AMPUTATION

Amputation should NOT be used as a treatment for eliminating the pain of RSDS/CRPS except in cases where the loss of a limb is imminent due to some other problem such as gangrene.

Unfortunately there are actually Doctors out there who are amputating limbs in an effort to eliminate the RSDS. Patients desperate for relief are vulnerable to these Doctors. The procedure does not work and in the end the patient is left without a limb and with worse RSD pain than before and most probably a spread of the disease itself.

ANALGESICS

OPIATE AGONISTS- THESE MEDICATIONS TRY AND REDUCE CENTRAL NERVOUS SYSTEM ACTIVITY AND THEREBY REDUCE PAIN.

FOR MORE INFORMATION SEE DRUG THERAPIES

ANTIDEPRESSANTS

Originally used only to treat depression, studies have shown that these medications can alleviate pain in certain situations. Furthermore, they may have the added benefit of helping the patient to sleep at night. Paxil, Zoloft, Elavil, Pamelor, and Trazadone are good examples. They have a side benefit of reducing headaches in many RSD/CRPS patients. Some have a tendency to cause weight gain and drowsiness.

Teens need to be careful with their use as some antidepressants have been linked to suicides when given to teens. Careful monitoring is recommended. Always talk these issues over with your physician.

FOR MORE INFORMATION SEE DRUG THERAPIES

BIER BLOCKS

A Bier Block is a procedure where an injection is made in the leg or arm and then they block the circulation with a tourniquet in an attempt to keep the medication in the leg for a longer period of time.

BIO-FEEDBACK

Teaches you to control things such as your body temperature (RSDS patients tend to have fluctuating extremity temperatures).

BLOCKS - VARIOUS TYPES

Also called Sympathetic Nerve Blocks/Lumbar/Cervical Blocks/Bier Blocks, and more - they are used to administer medication directly on the spine in an attempt to reduce nerve activity.

Usually performed in a series of three or more and can be very effective early on when pain is Sympathetically-Mediated.

Please read on for further details of specific blocks.

CLICK HERE TO LEARN MORE ABOUT NERVE BLOCKS

BONE SCANS - TRI-PHASIC or THREE PHASE BONE SCAN

Here is some information I put together regarding tri-phasic, or three-phase, bone scans and related information in response to some questions posted in one of our forums. Remember, we are not medical professionals but simply fellow patients and loved ones. Never start, stop, or change what you are doing with your Doctor based on what you read on the internet but rather, share what you learn with your Doctor and together formulate the best plan possible for your current and future care.

What is a bone scan and can it be used to diagnose RSD/CRPS?

Firstly, we should define what a bone scan is.

A bone scan is a nuclear scanning test that identifies new areas of bone growth or breakdown. It can be done to evaluate damage to the bones, detect cancer that has spread (metastasized) to the bones, and monitor conditions that can affect the bones (including infection and trauma). A bone scan can often detect a problem days to months earlier than a regular X-ray test.

For a bone scan, typically, a radioactive tracer substance is injected into a vein in the arm. The tracer then travels through the bloodstream and into the bones. Areas that absorb little or no amount of tracer appear as dark or "cold" spots, which may indicate a lack of blood supply to the bone (bone infarction) or the presence of certain types of cancer. Areas of rapid bone growth or repair absorb increased amounts of the tracer and show up as bright or "hot" spots in the pictures. Hot spots may indicate the presence of a tumor, a fracture, or an infection.

A bone scan may be done on the entire body or just a part of it. (WebMD)

Then we have to differentiate between bone scans and x-rays and their use, from a practical sense, concerning RSD patients.

Do X-rays have a use in diagnosing RSD patients?

Different Doctors will have different answers here. X-rays CAN show patchy thinning, or osteoporosis, in some patients. This is not always indicative of RSD of course and if a patient is believed to have RSD the appearance of osteoporosis on x-rays is not always a confirmation but it is an indicator. An x-ray is not something that is typically used to diagnose RSD, but it can be one of many pieces of information gathered. Typically Doctors prefer the more informative bone scan.

Is a bone-scan a way to diagnose RSD?

Some Doctors will use this method to diagnose RSD but according to a study done a number of years ago by Doctors Lee and Weeks in the Journal of Hand Surgery, it is only accurate in diagnosing RSD 55% of the time! That isn't very good.

Yet there are still Doctors who use this test as a way to rule in or out an RSD diagnosis. As Doctor Hooshang Hooshmand once noted, "If I have a heart attack and they tell me that they are going to do a test that has 55% chance of diagnosing my heart attack, obviously I'm not going to consent to such a test."

There are many reasons why bone scans are not accurate, from the spreading of RSD to the changes in bone circulation that take place during the different stages of RSD, and diseases that mimic RSD like arthritis.

Now bone scans can be helpful in ruling out some things when considering the diagnosis of RSD; things like stress fractures. The tri-phasic bone scan in particular;

CALCIUM CHANNEL BLOCKER

Drugs that dilate the coronary arteries and increase blood flow through the coronary arteries; useful for angina and blood-pressure reduction.

CAPSAICIN, TOPICAL LARGE-DOSE

The intermittent application of large-dose topical capsaicin may provide significant pain relief, decrease chronic analgesic dependence, and decrease aggregate health care expenditures.

CERVICAL NERVE BLOCK

The Cervical Nerve Block is different from the Lumbar Block in that it is performed at the front of the body, near the neck, instead of the lower back. It is usually performed when the patient is suffering from shoulder, arm, hand, and/or neck pain. whereas the lumbar blocks are typically done for leg/feet, and/or back pain.

Computerized axial tomography (CAT)

X-rays are passed through the back at different angles, detected by a scanner, and analyzed by a computer. This produces a series of cross-sectional images and/or three-dimensional views of the parts of the back. The scan shows the shape and size of the spinal canal, its contents, and structures surrounding it.

DIET FOR RSD PATIENTS

To see the complete RSD Diet, follow this link to the RSDRX website;

CHRONIC PAIN DIET

There is a Chronic Pain Diet that is excellent. We must remember that everything we put into our bodies is made up of chemicals; whether it is food or medication. They all must work together for a complete treatment. For instance, some foods such as Chocolate, candy, cake, and hot dogs are very bad for RSD patients.

DURAGESIC - FENTYNAL - PATCHES

Intravenous fentanyl has been used by anesthetists for many years to provide analgesia during surgery, its delivery via a transdermal patch and its use in patients with chronic cancer pain are both new and it is therefore helpful to gather information about the practical implications of this new system.

Transdermal Fentanyl therefore provides an alternative form of strong opioid analgesia for patients who cannot take oral morphine.

You can also visit FENTYNAL PATCH INFO

FLUOROSCOPY

A diagnostic procedure in which x-rays that have passed through the body are projected onto a screen, providing a continuous image of the body‘s internal structures.

More simply put it is a portable x-ray machine. One of its many uses is when a "block" is being performed, most especially a lumbar sympathetic block. It allows the Doctor to see, through the x-ray scans shown on the monitor, exactly where the needle is in the spine so that pinpoint accuracy can be maintained. It provides for a more effective block with a much lower likelihood of any problems resulting from an incorrect positioning of the needle.

It is HIGHLY recommended that this machine be used when the Dr. is performing a lumbar block!

GUIDED IMAGERY

A technique that teaches you relaxation methods.

HEAT

Effectiveness depends on the individual but NEVER use ice. Moist heat is best. The microwaveable packs are handy and most effective.

HYPERBARIC OXYGEN THERAPY - HBO

Initially used to treat underwater divers with the bends, HBO has been proven effective in treating many diseases. It does not replace other reliable treatments such as surgery and medication, but is generally prescribed in conjunction with other treatments. More studies are being done every day on using this treatment for RSD pain with very good results.

There are a couple of HBOT Treatment Center links in our MEDICAL Links section.

MEDICAL LINKS

Here is one that describes the process itself in depth (no pun intended) WHAT IS HBOT THERAPY  

CHECK OUT OUR HYPERBARIC OXYGEN SECTION! NEW!

HYPERBARIC OXYGEN THERAPY

INDWELLING SYMPATHETIC NERVE BLOCK - CONTINUOUS DRIP

Continuous Sympathetic Nerve Block usually performed by using an epidural catheter and dripping the medication continually over a period of hours or even days.

LIDOCAINE PATCH

The Lidocaine patch has been approved by the US Food and Drug Administration for the treatment of postherpetic neuralgia. Like other local anesthetics, the Lidocaine patch results in sodium channel blockade, dampening, both peripheral nociceptor sensitization and, ultimately, central nervous system hyperexcitability.

MEDICATIONS FOR RSD

THERE ARE A NUMBER OF DIFFERENT TYPES OF MEDICATIONS USED TO TREAT RSD / CRPS.

FOR MORE INFORMATION SEE DRUG THERAPIES

We also have a section on the website called MEDICAL ARTICLES and one of the sub-headings for it is MEDICATIONS, another is MEDICATION RECALLS. There are articles there about some of the latest studies and information. Be sure to keep that section in your favorites folder.

MEDICAL ARTICLES INDEX

In particluar, you might want to check out the latest articles added regarding OPIATES, ADDICTION VERSUS TOLERANCE.

link" http://www.rsdhope.org/ShowPage.asp?PAGE_ID=39 "," BACK TO MEDICAL TREATMENTS PAGE"}

MRI

A diagnostic technique in which radio waves generated in a strong magnetic field are used to provide information about the hydrogen atoms in different tissues within the body; a computer uses this information to produce images of the tissues in many different planes.

NARCOTICS

This is a very controversial topic. There are two different groups of Narcotics; the first are Morphine Agonists (such as Morphine and Demoral) and the second are Morphine Antagonists (such as Stadol and Ultram). The controversy surrounds which are better for treating RSD-type pain and which are detrimental.

More attention needs to be paid to the facts concerning addiction and pain. Many patients are concerned that if they start taking narcotics for pain that they will become addicted. Understand that taking narcotics to get high and taking them to relieve pain are two very different things.

In an excellent article in the 10/10/05 issue of the New Yorker Magazine Dr Jerome Groopman talks about RSD. If you haven't read it I would sugges ttrying to get a copy. He did an excellent job, just as his prior article on Fibromyalgia was. But in an interview about this article he was asked about narcotics and addiction for pain patients. Here is the question and answer.

"Question- Traditionally, as you say, pain has been treated with narcotics, and there are often side effects—addiction to painkillers being the most obvious. As you point out in the piece, therapies like nerve blocks are used to treat R.S.D. as it becomes better understood. Are there also cases where old, blunt, and not so efficient therapies are being abused? Or, for that matter, are there crank therapies? "

Doctor Groopman - "It’s interesting. These people generally don’t have a very high addiction problem, because they don’t have what’s called an “addictive personality.” They have terrible pain, and they use their medicines very judiciously. In fact, a lot of them don’t even want to use their medicines, because they don’t like the side effects. So they’re not psychologically predisposed to addiction. I think there is still a tremendous need for better therapies. As the biology has become better understood, there are drugs emerging that target specific neurotransmitters, specific channels, and so on, which can help these people.

The more extreme interventions, with nerve stimulators, for example, are a relatively recent development—in some cases the results are tremendous, and in others the technique doesn’t succeed. I haven’t seen a lot of crank therapies, because there is not much placebo effect here. You tend to see crank therapies proliferate where the placebo effect is profound. But the kind of pain that these patients are having is not amenable to suggestion or emotional state."

This Q&A is from the New Yorker online edition website, ARTICLE   , but the article, which was 6 pages long, was in the 10/10/05 issue of the magazine and was very well done.

OCCUPATIONAL THERAPY

Occupational Therapists (OTR/Ls)provide vital treatment services to individuals with upper extremity limitations and injuries....

PHYSICAL OBSERVATIONS

The patients MOST EFFECTIVE TOOL is a well informed Doctorr, or team of Doctors and Specialists, who truly understand this disease and are willing to work with the RSDS patient to battle it. Communication between the Doctor and the patient is critical.

PHYSICAL THERAPY

It is vital to keep the affected limbs moving but a fine line must be walked between "no pain-no gain" and "use it or lose it".

Some important things to think about concerning physical therapy.

Do not let them use ice or hot/cold contrast baths on the affected limbs/areas. While this seems to make sense at first thought (i.e. burning pain, ice cools, etc.) it can and usually does make the pain worse and in some cases can actually accelerate the progress of the RSD.

An excellent form of therapy for RSD patients is warm water therapy. The pool must be at least 90 degrees or you run into the same problem as the ice. Most PT Centers have a warm water pool though. A typical therapy plan for an RSD patient is range of motion exercises, water walking, etc.

Most important, as with any Medical professional, is to find a PT Center that has had RSD patients in the past and knows how they differ from the typical chronic pain patient. ALWAYS ASK, don't assume. There may even be some PT's in the same center who know more than others about RSD, these are the people you want working on you.

For a much more extensive look at Physical Therapy and CRPS including information on what to look for in a physical therapist, what questions to ask, what types of therapy are best, what to avoid, and much more, go to PHYSICAL THERAPY AND CRPS

PSYCHIATRIC CARE

To help you deal with the changes in your life brought about by RSDS and to help you learn to cope with the Chronic Pain you may want to have Psychiatric Care. BUT remember, this disease is Physiological not Psychological.

PUMP, MORPHINE OR INTRATHECAL DRUG DELIVERY

What is an Intrathecal Pump Implant ("Spinal Morphine Pump")?

An Intrathecal Pump is a specialized device, which delivers concentrated amounts of medication(s) into spinal cord area via a small catheter (tubing).

What is an Intrathecal Pump Implant ("Spinal Morphine Pump")?

An Intrathecal Pump is a specialized device, which delivers concentrated amounts of medication(s) into spinal cord area via a small catheter (tubing).

Am I a candidate for Intrathecal Pump Implant ("Spinal Morphine Pump")?

Currently at TPM, Intrathecal Pump is offered to patients with :

Chronic and severe pain, who have not adequately responded to other treatment modalities. Some of the examples are failed back syndrome, cancer pain, RSD. These patients receive infusion of painkillers such as Morphine or Dilaudid.
Spastic disorders such as Multiple Sclerosis, Spinal Cord Injury - associated with muscle spasms. These patients receive infusion of an antispasmodic medication called Baclofen.

What is the purpose of it?

This device delivers concentrated amounts of medication into spinal cord area allowing the patient to decrease or eliminate the need for oral medications. It delivers medication around the clock, thus eliminating or minimizing breakthrough pain and/or other symptoms.

How long does the procedure take?

It is done in two stages. In the first stage, a single injection is made to assess effectiveness and screen for unwanted side effects. If this trial is successful in relieving symptoms, then the permanent device is placed under the skin. The patients have to meet certain other screening criteria before implanting the pump.

Will the procedure hurt?

The procedure involves inserting a needle through skin and deeper tissues (like a "tetanus shot"). So, there is some discomfort involved. However, we numb the skin and deeper tissues with a local anesthetic using a very thin needle prior to inserting the needle. Most of the patients also receive intravenous sedation and analgesia, which makes the procedure easy to tolerate.

Will I be "put out" for this procedure?

The placement of the tubing is done under local anesthesia with patients mildly sedated. The amount of sedation given generally depends upon the patient tolerance.
For the pump placement, patients are given stronger intravenous sedation and analgesia.

How is the procedure performed?

It is done with the patient lying on the side. Sometimes the tubing is placed with the patient sitting up. The patients are monitored with EKG, blood pressure cuff and blood oxygen-monitoring device. The skin is cleaned with antiseptic solution and then the procedure is carried out. X-ray (fluoroscopy) is used to guide the needle for inserting the tubing.

Where is the tubing inserted? Where is the pump placed?

Tubing is inserted in the midline at the lower back. The pump is then placed on the side of the abdomen.

What should I expect after the procedure?

If the procedure is successful, you may feel that your pain may be controlled or quite less. The pump is adjusted electronically to deliver adequate amount of medication.

What should I do after the procedure?

This procedure is normally a day-procedure and patients are kept overnight for observation and pump adjustment.

How long will the pumps last?

The medication contained within the pump will last about 1 to 3 months depending upon the concentration and amount infused. It is then refilled via a tiny needle inserted into the pump chamber. This is done in the office or at your home and it takes only a few minutes.

The batteries in the pump may last 3 to 5 years depending upon the usage. The batteries can not be replaced or recharged. The pump is replaced at that time.

Will the Intrathecal Pump Implant ("Spinal Morphine Pump") help me?

It is very difficult to predict if the procedure will indeed help you or not. For that reason a trial is carried out to determine if a permanent device (pump) will be effective to relieve your pain or not.

What are the risks and side effects?

Generally speaking, this procedure is safe. However, with any procedure there are risks, side effects, and possibility of complications. Please discuss your concerns with your physician.

Who should not have this procedure?

If you are on a blood thinning medication (e.g. Coumadin®), or if you have an active infection going on, you should not have the procedure. The patients also have to meet certain other screening criteria before implanting the pump.

Where can I get additional information?

More detailed information is available from the manufacturer of this device. At the time of consultation you will receive a Synchromed™ Infusion System Patient Education Booklet.

Information courtesy of Redding Anesthesia Associates Medical Group

On the page with the video, if you scroll down there are more video's about the Pump

RHIZOTOMY

Surgical destruction of nerve roots and also of nerves (such as those around intervertebral joints) in order to relieve pain. Another version of a sympathectomy, WHICH HAS EXTREMELY LIMITED POSITIVE RESULTS but can have very damaging results.

Before you let a Doctor perform this procedure, once thought to be THE answer for CRPS/RSDS patients but for many years now known not to be, get a second opinion, and a third if needed.

This is an irreversible procedure. Once performed it also eliminates the ability to block the nerve pain through that nerve.

Think about it like this, you already have a sympathetic nervous system that is in a hyperactive state due to the RSD. The last thing you want to do is to aggravate it even further.

Many amputees, who obviously have had many nerves cut when their limb was removed, report RSD-type nerve pain long after the limb removal.

SPINAL COLUMN STIMULATORS (SCS) OR NEUROSTIMULATORS

Also called DORSAL COLUMN STIMULATORS, or DCS, these devices are implanted under the skin and send out electrical signals to "block" the signals the RSD-affected nerves are sending to the brain.

While some patients report good pain reduction from these units, they do have some problems, such as, they seem to be more effective early on than later, the leads can move off of the sweet spots they are placed on fairly frequently requiring further surgeries, and removal of the units can lead to further problems such as STAPH infections.

A National Survey done in 1998 showed that of the patients who had the SCS Unit implanted, 47% reported pain relief during the first year but only 20% reported pain relief after the first year. (Results of the survey are on the American RSDHope website).

Since then advances have been made and success rates are higher but more research needs to be done, especially involving RSD patients. Like any procedure a lot of the determination of success depends on the Doctor and how many times he has performed the procedure.

An alarming trend seems to be younger and younger patients being fitted with these units. This is an invasive procedure and RSD patients need to be aware that such procedures can lead to possible complications. It seems more money needs to be spent on research into less invasive treatment options.

There is an excellent video that has been produced that explains all about neurostimualtors. You can play this video by visiting the site below.

You can also get more information on stimulators by visiting either of the following websites;

MEDTRONICS HOME PAGE  

TAME THE PAIN  

Medtronics provides excellent follow-up care to the patients who receive their units.

SYMPATHECTOMY

There are many versions of this procedure, sometimes the nerve is simply cut, or it can be burned or frozen with chemicals, and there are a few other types.

However, Sympathectomies have EXTREMELY LIMITED POSITIVE RESULTS and can have very damaging results.

Once thought to be "the answer" to RSDS pain is now shown, according to a National Survey of RSDS Patients conducted in 1998, to have a very low rate of long-term success and in three out of four patients makes the RSDS spread and/or worsen. The study also showed that there is a 70% failure rate within the first year.

This procedure is irreversible AND THANKFULLY LESS AND LESS DRS ARE PERFORMING THEM!

Many Doctors who once supported them wholeheartedly have now publicly stated they would never recommend this treatment for an RSD patient.

TEST FOR RSD

Is there a single test to determine if a patient has RSD/CRPS?

Bone Scan, MRI‘s, CAT Scan, are used. Although these can show the presence of RSDS they do not always show it.

Recently a new test has been developed that may be able to help detect/confirm the presence of RSD. The test in conjunction with Doctor Oaklander's findings at MGH Hospital in Boston back in late 2005 signals a whole new chapter in the study of CRPS.

To learn more CHECK OUT THE RSDS/CRPS DESCRIPTION PAGE

THERMOGRAPHY

A diagnostic technique for measuring blood flow by determining the variations in heat emitted from the body -- to detect changes in body temperature that are common in RSDS.

This is NOT a definitive test to determine up or down that you have RSD. In certain stages of RSD they may not show a significant difference between limbs.

Unfortunately some Doctors will use this as a test to determine whether or not you have CRPS/RSDS, do not let them. If this is what they think, you will definitely want to consult with another Doctor who has more experience with CRPS/RSDS.

The same is true for a bone-density test, sometimes called a tri-phasic bone scan. Some may disagree with my suggestion to see another Doctor but if your Doctor feels that a Thermography test is going to show whether or not you have CRPS/RSDS, definitively yes or no, then you need get to a better RSD-educated Doctor. This is your life. You cannot afford to waste any time waiting for your RSD to move into the stage where the thermography will show a temperature change.