oedema,¹ and Singh and Davis have
shown that temperature and colour differences between the hands,² which
are sometimes used to support the diagnosis of Complex Regional Pain
Syndrome Type-1, can be produced by short-term immobility and dependency
of the hand.
In many situations, the evidence may point to a factitious disorder
rather than a pain syndrome.
1 Burke FD.Factitious Disorders Of The Upper Limb. JHS 2008
33E:2: 103-109
2 Singh HP, Davis TRC.The Effect of Short-term Dependency and
Immobility On Skin Temperature And Colour In The Hand.
JHS 2006 31B:6:611-615
CRPS
The photographs of the case in the Minerva column refer to a
diagnosis of chronic regional pain syndrome. The diagnosis should read
"Complex Regional Pain Syndrome". Although there are bone changes
associated with the syndrome, they are not pathognomic, and three-phase
bone scans are no longer considered necessary for the diagnois of this
syndrome, as their high specificity is matched by a very low sensitivity,
which gets lower as the disease progresses. The diagnosis is made purely
upon clinical grounds. The important point in this syndrome is that early
and agressive therapy with physiotherapy and good analgesia is essential
to obtain a good outcome. (Progress in Pain Research and Management Volume
32 DRPS: Current Diagnosis and Therapy Wilson PR Stanton-Hicks M, Harden
RN eds IASP Press Seattle 2005)
Competing interests:
None declared
Competing interests: No competing interests