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Done with back surgery and having unbearable pain. Suffering from Complex regional pain syndrome. Treatment?

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General & Family Physician
Practicing since : 2004
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Over one year after my back surgery my pain have been unbearable since I started to push myself to do more household chores excited to go back to work. Unfortunately even with pain medications and for spasms they did not work and left me staying awake at night and sleeps during the day. I w as referred to a neurologist and told Tibetans my surgery. She thoroughly did a physical examinations and asked me to walk and standing on my one leg and then the other. I am already in pain and immediately she notice a change in my lower extremity. The affected leg turns purplish and feels cold and my interests swollen and felt warm. The back of my foot feels like I'm w talking on a burning charcoal. She diagnosed CRPS since my pain and affected extremities have different stages of swelling and I am already sweating even though it's in the December month.She ordered a CT of my cervical spine and also a EMG. The CT OF MY CERVICAL SPINE SHOWS TWO DIFFERENT LEVEL.OF HERNIATED DISC. T1-T2 herniated disc and a small curvature of my spine. While my EM G does reveal that my pain from my Dr leg is related to mg S1 which is why I experience sciatica pain and also had several falls and bladder accident. Then recently I also had a colonoscopy and upper GI which revealed bacterial infection and was treated. Even after treatment I continue experiencing constant pain. They perform an USing my liver which rev e las I have a enlarged liver and fatty liver.I was not very concern since I gained weight since after surgery and frequent use of steroid bed of my asthma and CRPS and I am also suffers from type II diabetes and on insulin. I was able to control my diabetes with diet but then slowly gained weight because of physical restriction. Earlier t his year I had a very bad asthma attack where I end up having a respirator. What normallyhappens is if I can not control my pain I suffer from lack of sleep which may goes on days and that's why I experience a bad relapse of my CRPS along with my asthma. In devastating liver. After learning that I backslashes liver and fatty liver they did a liver biopsy where it shows inflammation of my liver and fatty liver. I fully understood him. He said that I already suffers from Stage1 Liver Fibrosis and at present I am still doing okay but because of my other medical problems and autoimmune disease he is hoping that they will not start attacking my liver. He added that I have5-10 years to observe its progression and begins with the treatment but warned me that it will be painful and probably worst than the pain I experience everyday due to my chronic pain, nerve injury, asthma, COPD and dependent on oxygen. I applied for SSD to take advantage of finding doctor's who's specialty is Neurologist to receive proper treatment and even a second opinion about my CRPS because I read that some of the early symptoms of liver disease can be mistaken with my other medical problems which I felt is true. Please help me to find a doctor who specialize in CRPS and Pain Management as well as my seizures and migraine headaches which also leaves debilitating. I no longersocialize with family and friends because I am really very sensitive almost like having a respiratory airway reaction. And I can't tolerate sittings too long because of poor circulation and dwellings of my lower extremities. It's been difficult for my husband and children and we spend all of our savings and even money saved for the boys when they go to college. Now my social worker will help me seek for TANF and apply for SSD and SSDI based on my recent hospitalization. I was denied perhaps they don't have a better understanding that my back injury was the reason why I am now suffering from CRPS which also attacks our organ which I am afraid they already did with my lungs and now my liver. Because of diabetes and remains under control I am praying that they will spare my kidney. My husband and my children are the one who is keeping me alive.Please May you help me with my medical situation and even explain it thoroughlyabout my problems related to my parasympathetic syndrome and sympathetic nerve syndrome. THANK YOU.
Posted Sat, 24 Aug 2013 in Back Pain
Answered by Dr. Chakravarthy Mazumdar 15 hours later

Surprising this query was not picked by any expert and this is very unusual.

On a whole it looks to be a very complex query to most clinicians working here. With a range of diagnoses and humble description of suffering it is perhaps difficult to XXXXXXX the satisfaction levels of the person who posted this query. I picked for to listen to you and understand the problem. Although not the best person I will try my best to help you.

That was a complex diagnosis too 'CRPS'. Few clinicians believe that CRPS develops when a continuous stimulus whether painful or non painful from an injured body leads to peripheral and central sensitization, thereby it demonstrate abnormally heightened sensation like pain. The skin in the injured area becomes more sensitive to all stimuli, even non painful stimuli and extends beyond the area.

The following are the different specialists (in order of importance) that will elevate the quality of living:
Pain specialists (this should be the consultation of choice)
Physical medicine and rehabilitation Specialist
Sometimes Neurosurgeon

This is multidisciplinary approach. steroids, opioids, Vitamin C supplements are generally drugs prescribed. Surgical sympathetectomy was also considered in refractory cases but not often. Approximately 80% of patients with CRPS achieve complete, spontaneous relief of signs and symptoms within 18 months if there is no obvious nerve injury. The daily activity is affected in most and 50% because of pain and movement disorder.

I think you should follow up with your pain specialists and rehab specialists. You should able to do passive range of movements. More importantly you should look at the filled part of the glass always, live with hope. Your family is your support.

You should qualify for temporary assistance, however I am not sure of the eligibility criteria.
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