I would think that the BMJ, while publishing articles of (less than) dubious verity, would be sure to check out well known names in their Rapid Response section. And here it is, a day later, and the post is still up.
But lest we feel alone over at the BMJ, here's the beginning of an article on Complex Regional Pain Syndrome (CRPS), also known as Reflex Sympathetic Dystrophy (RSD), a condition I once had in my foot after a botched operation. Once again, brace yourselves.
But fear not, not all of British medicine is completely nuts! Of the nine Rapid Responses to this article, eight seemed to be opposed to it (though it took careful reading of a couple to determine their position, if any). And we even got mentioned in one:
But lest we feel alone over at the BMJ, here's the beginning of an article on Complex Regional Pain Syndrome (CRPS), also known as Reflex Sympathetic Dystrophy (RSD), a condition I once had in my foot after a botched operation. Once again, brace yourselves.
Complex regional pain syndrome medicalises limb pain
BMJ 2014; 348 doi: http://dx.doi.org/10.1136/bmj.g2631 (Published 28 April 2014)
Cite this as: BMJ 2014;348:g2631
Christopher Bass, consultant liaison psychiatrist, John Radcliffe Hospital, Oxford OX3 9DU, UK
Christopher.bass{at}oxfordhealth.nhs.uk
Psychosocial factors may be more important than biomedical ones in type 1 disorder, writes Christopher Bass
I am a psychiatrist who has worked in general hospitals and pain clinics since the 1970s and have assessed many patients given a diagnosis of type 1 complex regional pain syndrome (CRPS). The syndrome is often diagnosed by inexperienced junior doctors when confronted by patients with unexplained symptoms, especially pain in the hands and feet. CRPS was once called algodystrophy, then reflex sympathetic dystrophy, but by 1994 the sympathetic component was abandoned and the current term was introduced.1 CRPS is part of a larger problem in chronic pain and reflects our lack of knowledge of causal mechanisms.
It has been my impression that increasing numbers of patients are being diagnosed with this disorder, and that incidence rates are increasing (estimates in 2007 of 50 000 new cases annually in USA).2 In my opinion excessive reliance on this so called biomedical diagnosis for these patients is misguided. How has this occurred?
Several new diagnostic criteria have been proposed,3 but they are not sufficiently objective or reliable.4 For example, criteria such as “continuing pain that is disproportionate to …
But fear not, not all of British medicine is completely nuts! Of the nine Rapid Responses to this article, eight seemed to be opposed to it (though it took careful reading of a couple to determine their position, if any). And we even got mentioned in one:
Dr. Bass also misses the point that changing the name of a condition does not change its clinical presence. His suggestion of renaming CRPS (previously known as reflex sympathetic dystrophy) as “legache” or “armache” may be attractive to some, but is unlikely to make the pain “proportionate” to the inciting event or change the treatment options offered by doctors. History shows that changing the name of myalgic encephalomyelitis (ME) to chronic fatigue syndrome did not reduce the incidence of the condition or its impact on patients’ quality of life, but may have changed our uderstanding of its biologic origin or lack of it.