Different definitions, same disease (15.07.2017)
Different definitions, same disease (15.07.2017)
For just over a year now, I’ve been on the lookout for definitions or descriptions of a rare disease called CRPS – and sometimes still called RSD. CRPS is Complex Regional Pain Syndrome. RSD or Reflex Sympathetic Dystrophy is its old name, but one that still seems to be used by many physicians. (See CRPS information from another doctor.)
I’ve been looking for good definitions of CRPS/RSD in medical & scientific journals, and decided to try a different tack to mark the one-year anniversary of my diagnosis back in March. I’d look for this disease in old-fashioned hard-copy medical dictionaries. I thought it’d be interesting to see the differences in definitions of CRPS over the past 20 or so years, so was hoping to “find” medical dictionaries from the 1980s, 1990s, and 2000s.
Have you ever been to a doctor’s office, and seen a bunch of old medical textbooks sitting on a shelf? It occurred to me that some of these might be medical dictionaries, so I started asking my various physicians whether they had a hard-copy medical dictionary in their office. I checked with my family physician, dermatologist, women’s health specialist, etc.
That often led to a conversation about why I was asking – a great opportunity to raise awareness of CRPS with doctors who wouldn’t normally encounter or treat it! And, in many cases, a quick search of the dictionary wouldn’t turn up any useful entries; not even under the disease’s very old name from the 1800s; “causalgia”.
If I did find CRPS, under any of its names, I’d ask to borrow the dictionary – and drop it off the next day or at my next visit. A few of my physicians gave me their dictionaries outright, as they now check medical information on-line or on smartphone apps.
But there was often no mention of CRPS, RSD, or even causalgia. In terms of raising disease awareness, one-on-one with physicians, it was actually more striking when the disease wasn’t included in their dictionaries! It would really get their attention to talk about a disease that wasn’t even listed in a medical dictionary…
I was like a little squirrel, storing away nuggets of information, until I was ready to dig it out and use it. Squirrelling away information, I suppose ‘-) This is what I found, including even partial definitions if I thought they were interesting or useful. This is the result of my medical dictionary treasure-hunt.
Much of the definitions are outdated – one of the dictionaries is almost 30 years old! – and this information is in no way medical advice. Consider it more of a historical look at what CRPS has been called through the past 20 years or so…
If there was no mention of causalgia, CRPS, or RSD in a dictionary that I’d been given, I checked for other related terms that could be interesting; like the term ‘dystrophy’.
My idea was to look at how different the definitions could be, from one dictionary to the other. That’s why the same word repeats sometimes in this list, with different definitions.
Here’s a list, in alphabetical order, of the CRPS-related terms in these dictionaries; the ones I thought were interesting. Detailed reference information, for each of these specific medical dictionaries, is listed at the end of the post.
- Causalgia: “[G. kausis, burning + algos, pain]. Persistent severe burning sensation of the skin, usually following direct or indirect (vascular) partial injury of a sensory nerve, accompanied by cutaneous changes (temperature and sweating).”(3)
- Dystrophy: “[dys- + G. trophë, nourishment). Dystrophia; progressive changes that may result from defective nutrition of a tissue or organ.”(3)
- Pain: “…The mechanics of pain are not thoroughly understood…”(4)
- Pain: “A sensation that can range from mild, localized discomfort to agony. Pain has both physician and emotional components. The physical part of pain results from nerve stimulation. Pain may be contained to a discrete area, as in an injury, or it may be more diffuse, as in disorders such as fibromyalgia. Pain is mediated by specific nerve fibers that carry the pain impulses to the brain.”(2)
- Pain: “[L. poena, a fine, a penalty]. 1. An unpleasant sensation associated with actual or potential tissue damage, and mediated by specific nerve fibers to the brain where its conscious appreciation may be modified by various factors. 2…”(3)
- Pain management: “The process of providing medical care that alleviates or reduces pain. Pain management is an extremely important part of healthcare because patients who are forced to remain in severe pain often become agitated and/or depressed and have poorer treatment outcomes than patients who do not remain in severe pain… Massage, acupuncture, acupressure, and biofeedback have also shown some validity for increased pain control in some patients.”(2)
- Reflex: “An automatic, involuntary, or learned response to a stimuli. Most of the actions of the body that allow it to function normally are reflex actions, such as the release of perspiration to adjust body heat, the secretion of digestive juices when food is ingested, or the adjustment of the eye to accommodate available light… The failure of the body to respond in a normal or expected way to stimuli may also be a sign of disruption in the neural function.”(4)
- Reflex: “An involuntary reaction. For example, the corneal reflex is the blink that occurs upon irritation of the eye.”(2)
- Reflex: “[L. reflexus, pp or re-flecto, to bend back]. 1. An involuntary in response to a stimulus applied to the periphery and transmitted to the nervous centers in the brain or spinal cord…”(3)
- Reflex Sympathetic Dystrophies: “This is a term that applies to pain, hyperalgesia, hyperesthesia, and autonomic changes, usually after injury to an extremity.”(1)
- Reflex sympathetic dystrophy syndrome: “A condition that features a group of typical symptoms, including pain (often perceived as burning pain), tenderness, and swelling of an extremity. Reflex sympathetic dystrophy syndrome is associated with varying degrees of sweating, warmth and/or coolness, flushing, discoloration, and shiny skin.”(2)
- Sympathetic (nervous system): “A part of the nervous system that serves to accelerate the heart rate, constrict blood vessels, and raise blood pressure…”(2)
- Syndrome: “A combination of symptoms and signs that together represent a disease process”(2)*
- Syndrome: [G. syndrome, a running together, tumultuous concourse; (in med.) a concurrence of symptoms, fr. syn, together + dromos, a running}. The aggregate of signs and symptoms associated with any morbid process, and constituting together the picture of the disease.”(3)
* For a description of the differences between a sign and a symptom, see Signs or symptoms, from 2008.
It was kind of fun to search out this disease, and related terms, in these old medical dictionaries. So I’ve decided to keep checking on this whenever I see a new doctor. If I find any more interesting definitions, I’ll write an update next year ‘-)
PS: Thanks to each physician who gave me a medical dictionary or textbook; you didn’t want to be named, but you know who you are ‘-) I truly appreciate your kindness.
(1) Cecil Textbook of Medicine, 18th Edition. Editors: James B. Wyngaarden, MD & Lloyd H. Smith, Jr., MD. W.B. Saunders Company. 1988.
(2) Webster’s New World Medical Dictionary. Second Edition. Co-Editors: Frederick Hecht, MD, FAAP, & William C. Shiel, Jr., MD, FACP. Wiley Publishing, Inc. 2003.
(3) Stedman’s Medical Dictionary, 25th Edition, Illustrated. Thomas Lathrop Stedman, MD (1853-1938); Editor William R. Hensyl. Williams & Watkins. 1990.
(4) The New International Webster’s Vest Pocket Medical. Trident Press International. 2001.