Thank you so much for the research information. My doctors and I discussed the risks a month ago and he did not mention the majority of those risks. In fact, he compared it to the nerve blocks that we have done and said that the risks were almost identical.
I know he has performed many of these and all his patients were able to walk away but that was my main concern..Mobility. It hurts a lot for me to move around but at least I can still do it..and the doctor said that my mobility would not be affected. Per the research you provided I now know different and this does not make me happy.
At this point, I will keep my procedure booked but now I have several different questions on my mind and those questions will have to be answered that morning prior to the procedure. If the answers I get don’t calm my ever increasing concerns than I won’t do the procedure. However, most likely I will try it because I'm desperate for just the littlest amount of

Please know that we all wish you ease with your decision, however this turns out. Please recognize, however, that there is something of a disconnect between sentences 2 and 3, above.

Information alone can't comfort your concerns as a whole, it can only respond to the specific questions you put it to. More importantly, desperation is never a reason for rolling the dice, unless the option won't be around a month from know, should you decide to think it over. (And if that was in fact the case, I would think that someone was trying to pressure me.)

Were I in your shoes, I would bring (A) a printout of Dr. Manchikanti's article, including his list of "Complications of Radiofrequency," along with (B) a tape recorder with a 120 minute tape or similar recording device [in many states, it's your legal right, otherwise, explain that you want to ask about a number of things you have come across that were posted on the official RSDSA (Reflex Sympathetic Dystrophy Association of America) website, with which you are unfamiliar, and the tape is a more effective way of you attempting to retain information than simply taking notes] and (C) a close friend or family member for moral support as well as driving you home when it's over. Once the tape is running, I would:

1. Ask your doctor if he believes the list fairly summarizes the possible complications of your procedure, keeping in mind that lower body procedures appear to be trickier than those for the upper body;

2. Ask him what risks on the list can be ruled out in light of the procedure he's planning; and

3. As to each of the remaining risks, ask him. in a completely nonconfrontational tone, to explain the risk in terms you can understand, the approximate likelihood of the risk, and whether he has ever come across that particular complication, and if so, how many times, how did things end up, etc.;

4. Finally, I would ask him to estimate not only the length of time for which you could realistically expect relief, but whether, at the end of that time period, you would be likely be a good candidate to repeat the procedure with similar results, or whether there would be any expectation of declining results with subsequent procedures.

I suspect that with that information in hand, you'll be remarkably calm and confident in your decision, whatever it is. Good luck and remember we're always here if you need us.

Mike

PS I leave to your sole and complete discretion perhaps the most interesting question, which is why he had not previously disclosed these risks to you.

Hello everyone,

After a discussion with my doctor yesterday morning I went through with the R.F. injection. The procedure itself was horrific and extremely painful (cried through the whole thing and for about an hour after) and today I find myself in extreme discomfort. My back feels like I was beat with a baseball bat and my nerves in my legs are extremely irritated. I will not know the results until 4-6 weeks from the procedure and statistically (and since I'm an accountant I love my numbers) there is 20% chance of this working. The 20% may sound discouraging but that’s a 1 out of 5 patients have relief and I'm hoping I'm that I fall in the 20%. I have been fighting this for a couple years so I'm not naive but I am still hopeful.
Per other discussions with my doctor yesterday, there are other options but they are all extremely invasive so I don’t think I will be taking that path. For me, it’s either this works and I can cut down on my medicine or it doesn’t work and I will be stuck with my medicine for a long time. I will keep everyone posted as to any progress or lack of progress. I hope everyone is doing well.

Sarah

Dear Sarah -

So very sorry you had such a miserable time yesterday.

I am, however, equally troubled by your doctor's suggestions that the only other techniques are "more invasive." This sounds 15 - 20 years out of date, where there exciting research is being done with medications.

If and when you have the energy, I would urge you to read "Outpatient intravenous ketamine for the treatment of complex regional pain syndrome: A double-blind placebo controlled study," Schwartzman RJ, Alexander GM, Grothusen JR, Paylor T, Reichenberger E, Perreault M, Pain 2009 (in press), FREE FULL TEXT at http://www.rsds.org/2/library/articl..._Pain2009.pdf:

ABSTRACT
Complex regional pain syndrome (CRPS) is a severe chronic pain condition that most often develops following trauma. The pathophysiology of CRPS is not known but both clinical and experimental evidence demonstrate the important of the NMDA receptor and glial activation in its induction and maintenance. Ketamine is the most potent clinically available safe NMDA antagonist that has a well established role in the treatment of acute and chronic pain. This randomized double-blind placebo controlled trial was designed to evaluate the effectiveness of intravenous ketamine in the treatment of CRPS. Before treatment, after informed consent was obtained, each subject was randomized into a ketamine or a placebo infusion group. Study subjects were evaluated for at least 2 weeks prior to treatment and for 3 months following treatment. All subjects were infused intravenously with normal saline with or without ketamine for 4 h (25 ml/h) daily for 10 days. The maximum ketamine infusion rate was 0.35 mg/kg/h, not to exceed 25 mg/h over a 4 h period. Subjects in both the ketamine and placebo groups were administered clonidine and versed. This study showed that intravenous ketamine administered in an outpatient setting resulted in statistically significant (p < 0.05) reductions in many pain parameters. It also showed that subjects in our placebo group demonstrated no treatment effect in any parameter. The results of this study warrant a larger randomized placebo controlled trial using higher doses of ketamine and a longer follow-up period.

(c) 2009 International Association for the Study of Pain. Published by Elsevier B.V. All rights reserved.

What's so significant about these results, as you can see reading the study, the study, is that no effort was made to limit the study participants to individuals who had been symptomatic for six months or less at the time of treatment: a group that is far more likely to benefit from any number of therapies than are those who have had this condition longer. And the out-patient treatment used by Dr. Schwartzman in this study is being implemented at a number of centers around the country. (I just can't have it because of pre-existing glaucoma.)

And on a different but also promising tract, please read "An Effective Treatment of Severe Complex Regional Pain Syndrome Type 1 in a Child Using High Doses of Intrathecal Ziconotide (Letter to the Editor)," Stanton-Hicks MD, Kapural L, J Pain Symptom Management 2006;6:509-510, FREE FULL TEXT (and a couple of amazing photos) at http://www.rsds.org/2/library/articl...32_6_pg509.pdf, which was followed more recently by "Intrathecal ziconotide for complex regional pain syndrome: seven case reports," Kapural L, Lokey K, Leong MS, Fiekowsky S, Stanton-Hicks M, Sapienza-Crawford AJ, Webster LR, Pain Practioner 2009 Jul-Aug;9(4):296-303:

ABSTRACT
Ziconotide is a nonopioid analgesic currently indicated as monotherapy, but frequently used in combination with opioids, for the management of severe chronic pain in patients for whom intrathecal (IT) therapy is warranted and who are intolerant of, or whose pain is, refractory to other treatments. There is a paucity of information regarding ziconotide use in patients with complex regional pain syndrome (CRPS). Seven cases in which IT ziconotide was used in patients with CRPS were analyzed. All patients (4 male, 3 female; age range, 14 to 52 years) had experienced inadequate pain relief with multiple conventional and interventional treatments. Three patients received ziconotide monotherapy exclusively; 4 patients received ziconotide monotherapy initially, then combination IT therapy. The mean ziconotide dose was 5.2 mcg/d (range, 0.5 to 13 mcg/d) at initiation and 24.7 mcg/d (range, 0.06 to 146 mcg/d) at the last available assessment. The mean duration of ziconotide therapy was 3.1 years (range, 26 days to 8 years). At ziconotide initiation, the mean visual analog scale (VAS) score was 89.3 mm (range, 75 to 100 mm); VAS scores decreased by a mean of 47.5% (range, 5% to 100%) at last assessment. Of the 5 patients who experienced substantial improvement in pain, edema, skin abnormalities, and/or mobility with ziconotide therapy, 2 have discontinued ziconotide and are pain free. Another patient experienced marked reversal of both edema and advanced skin trophic changes. Adverse events included urinary retention, depression, anxiety, and hallucinations. Adverse events generally resolved spontaneously, with treatment, or with ziconotide discontinuation/dose reduction. Although further studies are required, ziconotide holds promise as an effective treatment for CRPS.

PMID: 19500276 [PubMed - indexed for MEDLINE]

http://www.ncbi.nlm.nih.gov/pubmed/1...ubmed_RVDocSum

And note that the reported success rates in the foregoing studies were considerably better than the 1:5 you were quoted.

I apologize for laying all this on you. I just want you to know that there are kinder/gentler options out therebefore you return to your local butcher: even if he's on the faculty of a very good medical school, he's living in the past. So what I am suggesting is that before seeking further treatments from the same fellow, you seek another opinion. Since you live in Illinois, I would suggest the Cleveland Clinic, and specifically Michael Stanton-Hicks, M.D. Where he is now on senior status, I have been told by his department that he only sees patients with established cases of CRPS and then will do so only after first reviewing their medical records. Here's his directory page at the Cleveland Clinic http://my.clevelandclinic.org/staff_...taff_1175.aspx I believe the number for reaching his secretary is (216) 444-7246.

Finally, here's his departmental homepage http://my.clevelandclinic.org/anesth...t/default.aspx

And once again, I am so sorry for what you are going through.

Mike

Its bad enough to have ADD, DEPRESSION, and PANIC / ANXIETY disorders which are being treated with Class II medications, but with Chronic Transient Pain added to this noxious brew I should be on SSD. Since July 19 of last year I've been getting various treatments at a Pain Management facility here in Phoenix, AZ. Pain meds, epidurals to the neck, and now this Frankenstein RF. I thought it was just me, but after reading these posts I am obviously NOT ALONE in the relentless daily pain post-RF. Over a month and still in pain. Saw my PM doc the other day (cancelled next RF to discuss this horrible treatment) and he's used to seeing me smiling and maybe talking too much to the staff. That's all my meds, previous six needle epidurals, my daily laps in the pool and stretching talking. Then it all went to hell in a garbage bag with RF. Pain meds not as effective: he did not increase them, I did not request. Thought I made it clear I wanted previous injections. Left with refills and new appointment for next RF???? Too late, discuss at that appointment. If he insists, I want increased pain meds. Missed gigs (am a musician), interviews for jobs, church. I'm 50 (some might need to know but I don't even look it, not even close) and 20 years on opiates. They work so I'm all for 'em, but I refuse to deal with pain above and beyond my normal level. F!*?! RF.

MegaPain,

Here's a more recent thread on RF:http://neurotalk.psychcentral.com/thread156450.html

Time to at least consider firing your doc!