Hello old friend -

So very sorry to hear about this. Just tried to put up a long post but am at a cheap internet cafe on the road which logged me out as I wrote so am trying again. But must be brief.

Although it's usually used when there is "spead" to a new extremity, the difference between wat's going on in your right arm vs. wrist/hand sounds dramatic enough to that a fresh round of blocks combined with (my strong recommendation) inpatient continuous regional anesthsia - possibly with ketamine - might knock out the new stuff right away, but only if done ASAP. Basically, there's strong evidence that a whole new inflammatory reaction has kicked in, as opposed to more of the same old, same old CNS generated chronic CRPS. I know the inpatient option doesn't sound attractive in terms of taking care of the kids, etc., but I would beg you to discuss this with essentially every pain doc who has ever treated you and whom you respect.

In the meantime, one thing that's new is "potentiating" opioids with either Dextrapromorphone HBr (DM) or "low dose Naltrexone." While these are options that can be discussed with your doctors, and I agree with Hannah that some Neurontin can never hurt - put you to sleep maybe - DM has one amazing property: it is the most widely used active ingrediant in non-prescrption cough remedies, and at least in the U.S. there are a couple in which it is the ONLY active ingrediant. And the best part is, 120 mg./day is not only the maximim recommended dose in adults for coughs, but has been shown to be clinically effective in potentiating opioids! I would however start at a lower dose for the first day or so, just to make sure it doesn't work too well, as it could in rare circumstances with the right genetics. In any event, if Matt could pick something up where DM is the only active ingrediant, I would strongly suggest going for it. Then if it works, and it does for me in a new prescription format, you can mention at some point to your doc that "last week" you had a bad cold with a nasty cough, took something that you later realized was just DM and by the way can s/he prescribe it for you, where it really seemed to make the opioids more effective?

But having said this, recognize that whatever combination of meds relieves your pain won't take the RSD out of your hand and wrist, whereas, blocks and/or a continuous regional infusion - of given soon enough - just might. (Once more, my vote is on the infusion.)

Good luck! And know that more people than you can imagine carry you and yours in their hearts and thoughts. But what else is new?

Mike