CRPS nerve blocks
 

Hi, I am brand new here and looking for some much needed information from people who have/had nerve blocks.

Brief summary: Bilateral carpal tunnel (started in 2006), bilateral basal joint replacements, bilateral thumb IP fusions, Left MCP fusion, left tendonitis, right trigger thumb. These are all surgeries I have had since 2007, last one in July 2010. (worker's comp case). Each surgery amazingly helped the problems, yet after the last one, I noticed this burning sensation in both hands. I thought, this is new and scary. Surgical sight was healing a lot slower than prior surgeries. Doctor (hand surgeon) tried managing it for about 3 months and has since referred me to pain management.

First PM visit 2 weeks ago: put on lyrica (which caused my eyes to blur) and lidoderm patches (which caused my whole body to itch uncontrollably). Doctor wants to do nerve blocks. I am less than thrilled about it as I am afraid of needles and have never had success with cortisone shots. Of course I looked procedure up on computer to find that doctor goes in through front of neck/throat!! YIKES....anybody have these done?(for hands/arms) I would appreciate any information!

Thank you!

Well, I've had three, but not in my neck. And I've gotten relief from all, different amts and different lengths. I do think they have helped me integrate the pain into my daily plan, push through, learn how much is too much and what is not enough. But they have also shown me how important SLEEP, GOOD SLEEP is.

I've had the ones in the neck before, i didn't get relief but they figured out it wasn't nerves causing my problem.

Get a second or third opinion.
pat e

Had 1 block worked good for about 4-5 days far as pain relief,but I was allergic or caught a virus ( Doc. said that) I lived on toilet for 2 days went to hospital for ct scan came bk normal lived on toilet another 1 day. My PM Dr. wanted another block " DON'T TK So ". Mine was CRPS in leg but they do sort of wake you up to test the pain no big deal but I did remember it well.

I too have had 3 nerve blocks. I know the procedure itself sounds horrifying but the procedure itself isnt bad. Prior to the block the dr administers meds into an iv that includes a relaxing agent and pain medicine to enable the process to be as comfterble as possible. The procedure is a standard in treating CRPS but with that being said and if you deciede to go for it, make sure your dr is well qualified to do the treatment. If you are only interested in non-invasive treatments than i would reccomend declining the blocks and ask him to refer you to a center that offers non-invasive treatments such as ketamine. At the end of the day it's your body and you have final say as to what you will allow to happen to it as far as the treatments go. Good luck and keep me posted as to what you deciede.
Sarah

Hi
I have not had one in the neck but have had it in the spine. I would tell your doctor your fears. They usually give you something to relax and so you don't remember.

Yep, had that one. I was sedated the entire time the procedure was being done and don't remember feeling anything. I did have some pain relief in my left arm, wrist but I did have a rare side effect. After that , since I was so nervous about it, the doctor did not make me have any more that went in through the front of the neck. I had two that went in the back of the neck with minimal relief, but no side effects. It is a good way to see if your RSD is receptive to treatments other than drug therapy. Talk to your doc and the anethesist (sp) about your needle phobia and they will help you out. I have a real problem with being physically restrained and let them know this and the put me out before they restrain me. Lisa

What treatment method was used after the blocks were stopped? Do you take medication as well? i am interested in hearing about what kinds of medications and treatments are used when blocks are not working/helping!! thnx.

When nerve blocks stopped working for me and my RSD had spread far beyond the site of original injury, I started receiving lidocaine infusions. They were administered approx 3 weeks part, 300 mg at a time (mixed in a full bag of saline solution), and took a few hours to run.

They helped with the terrible burn, over time I definitely noticed a slight improvement. I had a total of 8 infusions. there were a few days that I even felt almost normal.

10 months after I started lidocaine, I started low dose ketamine infusions. Ketamine works well me. It has been 11 months for me since I started my infusions and I have received 36 (I started with the 10 day protocol set forth by Dr. S at Drexel.). Overall, I am 80% better than I was. 2 months after starting the infusions I was able to return to my FT job.

Lidocaine was readily approved by my insurance company after the other treatments had failed and because my RSD had spread and was deemed to be full body. My PM doc also offered the infusions in his clinic. Ketamine is harder to obtain because there are far fewer providers. And getting insurance to cover it requires a lot of perseverance, and even then you may not prevail.

Let me know if you have any questions... and good luck. sandy

Have had four of these blocks so far...
 

Sonny,
Just last week I had the fourth of eight of the nerve blocks that I believe you are referring to (stellate ganglion blocks) done for CRPS of my right arm. Because of where they insert the needle they are scary and in my experience I have had to be conscious for the procedures so that I can let them know if I am experiencing any side effects (they ask about tingling of the lips, metallic taste in the mouth, and ringing in the ears). I have had none of these effects. The procedure is done under x-ray guidance and I am lucky enough to have a great doc that I trust a great deal. My doctor does give me a mild sedative IV to make it easier on me (I assume that this is standard practice). An anesthetic is injected at the site and then the block is performed. If at any time I feel discomfort I signal the doc and he administers more of the anesthetic. The procedure itself does not take very long (maybe 15 to 20 minutes, including set up of the x-ray equipment, etc.) After the procedure you can expect temporary closure of the eye on the side or sides that the block is performed on, as well as sinus congestion. Your throat will be sore and you will be told to not eat or drink anything for two hours post injection and after that you can start with clear fluids until you feel that you are able to work your way up to solids. In my experience this is usually within just a few hours after the initial two hour waiting period (don't get me wrong...I'm not usually up for digging into any really crusty or hard foods with "sharp" edges). I tend to experience some neck stiffness and tenderness the day of the injection and the following day as well, but this could just be me. I was diagnosed with CRPS in October of last year and got into a pain management specialist at a large medical center two hours from home in January of this year and the blocks began in February. My pain has decreased, but is still bad enough to be disruptive to my daily living. In my opinion the blocks, although scary, have been worth it. Even though I still have pain, I would no longer rate it a 10 every day, as I would have prior to the blocks. I still have to use multiple oral pain meds and topical lidocaine patches daily. My doc's hope is that by the eighth block we will have disrupted the pain cycle, but I know that there is no guarantee. I know that I have written a great deal here (and please keep in mind that this information is all just from my personal experience, as I don't know anyone else who has had these) and I apologize if I have given you too much information. However, if you have any questions that you think I might be able to help with, don't hesitate to let me know. I hope that I have been of some help to you and I wish you the best on your path! :winky:

Thank you so much!! yes, these are the injections my PM doctor and I will be discussing on Tuesday. The lidoderm/Lidocaine patches have not helped in addition to making my whole body itch! I tried Lyrica, but it made my vision very blurred. I am on Cymbalta 120 mg a day, but find no change in pain with this either. I do not take narcotics for fear of addiction, BUT, I am reconsidering. I am very fearful of needles, especially in this instance, but at this point I think I would be willing to try it. I know I must sound like a nut case for fear of this and that, believe it or not, I have always been a strong person, but with time and pain, it is slowly withering down. I know I cannot conquer this alone, so I am ready to try new things and hopefully someday find some positive results. I know it will never go away, but any relief would probably feel 100% better.

How far apart are your injections? you said you just had your 4th of 8. My PM doctor is an anesthesiologist so I would hope she is good at this. If you don't mind me asking, how did you come to need these for your right arm? My CRPS is I am guessing from 10 bilateral hand/thumb surgeries. So yea, fix the pain only to end up with new pain! I think the hardest for me now is adjusting to life with this and also my limitations with my hands. My thumbs are fused, so they do not bend and that makes it hard to tie shoes, button pants, zipper etc. I am thankful that at least I am painfully functional as opposed to others who have it worse.

Thanks for your great info, that is just what i needed, a personal play by play!!

more info as requested
 

Sonny--Well technically my injections are supposed to be one week apart, but because I am only comfortable with my PM performing them they are sometimes as much as two weeks apart because of his schedule. As for how I developed CRPS, it's not a very fascinating story...went to the ER for treatment of an abscess on my leg and after treating that they decided to give me a tetanus shot. They administered the tetanus shot in my bicep and not the deltoid (which is where it is meant to be given) and they damaged a nerve. I ignored the swelling and the pain for months and by that time all of the nerves in my brachial plexus were involved. I have very little strength in my fingers and the arm itself. I am in physical therapy now (since October) (first to prevent muscle atrophy and regain range of motion; we are now going to be moving on to strength training hopefully, as I am right handed and this has caused a great deal of trouble with the things you mentioned like zipping coats, tying shoes, etc.) I also saw from a past post of yours that you experience coldness in your hands. I have that too, it is because the autonomic nerve is not telling your blood vessels to send blood to the area when it needs to. Sometimes my hand is freezing and purple/blue/almost black and other times it is bright red and very warm. I wear a glove everyday unless I am at home because even what other people think are comfortable temps (in the office for example) are too cold for my arm and hand. The injections also help restore the circulation. The relief is short term, especially in the beginning, but the reason that they give they shots (how many will be recommended for you I can't say) in the succession that they are giving them to me is that I am told that the length of relief from pain and circulatory problems gets longer and longer after each block. I have had to go from working full time to only four hours a day because I cannot take my pain meds and drive or work (not a very happy boss is mine). I do take a narcotic pain med along with Cymbalta, Neurontin, Lidoderm (and yes I take benadryl to try to control some of the itching), and several others. Certainly the choice of taking narcotics is yours and yours alone, but I find that at least they help me sleep for two hours or so at a time (as opposed to being up all night with the pain). You do not sound at all like a nut case! This is a very scary thing. The diagnosis is bad enough (Lord knows that because no one can "see" anything wrong with you they all think you're imaging it (at least in my case I see that a lot) and I was dumbstruck when they told me that they would be going in through my throat. To be honest, I am still scared every time that I go, but my doc told me that it is my best shot at getting my arm back. I am 42 years old and would one day like to be able to hold any grandchildren that I may have (among other things, you know, like being able to cut my own meat at dinner LOL), so I sucked it up and made the commitment to see it through. It's not a walk in the park, but it is probably not as bad as you are imaging it (I know I lay in bed at night before the first procedure and didn't sleep a wink just thinking about it). Talk to your doc, if you like her and are comfortable with her make sure that you tell her everything that you are worried about. Any dr. worth their salt should be willing to take the time to explain everything to you that you want to know and hopefully allay most of your fears. Again, if you have any other questions you can just keep responding on this thread or you can private message me. It is actually making me feel a little good being able to help someone else, because yes, even though there are plenty of people that have it worse than we do, it is still hard and there are times when I think we all feel that we've just had it! Chronic pain is not something that anyone should have to deal with. Pardon my language, but it just plain sucks! :hug:

Yes, I've had 13 now over 3 years and 2 suprascapular nerve blocks, lately. I would have gone postal without them!