Beta blockers, calcium channel blockers, sodium channel blockers, and RSD
 

Hi, everybody:

I have full body RSD. To control the various symptoms of this syndrome, I use Duragesic patches, MSIR capsules, Tambocor capsules, and Inderal tablets. The Keppra and Klonopin I take for my epilepsy might also help.

I know Inderal is a beta blocker. What I do not know is what the difference (for the control of RSD symptoms) is between beta blockers, calcium channel blockers, and sodium channel blockers.

I posted a question like this before but it seems like the person who had the answers got angry at me for some reason and did not reply to give me the information. We are all RSD sufferers, are we not? To get angry at me just because I posted a name with no evil intention at all, is exaggerated to me. As RSD sufferers, we are all in the same boat, so why not help each other instead of getting angry? If the NT guidelines do not allow the posting of names, I did not do it voluntarily; I have very, very bad memory problems caused by my RSD.

Dear Kitty,
My RSD is is both feet, ankles and lower legs and I have a great deal of trouble with cold, blue/purple feet and I have little to no tolerance for shoes and socks.
Recently my MD decided to fiddle with my BP meds(I'm not too fond of being fiddled with) and explained to me that the ones I was currently taking were all beta blockers, and that he was going to add a calcium channel blocker which relaxes the vessels so that more blood flow is possible than when the vessels are constricted. That obiviously was true after taking the first pill my feet went from purple/blue I've become so accustomed to, and turn fire engine red. Not exactly the trade off I was expecting. Honestly the blue was easier to deal with, and when i walked around the red got redder and more painful. Plus my head did not seem to be too keen on the relaxed vessels, so with the red feet came a show stopping headache and a BP of 76/48 and a pulse of 101-125. So he took me off of all my other BP meds(3) but I was weak, and energyless. So after 5 days he lower the dose of Procardia XL by 1/2 and added back my atenolol and clonidine(which is for BP and pain). Well my pulse went down, my BP up a bit, and the redness is less, but the headache is still here, a bit less debilitating, but my ankles are the size of my knees from swelling and my face is puffy and a few other things that are tipping the scale to the "more side effects that benefits" side.

I like having warmer feet without the pain of socks, but I can't enjoy it because of all the other crap. There is a procardia that is not extented release and i could cut them in half, but i don't know if he will just say it doesn't work and go back to what seemed to be working for me without all the side effects. I knew how to handle the blue/purple, the red neuron popping feet were a whole new learning curve. And I'm not a good headache person, never had many before RSD, and don't really need to have them everyday.

Do you take the Inderal for headaches? Now I don't really take a pill for my RSD except Zanaflex a muscle relaxer. I'm allergic or ultra sensitive to so much. I'm getting nerve blocks every 2-4 months and not walking or wearing socks or shoes. I have a wheel chair for long walks and a mobility cart to keep up with my grandkids at sporting events and some shopping. Winter is coming so I'm getting ready to hibernate. Not totally but I don't visit my g'kids, they come and 'babysit' me. I do some things, but I definitely count the cost first.

Rambling is my specialty if you hadn't noticed yet, so I will end by saying I don't know what a sodium blocker is. But my relationship is about to end with the calcium channel blockers. And I'm due for a nerve block soon, so I'm looking fwd to the wonderful period of almost total relief for a few weeks.

Have a great fall week. We had our first pot of chili this week, it must be fall. SSSOOO GOOD. I have set the bar high for the rest of the chili soup season. Next week is vegetable, I can't wait. I love soup season. The leaves are even beginning to change around here. Hope you find your answers.

Hi, gramE:

Thank you so much for your helpful information.

Are you taking your BP medications for BP problems or for the control of some of the symptoms your RSD causes (off-label use)?

Is your MD, the one that fiddled with your BP medications, a primary care physician, a cardiologist, or some other kind of specialist?

Did your MD decide to fiddle with your BP medications (all beta-blockers) to add a calcium channel blocker so that your vessels can be relaxed for better blood flow? Is that because your beta-blockers were not effective enough at relaxing your vessels or is that because your beta blockers are used only for high BP control?

Quote: "After taking the first pill my feet went from purple/blue I've become so accustomed to, and turn fire engine red."

My legs and arms are not purple, blue, or red. My left knee (where my RSD first started), then my left leg, was red, but only during the stage 1 of my RSD. After the red color disappeared, my left knee/leg became white and shiny. It does not feel like blood is running through my vessels, but liquid nitrogen instead. This causes my legs, arms, and sometimes the rest of my body to feel icy cold. This is why I asked my primary care doctor to prescribe a medication for this; he chose a beta-blocker (Inderal - propranolol). This was after my cardiologist had refused to help me. The beta-blocker I take (one 40 mg Inderal tablet twice daily) seems to help, but being in an air conditioned room (at about 22° Celsius) causes very bad RSD attacks.

You take two beta-blockers (atenolol and clonidine) while i take only one (propranolol). I did not know beta-blockers played a role against RSD pain.

Like you, I have horrible headaches. Mine are migraine headaches, which come with very bad tiredness, some fever, and some bad mood.

Quote: "My ankles are the size of my knees from swelling and my face is puffy and a few other things that are tipping the scale to the "more side effects that benefits" side." All these things are caused by your calcium channel blocker?

Quote: "I like having warmer feet without the pain of socks, but I can't enjoy it because of all the other crap." I also like to feel warm, but it is not always easy. Sometimes, I feel freezing cold and sometimes, I feel burning hot. This can happen from one minute to the next.

I do not use Inderal for my headaches, even though they do seem to decrease their frequency. I prefer Relpax (eletriptan) to control my migraine headaches.

I never heard about Zanaflex. I will do some research on it on the Internet. My main pain medications are Duragesic, MSIR, and Tambocor.

Maybe nerve blocks work on you because your RSD is not full body. I asked a pain management doctor and an anesthesiologist for lumbar sympathetic nerve blochs when my RSD was still in my left knee/leg only, but for some reason they refused to give me, they would not give me these blocks. Is it because of the public health insurance company? Possible.

You have a nice and loving family. This is wonderful, so you do not feel so lonely and you can get some support from them, if needed.

I love chili soup and chili con carne. However, my RSD gives me a very poor appetite, even with foods I usually enjoy.

I thank you again for taking the time to answer me and give me information about your experience with RSD, beta blockers, and calcium channnel blockers... Oh, I miss the U.S. so bad. To me, it is the most wonderful country in the world. I must admit I envy all the people living there.

Dear Kitty -

Please forgive me. I just saw this. Please know that I was never angry with you, nor would I have cause to be. And I simply don't have the answers to the numerous questions you posed.

Understand that my only "scientific" training was a BS in economics over 30 years ago. That and my training as a lawyer made me comfortable with online data searches.

As it was, I worked all evening and well into the night, trying to respond to your post. First, I searched Google for all of the FDA approved Prescibing Information sheets for all of the drugs you mentioned, and then pulled as many of the articles referenced in each from PubMed, and then, really armed only with my own disasterous experience with EXTREME edema following the administration of Norvasc, a calcium channel blocker, started writing.

Unfortunately, I didn't back it up as a Word file as I went, so when my browser crashed at 5 am with all of the open PDF files in tabs, the document was lost. No problem I thought, I would just get some sleep and redo it off of my open tabs. Unfortunately, in the meantime Microsoft purshed through an upgrage of the OS, wiping out my ability to use the "Restore Last Session" function in Firefox, leaving me with only hundreds if not thousands of pages in my history over the last week.

Please understand something else; I too have seen a tremendous loss in my memory and organizational skills in the 10 years I have had CRPS, as measured by repeated psychological and neuro-psyche testing. That and I've also been going through some unusually difficult personal problems over the last month or so, on account of which - by depression or distraction - I no longer had the energy to respond to PMs from too many good friends, some of very long standing, to all of whom I owe apologies.

So when I lost even the documents with which to attempt to respond to your post, I just gave up. I'm sorry, at the least I owed you a PM, but truth is, I wouldn't have known where to start.

Mike

I have to wonder about using Inderal when your symptoms include feeling "cold" ...

Beta blockers typically CAUSE cold extremities. This is a common side effect. Inderal being a non-selective type does this most. Think back to when you were not taking it, were you having this cold, ice type feelings then? Some of the studies show females react this way more than males, but that is not often mentioned in the literature. You should discuss this with your doctor. If you both decide to try without it, I suggest you taper carefully off. Sudden discontinuance of beta blockers is not recommended.
You can search the drug yourself and find more information on Google.
example:
http://www.ncbi.nlm.nih.gov/pubmed/6136158

Calcium channel blockers do help with RSD however, by improving blood flow. Some studies show when started very early in RSD cases, there may even be remission.

Clonidine BTW is not a beta blocker.

The problem with calcium channel blockers is that they work by relaxing vascular tone (and are primarily marketed for high blood preessure) is that they will by definition excascerbate edema caused by neurogenic vasodilation.

PLEASE check the PI sheets for edema as a side-effect/complication on any other drugs under consideration, especially if you already have any problems in that area. Txs.

Boy do you have that one right! And before the procardia I thought I didn't have enough skin, ha, my feet and ankles looked like water balloons ready to burst. Too many 'extra' side effects for me!

Even after they 1/2 the dose. But both were extended release. I'm hoping there is a regular dose I can adjust myself. There must be a happy medium between 70 degree feet and 95 degree feet. I prefer neither of those. But I can moderate the 70 better than the 95.

But they also relax the vessels in your brain, and that was a real headache! Literally and figuratively.

God's mercy and blessings to all
pat