Dear Nanpickle -

Sorry to hear what you're going through.

I totally agree that you should see a pain specialist ASAP, although I am not aware of any search engine for RSD doctors on the RSDSA site, as Loretta suggests. (More on the RSDSA below.) The best "doctor finder" I know of, showing the names, addresses, etc. of those pain management specialists who have been board certified by the American Board of Pain Medicine (ABPM), the group that oversees all pain management fellowships in th U.S. (And it's a certification that is only given after the doctor completes a formal residency or fellowship in pain medicine and then sits for an 8 hour written exam. This is in contrast to another "certifying" organization that requires no formal training in the field.) This link lays out who they are http://www.abpm.org/about/index.html and here's their search engine http://www.association-office.com/ab...dir/search.cfm Just fill in the blanks and go. For RSD, I would lean away from someone with a background in physical medicine, in favor of someone coming out of neurology or anesthesiology. That said, there no guarantees on bed-side manner.

When you do see a pain specialist, I would strongly urge you to raise the subject of commencing a series of lumbar sympathetic blocks as soon as possible, when all evidence indicates that a sustained course of blocks (injections of a local anesthetic and possibly a steroid, under fluoroscopy) matched with coordinated PT - working you the hardest the day after a block - can provide sometimes permanent relief if (and only if) initiated within the first six months or so of the time the pain first set in. The Reflex Sympathetic Dystrophy Syndrome of America (RSDSA) is an excellent source of information, http://www.rsds.org/index2.html with has a nice little article for patients, Clinical Q & A: Can there be too many sympathetic nerve blocks for the treatment of CPRS? by William E. Ackerman, III, MD, RSDSA Review. Winter 2008 at http://www.rsds.org/1/publications/r...inter2008.html

Similarly, you should be aware that one of the most important treatments out there right now (and becoming more widely available) is the “low dose” or “sub-anesthetic” iv infusion of an anesthetic called ketamine. For a good general discussion of the topic, again written for the layman, check out Overview of Ketamine Infusion Therapy by Philip Getson, DO, RSDSA Review, Spring 2006, Updated October 7, 2008 at http://www.rsds.org/3/treatment/ketamine.html I would also urge you to consider the possibility of getting “low dose” ketamine infusions sooner rather than later, where there is at least a strong suggestion in the literature that people are more likely to go into essentially permanent remission, as opposed to relief for a few months, if they begin treatment within a few - say 8 - months after being afflicted, but in any event before it's spread to any other sites on the body. Kiefer RT, Rohr P, Ploppa A, et al, A Pilot Open-Label Study of the Efficacy of Subanesthetic Isometric S(+)-Ketamine in Refractory CRPS Patients, Pain Med. 2008;9(1):44-54, 51–52, FREE FULL TEXT at http://www.rsds.org/2/library/articl...ohr_Ploppa.pdf:

Correll and colleagues reported significant pain relief in CRPS patients after prolonged infusions of subanesthetic racemic ketamine [12]. All of these reports suggest that ketamine may be more effective in earlier and more localized CRPS. A systematic investigation of the analgesic potency of ketamine for severe, long-standing, spreading refractory CRPS has not been reported. We sought to investigate this question with this pilot study. After completion of a series of four patients who showed no clinical or positive response by quantitative sensory parameters, the investigation was terminated. The discrepancy of the therapeutic efficacy of ketamine in different groups of patients might be explained by the degree of severity of the CRPS that they suffer. Our patients had either long-standing and generalized CRPS or a rapidly spreading form (one patient). All of our patients had failed numerous standard treatments. The extent of prior treatment in the previously reported trials has not been reported in detail. In Correll’s study, CRPS was of relatively short duration (8 months or less in 20/33 patients), which suggests that these patients were less severely affected than those comprising this series.

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The importance of the time of administration of ketamine and its effect on pain is suggested by the success of memantine and ketamine in reducing phantom pain if given perioperatively but its failure to modify established pain [30–32]. The effectiveness of ketamine in early vs established long-standing CRPS pain has not been studied by randomized controlled trials.

Notes
12 Correll GE, Maleki J, Gracely EJ, Muir JJ, Harbut RE. Subanesthetic ketamine infusion therapy: A retrospective analysis of a novel approach to complex regional pain syndrome. Pain Med 2004;5:263–75. [FREE FULL TEXT at http://www.rsds.org/2/library/articl...20ketamine.pdf]

30 Kiefer RT, Wiech K, Topfner S, Unertl K, Birbaumer N. Continuous brachial plexus analgesia and NMDA-receptor blockade in early phantom limb pain: A report of two cases. Pain Med 2002;3:156–60.

31 Kiefer RT, Wiech K, Dieterich HJ, Birbaumer N, Unertl K. The NMDA-receptor antagonist memantine for prevention and therapy of phantom limb pain. Anesthesiology 2003;A:1009.

32 Dertwinkel R, Heinrichs C, Senne I, et al. Prevention of severe phantom limb pain by perioperative administration of ketamine—Results of a pilot study. Acute Pain 2002;4:12–6.

And don't believe any scare talk about ketamine being a neurotoxin. I am advised that there hasn't been one reported case of neurotoxicity in the medical literature for over 30 years!

Believe it or not, seeing a good pain specialist, this early on in the course of your illness will make you more fortunate than many. Good luck!

Mike