Suggest treatment for pain due to complex regional pain syndrome
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Hi! I have complex regional pain syndrome in my right hand & a frozen right shoulder. It took over 2 yrs. To be diagnosed. I was in therapy for over a yr. before they realized it was doing more harm than good. I have been seeing a pain specialist and have received 4 nerve blocks. He has prescribed Gabapentin. I am still no better than before I started treatment. I have yet to experience relief. I have an appointment in April with a neurologist at Mass General. I live in MD so I cannot just travel there without a lot of notice. I am experiencing new symptoms, my eyesight is getting worse, the pain & swelling is spredding around my underarm to my right breast, & I have experienced burning tingling sensations through my whole body while lying down. My question is... Should I be worried or just wait till my appointment in April? Also are there any important questions I should ask the doctor at my visit?
Posted Sat, 1 Mar 2014 in General Health
Answered by Dr. Shafi Ullah Khan 6 hours later
Brief Answer: Rest can wait, seek ophthalmology opinion for eye Detailed Answer: Good day XXXX! Thank you for asking. I am Dr S XXXXXXX and i would like to help you with your these troubles you are worried for and i want you to know that this edema swelling thing is due to this CRPS but this visual derangement needs an opthalmologist to sort out the etiology as it may be geriatric age factor or it may be the complication of some high cholesterols or any associated morbidity you have. Rest assured it can wait for the appointment you have in April. Now why the pain is not responding is because it is not managed enough. There are many options which need to be explored by your Pain manager to help you get the relief. Some options i would like to mention and you can discuss them with your pain manager to get the relief. 1)Pulsed doses of steroids (60-80 mg/d for 2 wk) 2)Calcium Related drugs like a-Calcitonin administered intranasally tid or b-Intravenous (IV) clodronate (300 mg daily) and alendronate (either 7.5 mg/d IV or 40 mg/d orally) have been shown to significantly improve pain, swelling, and range of movement in patients with acute CRPS 3)Use of Opioids 4)NSAIDs use. 5)Antidepressants like a-Tricyclic antidepressants (TCAs) and b-selective serotonin reuptake inhibitors (SSRIs) 6)Sodium channel blockers like Intra venous lidocaine or 5 % lidocaine patch or oral or Intra venous mexilitines are also the option. 7)Gamma-aminobutyric acid (GABA) agonists like Baclofen 8)Gabapentin (which you are already on) 8)Calcium channel blockers like nifedipine 9)Beta-blockers like propanolol 10)Oral sympatholytic agents like prazosine, terazosine, phenoxybenzamine etc 11)Ganglion blockers like Clonidine 12)sympathetic ganglion blocks. 13)intravenous regional sympatholysis 14)Intravenous phentolamine infusion 15)Ketamine infusion 16)Intravenous immunoglobulin 17)Epidural clonidine 18)Surgical sympathectomy 19)Spinal cord stimulation/neuromodulation 20)Physical and Occupational Therapy 21)Psychological Therapy 22)Use of Vitamin C increased. So these 22 options are the questions you can ask and platform to select and try what is best for you. Get your specialist and these are 22 good questions you can ask from him regarding your management. And regarding your pain manager tell him to right click update your self as gabapentin and nerve block are only 2 out of 22 options and if the response is not good others need to be tried too. Hope it helps. XXXX i answered this query from the core of my heart spending the record highest time ever i took on a patient. Hope this answer finds you in good faith. Nut shell Wait for the appointment, discuss the options for management unless and until you get relief, and seek an ophthalmologist opinion for this visual derangement as this is not being explained by this CRPS and aetiology needs to be sorted out. Take good care of yourself and remember you have the right to remain pain free and us doctors duty to help you get that right. Don't forget to close the discussion please. Adios
Follow-up: Suggest treatment for pain due to complex regional pain syndrome 12 hours later
Thank you! You have given me more options than any of the 13 doctors I have seen since2009! I will discuss these treatments at my appointment in April. Thank you again!
Answered by Dr. Shafi Ullah Khan 6 hours later
Brief Answer: :) Detailed Answer: You are welcome XXXX I will be here if you need me. Please close the discusson. regards Khan
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