Dear BaseballMama -

Welcome. You will find this is a good and supportive place. You've been through a lot. Ironically, you will find that your peripheral vascular disease is a condition that many people with RSD/CRPS develop as a side effect. (I had a venal flow ultrasound study done the other day, and the tech couldn't believe her eyes and ears when it came to how constricted the return flow was, through one of the legs in particular.)

As someone whose been dealing with this for close to ten years, two primary thoughts occur in response to your post. First, at least for me, my third year of RSD was probably the worst in terms of pain, and Lyrica and Norco don't begin to cut the mustard. You need something stronger. And with regard to your current medical treatment, it's pretty well established that blocks don't have any effect after approximately the first year, at least for CRPS-1, so if you were being given blocks 2+ years after you first became symptomatic, that was a needless and I hope not too expensive exercise.

Thought one: you still need to find a new pain doctor.

Secondly, you clearly could use professional counseling/therapy from a psychologist/psychiatrist trained to work with pain patients. Similarly, you could benefit from participating in an MBSR (Mindfulness Based Stress Reduction) class, a program developed largely for pain patients by Jon Kabat-Zinn, PhD out of the University of Mass. Med. School over 30 years ago. Since then they have trained thousands of teachers, many of them PhD psychologists around the country. Two years into this beast, I was referred to an MBSR teacher by a very good pain psychologist, and it turned my life around, or started a new one, more to the point. Here's their homepage http://www.umassmed.edu/Content.aspx?id=41252 and a linked page specifically describing the MBSR program http://www.umassmed.edu/Content.aspx?id=41254 At the bottom of the second page is a link to find MBSR teacher's in your area: if they are mental health professionals, much of their fees will be covered by health insurance.

Thought two: whether or not you go with an MBSR class, you need to find a really qualified pain physician. For that, I would suggest using the search engine of the American Board of Pain Medicine (ABPM) at http://www.association-office.com/ab...dir/search.cfm If you link from there to "About ABPM" you'll see that they are the organization that accredits all pain management fellowships in the U.S. And unlike another pain management society, all but a few highly regarded practitioners who were "grandfathered in" back in the beginning, all certified specialists must not only complete a yearlong (or more) fellowship in pain management, but pass an 8 hour written examination as well.

When using the ABPM search engine, you can specify the city or state you wish to restrict your search to, as well as the physician's "Specialty of Origin." For RSD in general - and "intermediate" or chronic cases in particular - I would avoid someone who did his or her residency in physical medicine. People seem to have the best luck with pain specialists whose initial training was in neurology, psychiatry or anesthesiology. If such a person is available within a couple of hour’s drive of where you live, I would, in particular, recommend an ABPM certified specialist with a background in psychiatry.

Truly, the first thing you need to do is to find a pain specialist who’s not put off in prescribing what you need. From that point, you can consider some other real "treatment options," low dose out-patient ketamine infusion therapy for one. And for the best place to find information on RSD/CRPS, if you haven’t been there, check out, beginning with its home page the RSDSA (an old name: the Reflex Sympathetic Dystrophy Syndrome Association) at http://www.rsds.org/index2.html

Good luck. We are always here for you to answer any questions or just offer our support, with parenting issues as one of our specialties!

Mike