So, you have been sent to a Pain Specialist for a block. What can you expect? Can you expect your RSD to go away? Will the block hurt? Could there be complications? Could it make my RSD spread? Are all Doctors good at blocks?

Now here is where things can get good, bad, or stay the same for most patients.

1) Good – The blocks are typically done in a series of 3 to 5 over a period of days, weeks, or even months. The physician will typically only do another one if the previous block was successful. It is important to note that there is a HUGE difference between an injection, like a facet joint injection for instance, and a nerve block for CRPS/RSDS, which is generally either a stellate ganglion or lumbar sympathetic. There are other types of blocks but these are the two most commonly used to arrest CRPS/RSDS.

If they work as hoped they can stop the progression of the CRPS/RSDS and even reverse it, sending the CRPS/RSDS into remission. You will know if the block is working almost immediately because the CRPS/RSDS-affected limb will start turning very warm as the blood flow returns. The pain relief will start to follow. If this course of treatment works each successive block will provide more pain relief. More often than not however, the blocks don’t have any lasting effect. Blocks need to be started with a few weeks or months of the initial injury to have any real and lasting effect.

It is important to remember, nerve blocks can not be used as the sole diagnostic tool. . Failure of a block does not necessarily mean a patient does not have CRPS/RSDS. Usually it signifies the block(s) were begun too late in the treatment process. A block is simply one of the many tools a physician uses in the diagnostic process; the main tool being a clinical evaluation.

2) Bad – Things can turn bad for a few reasons here. It may be because the blocks didn’t work or maybe the first one or two help a little but then the next one or two don’t help at all. If the blocks don’t decrease your pain and/or symptoms, there is no need to keep having them done. Unless there is steady progression it is unlikely to be effective, provided the Pain Specialist knows what he is doing. This is key. If the Pain Specialist (PS) does not know what he is doing, regardless of how experienced he/she says he is, the damage they can do is immeasurable. Just because someone has been cooking for twenty years doesn’t mean they can cook well.

For instance, if a lumbar sympathetic block is going to be performed it is imperative that the Doctor use a Fluoroscope (portable x-ray machine). It should not be painful or bloody, unless he accidentally strays outside of the correct area. That is what the fluoroscope helps to keep him from doing. It takes snap-shot x-rays every few minutes so he can see where the needle has progressed. If it is done incorrectly, and I can attest to this, such as the needle passing into the cerebral spinal fluid, it can be very bloody and painful. It can lead to a massive headache and even spreading. This procedure is described in the “blocks section” noted above if you would like to see how it is supposed to be performed.

3) Stay the same – The blocks are performed correctly, no danger of spread and no unusual pain or problems, but they have no real effect. This is what typically happens in the majority of cases. Usually by the time blocks are attempted it is too far along in the disease for them to be effective and other methods of treating the disease need to be used.

See also, “What is the difference between SMP and IMP?”