Diagnoses Treated

Overview

Complex Regional Pain Syndrome (CRPS), formerly known as Reflex Sympathetic Dystrophy (RSD), is a chronic neuro-inflammatory disorder. 

It is classified as a rare disorder by the United States Food and Drug Administration. However, up to 200,000 individuals experience this condition in the United States, alone, in any given year.

CRPS is a form of chronic pain that usually affects an arm or a leg.  The reality is - CRPS can occur anywhere in the body.  CRPS generally follows a musculoskeletal injury, a nerve injury, surgery or immobilization, but it can also follow a sprain or strain.  The pain is out of proportion to the severity of the initial injury.

CRPS is uncommon, and its cause isn't clearly understood. Treatment is most effective when started early. Yet, it can take some patients years to get a diagnosis.  

CRPS occurs when the nervous system and the immune system malfunction as they respond to tissue damage from trauma. The nerves misfire, sending constant pain signals to the brain.   Essentially, think of it as the perfect storm in the brain.

The level of pain is measured as one of the most severe on the McGill University Pain Scale.  Most patients describe it as a burning, stabbing, gnawing pain.

The symptoms of CRPS can greatly impact the function of your affected limb or area, sleep, daily activities and overall mental health.

The persistent pain and disability associated with CRPS require coordinated / patient-centered care to achieve pain reduction and better function.  

While there is no cure at this time - it is possible to gain long-term remission. 

Symptoms

Signs and symptoms of CRPS include:

Continuous burning or throbbing pain, usually in the arm, leg, hand or foot (in affected area)

Sensitivity to touch, cold or heat

Swelling of the painful/affected area(s)

Changes in skin temperature — alternating between sweaty and cold

Changes in skin color, ranging from white and blotchy to red or blue

Changes in skin texture, which may become tender, thin or shiny in the affected area

Changes in hair and nail growth

Joint stiffness, swelling and damage

Muscle spasms, tremors and weakness (atrophy)

Decreased ability to move the affected body part

Symptoms may change over time and vary from person to person.  Pain, swelling, redness, noticeable changes in temperature and hypersensitivity (particularly to cold &/or hot and touch).

Over time, the affected area can become cold and pale. It may undergo skin and nail changes as well as muscle spasms and tightening. Once these changes occur, the condition is often irreversible.

CRPS occasionally may spread from its source to elsewhere in the body, such as the opposite limb.

Causes

The cause of CRPS isn't completely understood. It's thought to be caused by an injury to or difference in the peripheral and central nervous systems.  

CRPS occurs when the nervous system and the immune system malfunction as they respond to tissue damage from trauma. The nerves misfire, sending constant pain signals to the brain.   Essentially, think of it as the perfect storm in the brain.  [Think of it as malware in the brain.]

CRPS occurs in two types, with similar signs and symptoms, but different causes:

Type 1 - Also known as reflex sympathetic dystrophy (RSD), this type occurs after an illness or injury that didn't directly damage the nerves in the affected limb. About 90% of people with CRPS have type 1.

Type 2 - Once referred to as causalgia, this type has symptoms similar to those of type 1, but type 2 CRPS occurs after a distinct nerve injury.

Many cases of CRPS occur after a forceful trauma to an arm or a leg. This can include a crushing injury or a fracture.

Other major and minor traumas — such as surgery, heart attacks, infections and even sprained ankles — also can lead to CRPS.

It's not well understood why these injuries can trigger CRPS.  Not everyone who has such an injury will go on to develop CRPS. It might be due to an interaction between your central and peripheral nervous systems that isn't typical and different inflammatory responses.

How is CRPS diagnosed?

Since CRPS is rare and healthcare providers don’t totally understand it, it’s often misdiagnosed.

There’s no specific test to diagnose CRPS. Healthcare providers mainly diagnose it through a careful medical history, physical examination and review of your symptoms. Your provider will ask you if you’ve had a recent injury or surgery.

Your provider may also order other tests to rule out other diagnoses/conditions that cause similar symptoms. For example, electromyography (EMG) may reveal other causes of neuropathy, which may result in some similar pain scenarios.

Once other possible diagnoses are ruled out, your provider will us the Budapest criteria to make the diagnosis.  

Budapest criteria for CRPS

There are currently no medical tests for Complex Regional Pain Syndrome (CRPS).  A clinical diagnosis is based entirely upon an accepted set of guidelines.  At a medical conference in 2004, the International Association for the Study of Pain (IASP) adopted a new set of guidelines for diagnosing CRPS, superseding guidelines which had been in place for the previous decade.  As the conference took place in Budapest, the new guidelines were named the Budapest Criteria.

Signs and Symptoms

The Budapest Criteria differentiates between ‘signs’, which are seen or felt by the person carrying out the examination and ‘symptoms’ which are reported by the patient.

Symptoms

Under the Budapest Criteria, for a diagnosis of CRPS, a patient must have at least one symptom in three of the following four categories:

Sensory: hyperaesthesia (an abnormal increase in sensitivity) and/or allodynia (pain caused by usually non-painful stimuli);

Vasomotor: skin colour changes or temperature and/or skin colour changes between the limbs;

Sudomotor/oedema: oedema (swelling) and/or sweating changes and/or sweating differences between the limbs;

Motor/trophic: decreased range of motion and/or motor dysfunction (weakness, tremor, muscular spasm (dystonia)) and/or trophic changes (changes to the hair and/or nail and/or skin on the limb).

Signs

At the time of clinical examination, at least one sign must be present in two or more of the following categories:

Sensory: hyperalgesia (to pinprick) and/or allodynia (to light touch and/or deep somatic (physical) pressure and/or joint movement);

Vasomotor: temperature differences between the limb and/or skin colour changes and/or skin colour changes between the limb;

Sudomotor/oedema: oedema and/or sweating changes and/or sweating differences between the limbs;

Motor/trophic: decreased range of motion and/or motor dysfunction (ie weakness, tremor or muscle spasm) and/or trophic changes (hair and/or nail and/or skin changes).

Finally, it is important that no other diagnosis can explain the signs and symptoms.

While a diagnosis is fundamental if appropriate treatment is to be obtained, a common diagnostic problem is that not all symptoms and signs are always present at the same time.

Treatments

In traditional allopathic medicine they will look at the following treatments:

PT or OT

Medications

Gabapentin or Lyrica

NSAIDS

Anti-depressants

Muscle Relaxants

Opioids

Blocks

Spinal Cord Stimulators

Nerve Ablation

Pain Pumps

The Problem

Most CRPS patients are not getting relief from traditional allopathic treatments.  As a matter of fact – most CRPS patients are getting worse with traditional treatments.

Just treating the symptoms is not working.  Then the patients are left feeling hopeless.  

CRPS is not a sprain, strain or fracture.  The body will typically heal in 6-8 weeks following a surgery, fracture or injury.  CRPS surpasses the initial injury and healing process - CRPS persists.  Therefore, it must be treated with a different approach.

Effectively Treating CRPS

You need a top-down approach.

Start with the Brain

Biology & Physiology of the Body

Understand the biology and physiology of the human body.

How does it work…

Know that the brain controls every aspect of the body – including pain.

Biology of Pain

With CRPS or chronic pain: The brain perceives ongoing danger, and the pain pathways are reinforced instead of inhibited. 

The pain response is enhanced in the brain, the spinal cord and the peripheral tissue. 

These processes are reinforced with continued signaling from the periphery to the brain and the brain back to the periphery. A loop is set up and pain causes more pain, even if the original injury heals

Treating the Whole Person

Physically, Mentally & Emotionally

A holistic approach to treating CRPS ultimately means treating the whole person.  

This includes addressing:

Fight / Flight

The Vagus Nerve

Balancing the autonomic nervous system (ANS)

Breaking the pain loop

Addressing co-existing conditions

Reducing and managing – stress, anxiety and depression

Increasing restorative sleep

Increasing overall sense of wellbeing

Providing patients with the tools to live a fulfilled life.

This is how the body can heal.

Think of our multi-modality protocol as a blueprint that is individualized to meet your specific needs and goals.   

Holistic Centered Treatment is the only program created by a CRPS survivor.  Unlike other programs – we can truly say we understand CRPS.

I believe that causing pain actually pushes the body further into fight/flight.  

This is what makes us different and allows us to see remarkable changes in our patients. 

 What is amplified musculoskeletal pain syndrome (AMPS)?

Amplified musculoskeletal pain syndrome (AMPS) is a very painful medical condition that can cause pain anywhere in the body. These episodes of pain can be intermittent or constant, can affect the whole body or be localized to one area of the body or affect just a limb. Whenever it occurs, the degree of pain children with AMPS experience is more intense than one would normally expect.

Normally, pain is triggered in response to tissue damage such as would occur when a child steps on a tack. When that happens, the following events occur:

• The damage sends a signal through the pain nerve to the spinal cord.
• The signal is transferred up to the brain.
• The brain recognizes the signal as being painful.

In AMPS, there is an abnormal short circuit in the spinal cord. The normal pain signal not only travels up to the brain but also goes to the neurovascular nerves (also known as autonomic or “flight or fight” nerves) that control blood flow through the blood vessels.

These nerves cause the blood vessels to become smaller (constrict). This constriction restricts blood flow and oxygen to muscles and bone and leads to an increase in waste products such as lactic acid. It is this lack of oxygen and acid build-up that causes pain.

This new pain signal also goes across the abnormal short circuit in the spinal cord and causes a further decrease in blood flow leading to more pain. The pain then becomes greatly “amplified” through this continuous cycle.

Forms of amplified pain:

• Diffuse amplified pain – also called total body pain or pediatric fibromyalgia
• Intermittent amplified pain
• Complex regional pain syndrome (CRPS) with autonomic changes
• Localized amplified pain without autonomic changes (autonomic changes include color and temperature changes - for example, cold and blue - as well as swelling and sweating.)

Causes of amplified musculoskeletal pain syndrome (AMPS):
There are three major causes for amplified pain: injury, illness and psychological stress. There may be other factors such as age, genetics or hormones that can also affect amplified pain. It is often a combination of these factors that lead to amplified pain.

Injuries

These children have suffered a significant specific injury such as a broken bone, moderate to severe musculoskeletal injury or have developed pain after surgery. The symptoms of AMPS can occur suddenly or take weeks to develop.

Illnesses

Illness is an infrequent cause of AMPS but can be more commonly seen in conjunction with inflammatory conditions such as arthritis, tendonitis, myositis or enthesitis. Other illnesses that may be the initial cause are infections such as mononucleosis, gastroenteritis or influenza.

Psychological Stress

Stress can be both a complicating factor and trigger for amplified pain. Stressors can be positive or negative, big or small, and can include not just events, but feelings and personality styles.

Many children with AMPS and their families have been negatively affected by peers, school officials and even health care professional who have dismissed the child’s symptoms.

Chronic pain can also significantly affect individual and family dynamics. Exploring individual and family dynamics does not imply that the pain is not real or is entirely due to psychological cause.

Overview

Fibromyalgia is a disorder characterized by widespread musculoskeletal pain accompanied by fatigue, sleep, memory and mood issues. Researchers believe that fibromyalgia amplifies painful sensations by affecting the way your brain and spinal cord process painful and nonpainful signals.

Symptoms often begin after an event, such as physical trauma, surgery, infection or significant psychological stress. In other cases, symptoms gradually accumulate over time with no single triggering event.

Women are more likely to develop fibromyalgia than are men. Many people who have fibromyalgia also have tension headaches, temporomandibular joint (TMJ) disorders, irritable bowel syndrome, anxiety and depression.

While there is no cure for fibromyalgia, a variety of medications can help control symptoms. Exercise, relaxation and stress-reduction measures also may help.

Symptoms

The primary symptoms of fibromyalgia include:

Widespread pain. The pain associated with fibromyalgia often is described as a constant dull ache that has lasted for at least three months. To be considered widespread, the pain must occur on both sides of your body and above and below your waist.

Fatigue. People with fibromyalgia often awaken tired, even though they report sleeping for long periods of time. Sleep is often disrupted by pain, and many patients with fibromyalgia have other sleep disorders, such as restless legs syndrome and sleep apnea.

Cognitive difficulties. A symptom commonly referred to as "fibro fog" impairs the ability to focus, pay attention and concentrate on mental tasks.

Fibromyalgia often co-exists with other conditions, such as:

Irritable bowel syndrome

Chronic fatigue syndrome

Migraine and other types of headaches

Interstitial cystitis or painful bladder syndrome

Temporomandibular joint disorders

Anxiety

Depression

Postural tachycardia syndrome

Causes

Many researchers believe that repeated nerve stimulation causes the brain and spinal cord of people with fibromyalgia to change. This change involves an abnormal increase in levels of certain chemicals in the brain that signal pain.

In addition, the brain's pain receptors seem to develop a sort of memory of the pain and become sensitized, meaning they can overreact to painful and nonpainful signals.

There are likely many factors that lead to these changes, including:

Genetics. 

Because fibromyalgia tends to run in families, there may be certain genetic mutations that may make you more susceptible to developing the disorder.

Infections. 

Some illnesses appear to trigger or aggravate fibromyalgia.

Physical or emotional events. 

Fibromyalgia can sometimes be triggered by a physical event, such as a car accident. Prolonged psychological stress may also trigger the condition.

Overview

What is dysautonomia?

“Dysautonomia” is the general term for disorders that disrupt your autonomic nervous system (ANS). It can describe several disorders, each with varying symptoms. Dysautonomia can range from mild to severe. Other less common names for dysautonomia are autonomic dysfunction or autonomic neuropathy.

Your ANS is a subdivision of your nervous system. The term “autonomic” means ”self-governing,” and the ANS manages all of your body system processes you don’t think about. That includes your blood pressure, body temperature, breathing, digestion, heart rate, sweating and much more.

If you have dysautonomia, one or more of these ANS processes aren’t working as they should. As your ANS does so many things for you, dysautonomia can cause a lot of different symptoms. These include, but aren’t limited to, chest pain, mood swings, fainting, fatigue and dizziness.

How common is dysautonomia?

Various forms of dysautonomia are relatively common. More than 70 million people worldwide have some form of it. It can be congenital (meaning it’s something you have at birth), or you can develop it at any point in life. The average time of onset is between the ages of 50 and 60.

Dysautonomia is often something that healthcare providers have limited experience with, though. That’s because the condition can vary widely and take many forms. Dysautonomia is often a complicated condition to detect, diagnose and treat.

Symptoms and Causes

Dysautonomia symptoms can affect eyes, heart, breathing and more.

Dysautonomia symptoms can affect automatic body processes throughout your body.

What are the symptoms of dysautonomia?

Symptoms of dysautonomia can affect many body systems, and they may look different depending on the system they affect, like:

• Balance problems.
• Fainting or passing out (especially when standing up).
• Nausea and vomiting.
• “Brain fog,” forgetfulness or trouble focusing.
• Fast heart rate (tachycardia) or slow heart rate (bradycardia).
• Pinpoint eye pupils or unusually wide eye pupils.
• Changes in bowel movements (constipation or diarrhea).
• Fatigue or ongoing tiredness.
• Sexual dysfunction.
• Chest pain or discomfort.
• Frequent urge to pee (urinate) or urinary incontinence.
• Shortness of breath (dyspnea).
• Clammy or pale skin.
• Heart palpitations
• Sleeping problems.
• Trouble swallowing (dysphagia).
• Irregular heart rhythm (arrhythmia).
• Sound or light sensitivity.
• Dizziness or lightheadedness (especially when standing up).
• Low blood sugar (hypoglycemia).
• Sweating more or less than usual, or sweating more in certain body parts.
• Unusually dry or watery eyes.
• Migraines or frequent headaches.
• Swings in body or skin temperature.
• Excessive drooling.
• Mood swings or anxiety.
• Vision issues (blurred vision or trouble with your eyes adjusting to light changes).
• Exercise intolerance (your heart rate doesn’t change with physical activity).
• Runny nose.
• Vertigo.

What causes dysautonomia?

There are two main types of dysautonomia, primary and secondary:

Primary: 

It happens on its own without another cause.

Secondary: 

It happens because of another condition.

Primary dysautonomias

Primary dysautonomias happens on their own, without a specific cause. They aren’t as common as secondary dysautonomia (secondary means something else is causing it).

A specific example of a primary type is an inherited form called familial dysautonomia. Any of the following can increase your odds of having it:

• Being of Jewish (especially Ashkenazi Jewish) heritage.
• Being of Eastern European heritage.
• Having a family member with dysautonomia (especially a first-degree relative like a parent or sibling).

Another primary form is “idiopathic” dysautonomia, which means it happens for a reason that healthcare providers can’t explain or detect.

Secondary dysautonomias

There are conditions that can cause or contribute to dysautonomia. Some examples include (but aren’t limited to):

Amyloidosis.

• Amyotrophic lateral sclerosis (ALS), often known as “Lou Gehrig’s disease.”
• Autoimmune autonomic ganglionopathy (AAG).
• Autonomic dysreflexia.
• Botulism.
• Brain tumors (including cancer).
• Chiari malformation.
• Complex regional pain syndrome (CRPS).
• COVID-19 infection (especially ”long COVID,” when you have symptoms for much longer than expected).
• Ehlers-Danlos syndrome (and other connective tissue disorders).
• Guillain-Barré syndrome.
• Lewy body dementia.
• Lupus.
• Lyme disease.
• Medications or medical procedures.
• Multiple sclerosis and neuromyelitis optica.
• Multiple system atrophy (MSA).
• Neuroleptic malignant syndrome.
• Orthostatic hypotension.
• Parkinson’s disease.
• Porphyria (especially acute intermittent porphyria).
• Postural orthostatic tachycardia syndrome (POTS).
• Primary focal hyperhidrosis.
• Pure autonomic failure.
• Rheumatoid arthritis.
• Sarcoidosis.
• Serotonin syndrome.
• Sjögren’s syndrome.
• Spinal cord injury.
• Toxins, poisons or heavy metals (like mercury, arsenic or organophosphates found in pesticides).
• Traumatic brain injury.
• Stiff person syndrome.
• Tetanus.
• Type 2 diabetes.
• Vasovagal syncope (less commonly known as “neurocardiogenic syncope”).
• Vitamin B12 deficiency.
• Wernicke-Korsakoff syndrome (or vitamin B1 deficiency).

What are the complications of dysautonomia?

Because dysautonomia affects vital body processes, there are many possible complications. Most of the complications revolve around symptoms of dysautonomia, especially when they’re severe or disrupt your usual routine and activities.

Serious symptoms and complications generally include:

• Heart rate issues (too fast, too slow or irregular).
• Fainting (which can lead to injuries from falls).
• Trouble breathing.
• Disrupted digestion, which may lead to constipation, diarrhea or other problems.
• Disrupted kidney function, leading to urinary tract infections or incontinence.

Overview

What is phantom limb pain (phantom pain)?

Phantom limb pain is pain that you feel in the part of a limb that was removed after an amputation. It might seem unusual to feel pain in an area of your body that doesn’t exist anymore, but the pain you feel is real.

Phantom limb pain ranges from mild to severe and can last for seconds, hours, days or longer. A healthcare provider can help you manage phantom pain.

What are the types of phantom pain?

There are different types of feelings or sensations you can have after an amputation. Not all sensations involve pain. Healthcare providers describe these sensations with the term “phantom,” relating to the missing limb (arm or leg) or removed part of your limb (like a finger or toe).

After an amputation, you might experience:

• Phantom pain: You feel pain in the missing limb after an amputation.
• Phantom sensations: The missing limb still feels like it’s part of your body. There isn’t any pain, but you feel sensations of touch, pressure, itch, temperature and vibrations. You may forget that part of a lower limb is missing and try to walk on both legs, for example.
• Phantom pain syndrome: You feel pain and other sensations like touch, pressure, itch, temperature and vibrations in an area of your body that experienced an amputation.
• Residual limb pain: This is pain that affects the remaining part of your limb (stump) that’s still on your body after an amputation. Residual limb pain often has a medical reason, such as infection or nerve damage.

Symptoms and Causes

What does phantom limb pain feel like?

Phantom pain causes painful sensations in an area of your body where you no longer have a limb. It might feel like:

• Aching.
• Burning.
• Itching.
• Numbness.
• Pinching.
• Tingling.
• Stabbing.
• Temperature change.
• Throbbing.
• Twisting.

You might feel like your missing limb is:

• Still attached.
• In an unusual position.
• Moving around.
• Shrinking.

When will I feel phantom limb pain?

Many people report that they feel phantom pain during the first six months after a limb loss. The pain intensity and frequency usually decrease after that. Research shows most people continue to have some phantom pain two years after amputation.

What triggers phantom limb pain?

Phantom pain might trigger (start) or get worse if you have:

• Fatigue.
• Stress.
• Anxiety.
• Depression.
• An infection.
• Blood flow issues.
• Pressure or swelling on the stump.

What causes phantom pain?

Healthcare providers aren’t sure of the exact reason why phantom pain occurs. Many believe it’s a miscommunication in your nervous system. Your peripheral nerves send signals to your spinal cord and brain. These signals tell your body to move. After an amputation, the nerve connection still exists within your body, even though the nerves in the amputated body part aren’t there anymore.

An amputation causes trauma. Your brain is learning how to adjust to the change. Sometimes, nerves can get angry in response to trauma or change. They may send more signals than they usually do or mix up signals. Your brain misinterprets the signals it receives, which increases your sensitivity and leads to pain.

What causes residual limb pain?

You may also feel pain in the remaining part of your body that wasn’t amputated. This is a residual limb or stump. Since this part of your body still exists, several complications can happen that may be causing the pain:

• Bruising.
• Bone infection (osteomyelitis) or bone spurs.
• Inflammation (neuroma).
• Nerve damage (neuropathic pain).
• Poor blood flow.
• Poorly fitting prosthetic device.
• Pressure injuries (bedsores).
• Skin or wound infections.

You can experience residual limb pain at the same time as phantom limb pain.

What causes phantom limb sensation?

Phantom limb sensation (feelings of touch without pain) happens because your brain is trying to rearrange sensory signals after an amputation. Your body naturally sends signals to your limbs throughout your entire life. If there’s an amputation, your brain needs to relearn where to send signals to adapt to the change. It takes time to learn something new. In the same way, your body needs time to adjust, which is why you feel phantom sensations.

Overview

What is small fiber neuropathy?

Small fiber neuropathy (SFN) is a form of peripheral neuropathy. It happens when something damages small nerve fibers in your skin, causing symptoms like painful tingling or burning sensations in your hands and feet. The condition also can affect other small nerve fibers that manage essential body functions, like your blood pressure or heart rate.

SNF symptoms can be severe and affect your overall quality of life. While small fiber neuropathy isn’t a serious medical condition, it may be a sign of other conditions that could be life-threatening. Healthcare providers treat the condition by focusing on the underlying causes and with medication that helps with SFN’s painful symptoms.

How common is small fiber neuropathy?

It’s not common. Based on one study, researchers estimate that 53 out of 100,000 worldwide have small fiber neuropathy. But that estimate may be low: Researchers believe not everyone who has the condition receives a diagnosis.

Symptoms and Causes

What are the symptoms of small fiber neuropathy?

Symptoms of small fiber neuropathy vary, but common early symptoms are “pins-and-needles” pain or a burning sensation in your hands and feet. These symptoms may come and go or be constant and often get worse over time. 

Other symptoms include:

• Feeling lightheaded or fainting.
• Heart palpitations.
• Numbness.
• Not being able to feel pain and temperature in a small spot on your body.
• Stomach cramps.
• Sweating more than usual.

What causes small fiber neuropathy?

About half of small fiber neuropathy cases happen for no known reason. Healthcare providers may call this idiopathic small fiber neuropathy. Research shows several medical conditions, inherited disorders or exposure to toxins may cause SFN.

Medical conditions that cause SNF

Diabetes is the most common condition causing small fiber neuropathy, but you could also develop SNF if you have:

• Alcohol use disorder.
• Immune system disorders like celiac, sarcoidosis or Sjögren’s syndrome.
• Impaired glucose intolerance.
• Infectious diseases like hepatitis C or human immunodeficiency virus (HIV).
• Metabolic syndrome.
• Thyroid disease.
• Sepsis.
• Vitamin B deficiency.
• Inherited disorders that may cause SFN

You could develop small fiber neuropathy if you inherit certain genetic mutations that affect your cells’ ability to make and send electric signals throughout your peripheral nervous system. 

Other inherited disorders include:

• Ehlers-Danos syndrome.
• Fabry disease.
• Familial amyloidosis.
• Pompe disease.
• Porphyria.
• Wilson disease.
• Toxins that may cause SFN

Overview

What is chronic migraine?

Chronic migraine is a condition where you have frequent or long-lasting episodes of headaches and migraines. With chronic migraine, your symptoms can shift daily (or even hour to hour). That can make it hard to tell where one migraine or headache ends and another begins.

What’s the difference between a headache and a migraine?

IMPORTANT: A migraine isn’t just a bad headache. While the International Classification of Headache Disorders definition of chronic migraine includes both headaches and migraines, they aren’t the same.

Headaches are typically unpleasant and disruptive but aren’t severe enough to affect whether or not you can go about your usual routine or activities. The most common type is tension-type headache (TTH). The main symptom of TTH is pain that affects your head or face, but not your brain.

Migraines affect your brain directly, which is why they’re so severe. It’s common for the symptoms to be severe enough to disrupt your routine and activities. Trying to go about your life as you would under ordinary circumstances can feel unbearable when you have a migraine.

How common is chronic migraine?

Migraines are relatively common, affecting around 12% to 15% of the population worldwide. Chronic migraine is less common, and experts estimate 1% to 2.2% of people worldwide have this condition.

Chronic migraine is more likely to affect females.

Migraines often start around puberty and usually become less frequent as you age. Migraines rarely happen or stop entirely after menopause.

Symptoms and Causes

What are the symptoms?

Chronic migraine symptoms are the same as those of episodic migraines. Chronic migraines simply last longer or happen more often. Chronic migraine also involves headaches.

To receive this diagnosis, you must have:

At least 15 days in a month where you experience a headache or migraine. This must happen for at least three months.

At least eight days per month where your headaches include migraine symptoms or features. This must happen for at least three months.

Migraines symptoms

As mentioned, migraines aren’t the same as headaches, and they can take different forms. The symptoms you experience from migraine to migraine can also vary. Migraines happen in up to four stages (but not every migraine involves all four):

Prodrome: 

This is a pre-migraine stage. You can often feel subtle differences that hint that a migraine is forthcoming.

Aura: 

These are symptoms that happen as a migraine disrupts different areas of your brain.

Headache: 

This is the pain stage of a migraine.

Postdrome: 

This is when you feel the aftereffects of a migraine. A common way to describe it is like a “migraine hangover.”

With chronic migraine, your symptoms must meet the following criteria:

• Migraine without aura (must last between four hours and 72 hours)

A headache phase that meets at least two of the following criteria:

• Pain on one side (left or right) of your head.
• Pain that has a pulsing or pounding feel.
• Pain that’s moderate or severe.
• Pain that worsens with even basic levels of activity (such as walking or using stairs) or makes you avoid activity.

A headache phase that involves at least one of the following:

• Nausea.
• Vomiting.
• Both light sensitivity (photophobia) and sound sensitivity (phonophobia).
• Migraine with aura

One or more of the following types of aura symptoms:

• Visual (flashing lights, haze, zig-zag-like areas around the center of your vision or other vision changes).
• Touch (tingling or numbness).
• Speech/language (difficulty speaking or understanding what others say).
• Motor (hemiplegia, which is one-sided weakness or paralysis, affecting your body and/or face).
• Brainstem (loss of coordination, balance issues, vertigo, tinnitus or digestive problems like diarrhea or constipation).
• Retinal (one-sided blindness, either partial or total, or shimmering areas).

At least three of the following criteria:

• At least one aura symptom spreads gradually over five minutes or longer.
• Two or more aura symptoms in succession.
• Each aura symptom lasts between five minutes and one hour.
• At least one aura symptom is one-sided.
• At least one aura symptom with positive symptoms (“good” means the symptoms add an effect; negative symptoms cause you to partly or completely lose the affected ability).
• A headache phase that occurs at the same time or within 60 minutes after an aura.

What causes the condition?

Migraines can be genetic, meaning you’re more likely to have migraines if you have a close biological relative, especially a parent or grandparent, with this condition.

Overview

What Is a Central Sensitization Syndrome?

An illness described as a CSS involves something called central sensitization. "Central" means the central nervous system, which is made up of your brain and spinal cord. "Sensitization" is the end result of something that has made you sensitive.

In CSS, the body becomes sensitive to things that are processed by the central nervous system. Allodynia—pain due to a stimulus that does not typically provoke it, like a hug—results in episodes where certain things cause pain where none existed before.

A development called global sensory hyperresponsiveness can mean that bright lights, loud noises, strong smells, or certain foods or chemicals cause a strong response. This is a common symptom for people with fibromyalgia.

What Are the Symptoms of Central Sensitization Syndrome?

Neurotransmitters that are involved in at least some of the CSS include:

• Serotonin
• Norepinephrine
• Dopamine
• GABA and glutamate

The pain of CSS comes from a couple of different abnormal pain types: hyperalgesia and allodynia.

Hyperalgesia takes normal pain from things that everyone considers painful (a broken limb, an infected tooth, etc.) and makes it worse. It's often referred to as "turning up the volume" of pain. This makes things like injuries, surgeries, and chronic sources of pain especially debilitating.

Allodynia makes you feel pain from things that shouldn't hurt, such as the brush of fabric against your skin, or your arm resting against your side when you sleep. Allodynia can feel like your clothes painful even when they're not too tight or make you unable to enjoy touch. It turns all manner of ordinary experiences into painful ones, which often means making significant changes to your life to minimize it.

Other proposed mechanisms of CSS include:

• Inflammation in or originating in the nervous system
• Autonomic nervous system dysfunction
• Dysfunction of the HPA axis, which is part of the body's stress-response system

Overview

Chronic pain can be described as ongoing or recurrent pain, lasting beyond the usual course of acute illness or injury or more than 3 to 6 months, and which adversely affects the individual’s well-being. A simpler definition for chronic or persistent pain is pain that continues when it should not. (IASP 2004).  

People of all ages are diagnosed with chronic pain every year.  Pain does not discriminate.  In the United States over 100 million people are diagnosed with some type of chronic pain.  This is greater than cancer, heart disease and diabetes combined.  However, pain reaches far past our borders and affects an astonishing 1.5 billion people worldwide.  Pain is a universal experience, serious and costly.  

Chronic pain patients want to be heard and understood.  Their pain is real, and they need solutions.  They don’t want to be told not to worry, that they don’t look sick or that it’s all in their head.  

Chronic pain can be effectively treated when we look at treating the whole person and not just the symptoms.

At Holistic Centered Treatment, we understand chronic pain.  Dr. Traci Patterson - lived with type 2 CRPS for 7 years prior to gaining long-term remission.  

Overview

What is long COVID?

Long COVID is a collection of symptoms you might experience after your initial (acute) COVID symptoms get better. You thought you’d only have to deal with COVID for a week or two, but you’re still exhausted all the time. Or you can’t think straight. Food you once loved tastes metallic — or you can’t taste it at all. You might not be able to remember the last time you got a good night’s sleep.

Long COVID isn’t one symptom or set of symptoms. It’s any medical condition linked to a COVID-19 infection that goes on for three months or longer after your first COVID symptoms. It can happen whether you had a mild case of COVID or a severe one. The symptoms could be similar to autoimmune, lung, heart, neurological or psychological disorders. Some symptoms are mild, and others are completely debilitating. They may come and go, change or get worse over time. You may feel like you never really got better from your initial bout with COVID at all.

Long COVID is also called long-haul COVID, post-COVID syndrome (or conditions) and post-acute sequelae of COVID-19. In many people, it’s compared to myalgic encephalomyelitis/chronic fatigue syndrome (ME/CFS). Because of the different symptoms and possible causes, there’s no single treatment that works for everyone.

How common is long COVID?

Post-COVID conditions may affect about 5% to 10% of people who’ve had a COVID infection. But the variety of symptoms and differences in how long they last can make it hard to know exactly how many people experience it.

Symptoms and Causes

What are the symptoms of long COVID?

Long COVID has a variety of symptoms. Some people with long COVID have more than one symptom, but most people don’t experience all of them. The two most common symptoms are fatigue (lack of energy) and shortness of breath. Other possible symptoms include:

• Loss of or altered sense of smell or taste (anosmia or dysgeusia).
• Trouble thinking or focusing — “brain fog.”
• Chronic cough.
• Headaches.
• Difficulty sleeping or insomnia.
• Depression.
• Anxiety.
• Chest pain.
• Heart palpitations.
• Diarrhea.

What causes long COVID?

Experts can’t pinpoint one single cause for long COVID. But other coronaviruses, including Middle East respiratory syndrome (MERS) and severe acute respiratory syndrome (SARS), have been known to cause long-term effects. So perhaps it’s no surprise that COVID symptoms can last a long time, too. Multiple factors might contribute to the causes of long COVID, including:

• Tiny blood clots. Very small blood clots might not cause a major event (like a stroke), but they can prevent your lungs, brain and other organs from working properly.
• Inflammation. Your immune system may overreact and continue to cause inflammation in your organs and tissues long after it’s fought off the infection.
• Autoimmune disorders. For reasons we don’t understand, COVID might cause your immune system to start attacking parts of your own body, like an autoimmune disorder.
• Viral persistence. SARS‑CoV‑2, the virus that causes COVID-19, might hang around in your body long after you feel better from your initial illness. You can test negative for COVID and you aren’t contagious anymore, but it could continue to cause issues in your body.
• Reactivation of other viruses. Some viruses remain inactive, or dormant, in your body without you knowing it. These can sometimes get reactivated and cause symptoms again. Some evidence suggests that COVID might reactivate Epstein-Barr virus (the virus that causes mono), causing long-lasting symptoms.
• Long-term psychological effects of having a serious illness. If you had a severe case of COVID, especially if you were hospitalized, you might have anxiety, depression or other mental health conditions as a result.

Orthopedic Injuries | Strains | Sprains | Overall Wellness

Your Health Journey Starts at Holistic Centered Treatment

Holistic Centered Treatment offers a full range of services to help to restore, rejuvenate and heal.  Our premiere facility offers the latest in cutting-edge science that is geared towards healing.  Whether you are dealing with back pain, strains, sprains, orthopedic injuries, or you just need to rejuvenate - Holistic Centered Treatment is here to help.

You can rejuvenate your body and mind with superior treatment modalities.  All in an atmosphere of healing, tranquility and luxury.  We offer services such as photobiomodulation (laser), PEMF, microcurrent, vagus nerve toning, EMDR, hypnotherapy, and more.