[AintSoBad]

Hello Friends!

My question about blocks has a little background.
Dr S., dx'd me in about '90, injury= '83. He hospitalized me and put me through a barrage of tests. (I was the RSD/TOS patient on the floor, that twice a day, he came in with his troop of students, and I did the "TOS TEST" for them all. Hands up, shoulders back. Hands turn white and no pulse.)

I had a "block" that was diagnostic. It made the right side of my face numb, and I think my arm was too.
But, the pain was still there. Dam, said the Dr.! I knew it. It's too late. Dam, said the patient!

I was also sent for lumbar blocks.
They had the same outcome, except, I don't remember any numbness, so I think they were more for pain.

They just didn't work, and Dr S told me not to get any more, for fear of aggravating the rsd.

Now, I notice that lots of you get blocks, regularly.
Some of you like them, some of you don't.
Why?

And, another question, I don't quite get the difference, between type I /II RSD.
I've read it, but it's not sinking in, but does this have something to do with why blocks help some, and not others? (the real question). I know I've gone from Sympathetically maintained to, S. independent... is that it?

Thanks.

I want to express my concern for everyone in the NE, and elsewhere, who are suffering with this weather. Keep tight, say your prayers, and always know, that someone, many, have it Far Worse elsewhere!
We're lucky to be Americans!
(and if you think health care is expensive now, wait 'til it's free!) just a joke...for a lousy friday afternoon....
TGIF!

pete
asb

[GalenaFaolan]

The difference between type 1 and type 2 is actual nerve damage. Type 1 is no nerve damage and type 2 is nerve damage. Typically those with type 2 will have an EMG done and it'll show that there is nerve damage in the limb that was injured. :-)

Yup, you got the terminology right. You go from SMP to SIP, maintained to Independent.

As for blocks, I was forced by WC to get one a year and 3 months after I was hurt. My pain was already independent by then and had been for quite some time! All it succeed in doing was throwing me into a flare for 2 months with a pain level that hovered around 15-20 every single day. I couldn't lay down, sit down, stand up, walk, etc. LOL I was so glad when it finally went back to "normal."

Hugs,

Karen

[bobber]

Hi Pete
I'm rsd II[causalgia} as Galen said,,I have a nerve entrapment in the back of my r-heel,,The dr's can try to free it up with surery,,but its a low percentage for success,,Thats why they dont elect to do it,,It can make it worse in most cases,,,Ive got to be carefull not to stretch the nerve by dorsa flexing the ankle,,,either way as rsdI and rsd II exercise is our friend,,Rememeber one of my old posts pete? the one you replied to, where the TENS unit made my rsd flare? I wasnt useing it cranked up,,the trapped nerve was being aggravated by it,,,,and the dr;s waited to long to give me the blocks,,,nthen when they did,,,the shots sent me in a flare,,,,because im in SIP,,Plus it's more likely that id be a bad canadate for SCS, for the same reason,,,,,I can find a dr willing to do the surgery to free up the nerve,,If i really wanted to throw the dice and gamble,,but as for right now,,I realy on God to heal me,,He is doing his part,,and im exercising and trying to be faithfull,to do my part,,,,[psalms 41:1-4},, call me sometime pete,,,Id love to hear from you,,,your friend in Christ Jesus our lord and Savior ,,,,,,,,, boyd

[Sandel]

Hi Pete
I was given lumbar sympathetic blocks when I was 9 month along, it diagnosed my RSD (again) and helped with some of the pain, some areas of my thigh were usualy numb I found. I was given propofol by IV, a white milky substance to put me to sleep before each block, so it was a nice nap. (yes micheal jacksons sleep med)

They continued with the blocks untill after they no longer helped me at all..
I do feel they helped take the awful thermal freeze out of my foot when it was getting nothing but colder, and I apreciate my doctor later doing bilateral blocks when WCB only wanted to pay for my right leg. We probibly continued them too long, I just wanted them to work so bad.

I also think it should be mentioned that I feel the blocks caused some of the spread to my torso area, particularly my kidney area and up the back, that area still burns since a very specific block procedure. Not that I wasn't in spread mode anyway.. sigh who knows part of me thinks we should all just stop ALL invasive procedures.. A large part.. but I feel like I'd be giving up hope because of my treatments now.. but they too are very invasive.. Sory Pete I am rambling.

There are all kinds of blocks, this is why you have been hearing alot of diffrent things on them.
Not just sympathetic blocks to be given before the RSD pain becomes more centralized.. but prior to this while in the ACUTE stage of RSD, pain is usualy sympatheticly mediated meaning it is delivered through the disfunctional sympathetic nervous system (so they block that nerve see)

my pain was never totaly taken away by sympathetic blocks so it wasn't totaly sympatheticly maintained as they say, I am SIP too, also I was being helped to a minor degree by the sympathetic blocks after one year so I have both centraly or sympatheticly independant pain(SIP) and sympatheticly mediated pain (SMP), or did at @ one year post RSD.

I am in only in my 5th year with RSD and I have it full body including some organs.. I can honestly say it isn't worse than it was when my RSD was in it's ACUTE stage.. as far as mind blowing agony goes anyway. Blocks took that pain down from a 9-10 to a seven that winter and lidocaine and my medicinal herb help too make my life alot more manageable.. find what works for you.. nothing works well for all of us it seems.. and agin I ramble,
hugs pete,
sandra

[Mslday]

That is a good question Pete, something I was never too clear on either. Here is what I found, it is from the most up to date Medifocus Guidebook on Reflex Sympathetic Dystrophy.

Sympathetically-Maintained Pain
The sympathetic nervous system (SNS) regulates involuntary responses to stress such as increased heart rate and constriction of peripheral blood vessels as well as some of the body's initial response to any injury. Research indicates that the sympathetic nervous system also plays a role in
neuropathic and inflammatory pain. In patients with RSD, there may be evidence of more widespread impairment of sympathetic nervous system function which is not necessarily limited to the affected extremity.

Until recently, it was thought that RSD was characterized by sympathetically-maintained pain where the SNS basically overreacted to an injury. Typically, after an injury occurs, the sympathetic nervous system is activated. It mobilizes the body's inflammatory response with the release of certain substances in order begin the process of healing the wound. The sympathetic
response typically decreases within minutes or hours after the initial injury. When the inflammatory response continues unchecked, even when the stimulus is no longer present, the pain becomes sympathetically driven and the condition known as RSD develops. When treatment is directed towards interrupting the sympathetically-maintained pain, the patient experiences relief from pain.

Sympathetically-Independent Pain
With sympathetically-independent pain, the pain is caused by a combination of factors that interact with the SNS, such as the peripheral and central nervous systems. Treatments directed towards the SNS do not bring relief to people experiencing this type of pain. Reflex sympathetic dystrophy appears to be a combination of both the sympathetic nervous system as well as other systems such as peripheral, central, immune, and vascular. In effect, what may be happening with RSD is that a vicious cycle is created: the sympathetic response leads to chemical changes which then activate the response of other systems (e.g., central nervous system) which
leads to more pain, which leads to more chemical changes, and so on.
Some of the evidence that points away from RSD being exclusively related to the sympatheticnervous system includes:
• While some symptoms of RSD can be traced to the sympathetic nervous system, such as pain, or changes in sweating of the affected limb, other symptoms, such as warming of the limb, or swelling, are caused by substances released from other sources such as damaged blood vessels and not the sympathetic nervous system.
• Sympathectomy, a procedure which interrupts the flow of the sympathetic nervous system, is effective for individual patients, however larger clinical studies have shown the procedure to be no more effective than a placebo.
• The symptoms of RSD do not include those typically seen by an overactive sympathetic nervous system, such as an overactive thyroid and increased heart rate or by an underactive sympathetic nervous system, such as decreased sweating, orthostatic hypertension (drop in blood pressure when changing positions), or ejaculation problems.

In short, it appears that the pain of RSD is not related to an overactive sympathetic nervous system, but rather, reflects a more global involvement including:
• Peripheral nervous system
• Sympathetic nervous system
• Central nervous system
• Vascular system
• Immune system
• Inflammatory responses

MsL

[love2laugh]

I have RSD/CRPS that started in my legs and pelvis , and has since gone "full body" .....

One of my first pain management drs wanted to try a lumbar spinal block for one of my legs and I agreed. However, I only got about 10- 20 % relief, that lasted maybe two weeks--- and I had side effects from it.

I have since switched pain management drs and my current one does not believe any more blocks would be beneficial to me. Because the RSD/CRPS is SIP and what little relief I got from the block, was/is not worth to try again. He thoughts on the LSB's are that they look cool (as in the patients limb change color, etc), but if you don't dramatically improve after one or two, then I don't like them....

Having said that, if your RSD/CRPS is fairly isolated or more severe in one are then another, then blocks can be wonderful. I am glad I tried it though, even though I won't be having any more....

L2L

[olecyn]

MSLDAY ~ I am so happy you quoted this....
Now if my brain could digest & methodically understand & speak it.

My pain management doc doesnt want me to have any more TOS surgeries due to the CRPS but how long can my system hold out to Botox Chemodenerviation procedures 4 x's a year for the TOS pain & not increase the CRPS.

I have pretty much full body CRPS 10+ years now including it now affecting my stomach. I read here so many people say it has affected their organs. I can so relate. Its so incredibly frustrating that CRPS cannot be used for my SSDI doc & W/C defense. FM & RSD is not spoken in court & result in approvals these days in California.

Originally Posted by Mslday

That is a good question Pete, something I was never too clear on either. Here is what I found, it is from the most up to date Medifocus Guidebook on Reflex Sympathetic Dystrophy.



MsL

[CZZ74]

After I was dx, a year and a half after I developed rsd, my treatment began with LSB, I had 23 of them. the first was of course diagnostic. This one was the best one. The relief I felt was great, immediate warmth to my freezing leg and I was within 15 mins after the procedure able to go up and down stairs- something i had not been able to do for some time. After that I had the following 22 trying to recapture that success. And we did in varying degrees. But it never lasted over lets say 24 hours. Atsome point during this time, the rsd spread to my left leg.

After many mri of every part of my spine except my thoracic, and finding nothing, I finally asked for one of my thoracic due to severe flares, lesions and spasms in that area and my ribs.
Dr. S had said for some time that a conditon in my spine was continually"setting off" my horrible flares daily. How he always knew there were problems there without an mri is just to his credit. As when the mri came back there were many many problems.

So all of that was to share this - since the tradional rsd blocks had failed years before and since I was full body my pain management doctor decided to do a series of epidurals -15 to be exact- in the thoracic area. The relief was unbeliveable. It took several as every T disc i have is herniated but it did stop that area of my body from the horrible spine burning, bone burning and lesions on my back and ribs.

Although they only last three months I am anxiously awaiting the next round. You have to have a long break in-between .

Sadly the rsd just moved its intensity to other areas of my body. However, the spine pain is so dibilatating that this has made a significant difference.

I also should mention that after each epidural I did have a horrible 3-4 day full body flare from the I V and the catheter . But it has still been worth it.

Again these were not rsd nerve blocks - these were epidurals anyone with disc problems would get. I think our disease is so dibilatating that sometimes we forget to treat our "normal" problems and in doing so it can help abate our opportunistic rsd. cz

[AintSoBad]

Ya'll nailed it here!

Opportunistic RSD!

It seems to me after 26 years, that anything that's wrong in your body, from a bad meal, to a flu or cold, a toothache, or a disbelieving family member; will "set off" the RSD's Trigger. And, it's a Hair Trigger!

How many days I've just sat or layed down, when I was working, before the tbi in '98, I usually layed down for an hour, maybe just a half, around 3-4 in the afternoon.
And, of course, took some meds. But, ,this was planned!
It was working for me.
No more.

For the past Eleven years, nothing works.
Now, it'll (the rsd) just come and take me.
I ride in someone's car, and since mine is gone (wife wrecked it), and, I think she had the other stolen, these cars have (so wonderfully) different temperature controls for each side. and, I ALWAYS want it different than the driver! Makes them crazy. (but, I do have my own control)..
Anyways, I just called an attorney, he's of course, on the phone. Wanna take bets on if he'll call me back? haha!

Between the TBI, and the RSD/TOS, discs, apnea, etc. I feel as though I'm losing the battle. But this is compounded by my ineffective attorneys.

It seems, as always I hafto be the plow, that pushes them along.
But that's just not my way.....
See, I've always believed that,
"It's easier to pull a spaghetti, than to push one"!

pete

[hopeful]

Thanks for the info. I have an appt on Monday to talk with the doctor about a nerve block. At least I'll know what he is talking about. I am scared of the nerve block but I need something to give me relief with my feet especially with winter coming.
Hopeful

Originally Posted by Mslday

That is a good question Pete, something I was never too clear on either. Here is what I found, it is from the most up to date Medifocus Guidebook on Reflex Sympathetic Dystrophy.



MsL