Dear Lynnie -

Thanks for the post. We had a decent discussion on this article a month ago. You can link to it here: http://neurotalk.psychcentral.com/thread84013.html

The take-away points were:

1. There is a lot of eveidence that blocks are really important in the first few months of the disease;

2. There is no evidence that blocks cause never danage is properly administered, e.g., under flouroscopy, and in a limmitted amount. Or, as GalinaFaolan put it:

Getting nerve blocks are crucial treatment in the beginning. They don't cause damage when you get a series of them to begin with. You often don't get more than 4-6 at the start if they help. The danger begins when you keep getting them over a very long period of time. I'm not saying anyone should stop blocks if they help. It means the pain is still SMP. But you have to weigh the risk versus benefit if you start getting more than 20.

The "damage" they mention is to the ganglion the blocks are injected in when you get A LOT of them, as in 20 or more. I read that in the first year I got rsd when I was researching. The repeated inserting of the needle in the ganglion is what does it. Something most people also don't know is that in just 6 months after getting rsd, there is permanent damage to nerve endings in the body.

Thought I'd put this down because I do not want anyone canceling blocks or afraid to get them. There is NO danger of damage for most everyone who gets blocks because they rarely get so many.

and

3. The whole concept that 6 -7 hours of physical therapy a day will cure you, comes as news to a lot of us who have been through intensive PT programs, and the idea that immobizing (casting) the RSD affected limb back into position is a real shocker, where many of us know from upclose personal experience, just how immobilization can exacerbate RSC/CRPS.

I believe someone also made the point that you can't really base an article around a one-off success rate invloving a teenager, where they're the most likely to have their cases go into spontaneous remission. (Apologies to al teenagers for whom that hasn't been the case.

Finally, as to Dr. Oalander's comment that CRPS is a disease soley of the peripheral nerves, and that all observed changes in the brain are just do to pain, I would just ask how it is that recent structural MRI brain research can discern staticially signicant changes in CRPS patients, that do not appear in similar populations with either chronic low pack pain or fibromyalgia? See, "The Brain in Chronic CRPS Pain: Abnormal Gray-White Matter Interactions in Emotional and Autonomic Regions," Paul Y. Geha, Marwan N. Baliki, R. Norman Harden, William R. Bauer, Todd B. Parrish, and A. Vania Apkarian, Neuron 60, 570–581, at pp. 574-575, November 26, 2008, free full text at http://www.apkarianlab.northwestern....S_Neuron08.pdf (For the applicable paragraghs from this article, anyone interested can check out my Post #12 yesterday at http://neurotalk.psychcentral.com/thread87609-2.html)

Mike