lillizziem -
There are two things you should know here. First, the reason peripheral nerve blocks/continuous regional anesthesia (or just a dentist injecting you with two or three times as much local anesthetic than would normally be the case) are stressed for CRPS patients - as opposed to relying on a general anesthetic - is that a general anesthetic simply knocks you unconscious, but does nothing to keep the pain nerves from going into overdrive and ultimately flooding the dorsal horn of the spinal column, which in turn may trigger "central sensitization" and a neuro-autoinflammatory response, as the area where the procedure is being done is flooded with a wide range of immunological agents: witness the swelling in your face the first time around. At which point, there is too good a chance that you will have managed to induce "spreading" to an area of the body that was previously not generally affected by your RSD/CRPS. From the first and by far the most moving article I recall seeing on the subject, "The Painful Truth: The Iraq war is a new kind of hell, with more survivors - but more maimed, shattered limbs - than ever. A revolution in battlefield medicine is helping them conquer the pain."
WIRED, Issue 13.02 - February 2005 [at p. 4/6]:
When an arm or a leg is wrenched from the body by trauma or surgical amputation, torrents of signals from the severed nerves travel up the spinal cord and converge in the cortex. In the weeks following the loss of the limb, the brain redraws its map of the body by growing new neural connections. Pain specialists theorize that windup creates glitches in this new map, causing acute pain from the injury to be hardwired into the body as chronic pain. A 2001 brain-imaging study in Germany found a strong correlation between disturbances in the process of cortical reorganization and the development of phantom-limb syndrome.
A brain under general anesthesia is still bombarded by frantic pain signals; it just can't do anything about them, therefore the patient is still susceptible to chronic pain. Nerve blocks intercept the cascades of bad news before they sensitize the central pain pathways. Blocks also dilate capillaries in the damaged tissue, improving blood flow and accelerating healing.
By the time a soldier typically sees an anesthesiologist, the windup process has already begun, but several studies have shown that use of regional anesthesia before, during, or after the removal of a limb may reduce the incidence of chronic pain. Danish patients given epidural blocks before surgical leg amputation showed a dramatic reduction in postoperative discomfort. Other research has shown that even the short-term administration of a block reduces the need for narcotics in the recovery room.
http://www.wired.com/wired/archive/1...ain&topic_set=
Now for the good news, It was my experience and that of quite a number of people with whom I've been in contact that the absolute level of physical pain was at its worst in the first three years if the affliction, Yes, other issues may pop up, but the sheer level of physical pain seems to top out for many people by the fourth year. I don't know whether that's due to the pain, in the chronic stage, not being maintained by any neuro-inflammation in the body, but at that point significant "cortical reorganization" in the brain, or simply that the capacity to feel the most severe pain somehow burns out along the way. (Citations available upon request.) Having said this, I caution that this is all anecdotal, but it may explain how some people who have had this for a while start to cope with it.
*
Mike
* For me, my break came a year into this when a senior pain psychologist referred me to an
MBSR (Mindfulness Based Stress Reduction) instructor in my area. It's a ten week program that combines 2 & 1/2 hour small group classes, in comfortable rooms with lots of cushions, which is geared to dampening down the chaos, largely with the aid of guided meditations and simple yoga exercises that are great for regaining the proprioceptive skills that CRPS specifically undercuts. For the rest of the week, students are asked to practice guided meditation and yoga exercises with the aid of pre-recorded instruction. MBSR was developed over 30 years ago, largely for chronic pain patients, by Jon Kabat-Zinn, PhD, of the University of Mass. Medical School, which continues to administer the program and has trained thousands of instructors over the years. Here’s one of their homepages explaining the program:
http://www.umassmed.edu/cfm/stress/index.aspx And here’s a link to a search engine that will find teachers in your area:
http://w3.umassmed.edu/MBSR/public/searchmember.aspx Finally, a hint regarding insurance coverage. Many but not all of the MBSR instructors are also licensed mental health professionals. And if you go with someone who is so licensed, your health insurance will likely pick up most of the cost of the program, which varies by the region in which the class is being offered.