Hiya,

My right hip has been subluxed for the last week/ two weeks or so and locked in spasm at about 140 degrees. Since then my knee has gone into spasm and is locked in a 30 degree upwards hyperextension (so my knee is bending backwards). The stupid leg is also shaking all the time and gone black with reddish patches from foot to thigh which is incredibly painful and at the moment I'd happily have it amputated. Although I have experienced this many times before I haven't found anything that works to reduce the spasm. Does anyone else have any ideas? We've tried increasing my muscle relaxants, large doses of diazipam, positioning, trying to bend my knee and hip (which no one can as they aren't strong enough). At the moment I'd willingly have it either amputated or put in plaster or just.. something!

Any ideas would be great. Normally my right leg is twisted around my left but in deciding to hyperextend it means that getting around the house in my wheelchair is almost impossible, the dogs keep tripping up over it (which just makes it hyper-extend even more) and it, alongside the horrific pain, is driving me nuts!

Many Thanks

Rosie xxx

Rosie,
I'm so sorry this is going on. Usually, I'd suggest the normal, heat, muscle relaxants. But this sound like you need to contact your doctor, and probably get to a physical therapist. Where, they may need to 'throw the book' at you. It may take some time.
My prayers are with you...

Pete

Rosie -

Excuse my poor memory, but pending DBS, it's my understanding that Baclofen pumps are available from the NHS. Have you tried one?

Please see the discussion in Ali's thread of a fortnight/two weeks ago, Bacofen Pump and Pain Control, including the following at http://neurotalk.psychcentral.com/sh...d.php?t=129262:

Intrathecal baclofen for dystonia of complex regional pain syndrome, van Rijn MA, Munts AG, Marinus J, Voormolen JH, de Boer KS, Teepe-Twiss IM, van Dasselaar NT, Delhaas EM, van Hilten JJ, Pain 2009 May;143(1-2):41-7, Epub 2009 Feb 18, FULL TEXT @ http://www.rsds.org/2/library/articl...G_MarinusJ.pdf

Department of Neurology, Leiden University Medical Center, P.O. Box 9600, 2300 RC Leiden, The Netherlands.

Comment in:

Pain. 2009 May;143(1-2):3-4.

Abstract
Dystonia in complex regional pain syndrome (CRPS) responds poorly to treatment. Intrathecal baclofen (ITB) may improve this type of dystonia, but information on its efficacy and safety is limited. A single-blind, placebo-run-in, dose-escalation study was carried out in 42 CRPS patients to evaluate whether dystonia responds to ITB. Thirty-six of the 38 patients, who met the responder criteria received a pump for continuous ITB administration, and were followed up for 12 months to assess long-term efficacy and safety (open-label study). Primary outcome measures were global dystonia severity (both studies) and dystonia-related functional limitations (open-label study). The dose-escalation study showed a dose-effect of baclofen on dystonia severity in 31 patients in doses up to 450 microg/day. One patient did not respond to treatment in the dose-escalation study and three patients dropped out. Thirty-six patients entered the open-label study. Intention-to-treat analysis revealed a substantial improvement in patient and assessor-rated dystonia scores, pain, disability and quality-of-life (Qol) at 12 months. The response in the dose-escalation study did not predict the response to ITB in the open-label study. Eighty-nine adverse events occurred in 26 patients and were related to baclofen (n=19), pump/catheter system defects (n=52), or could not be specified (n=18). The pump was explanted in six patients during the follow-up phase. Dystonia, pain, disability and Qol all improved on ITB and remained efficacious over a period of one year. However, ITB is associated with a high complication rate in this patient group, and methods to improve patient selection and catheter-pump integrity are warranted.

PMID: 19232828 [PubMed - indexed for MEDLINE]

http://www.ncbi.nlm.nih.gov/pubmed/19232828

The article suggested that results with Baclofen pumps have been mixed. But having the pump "explanted" in six of thirty-six patients following the end of the trial suggests that five out of six patients preferred life with it than without. Still, the article notes a relatively high rate of mechanical problems, implying, at least at the time of the study, that this was still a work in progress.


Mike

Thanks Pete and Mike,

My hip and knee are a bit better although my leg is still hyper extended although mum and James can now bend my hip 20 degrees and bend my knee to 80 degrees. They gave me 20mg rectal diazipam (which we normally use for storms or sedation and started physio. The leg is still shaking a lot of the time but not as badly so fingers crossed we've got it under control - it's just going to take a long time to get it back. Mum and James both feel that if my joints go into that sort of spasm that we have to get it out as soon as possible or it can become a permanent contracture.

Mike - I've had the trial for the baclofen pump as I take 100mg a day of baclofen. However, it didn't make a large enough difference for me to go through the surgery, especially considering how much pain I am in whenever I come round from a general anaesthetic.

Thanks

xxxxx

Frogga.

When my spasms are out of control I park myself in my bathtub with epsom salts. Once I am good and waterlogged I get out and climb under my heating blanket and sit on my heating pad. it causes me to sweat horribly, but for some reason it breaks up the spasms. Good luck!

Kim

Dear Rosie -

Should have picked up on something you said in another thread about your doctor's reaction to smoking, to the effect that you would be better off with cannabis. It's true. I personally am prescribed a drug called Marinol, which contains an exact copy of one of 9 naturally occurring THC molecules, and it's the best thing I know if for spasms, by far. The only problems with it are (1) it takes a while to come on but then your're stoned for hours - too long really - and (2) it's not a nice sharp crisp high, but something definitely more stolid. Sort of like cheap Mexican pot from 40 years ago, before everyone got into the cultivation of bigger and stickier buds. So forget about being productive on it in any sense. And, oh yeah, it leaves you (Not sure why they had to choose that particular THC to replicate, could have been the easiest, my docs don't know.)

But speaking of docs, I roll a die every time I go in to see my pain specialist and last week I was called on to produce a sample of my renal output. Not sure what would happen if they found a few unauthorized THC molecules in the stew - legal medical marijuana is after all the rage in California and I'm not under any formal "pain contract" - but where I have a great pain doc. who is comfortable prescribing Marinol in 5 mg. capsules (up to 4 /day) but NOT medical marijuana, I wouldn't want to test the professional relationship by adding something unauthorized to the mix. So I don't.

That said, I understand the same stuff is available in Canada in an aerosol spray that's shot in the mouth/under the tongue. No idea what's available in the UK, but it's certainly worth checking out if you haven't done so already. MS patients swear by the real thing.

Mike

I am 59 and also have Parkinson's.(Double whammy for dystonia) Even before being diagnosed with PD 11 yrs ago, I was an advocate of yoga & stretching. When the CRPS surfaced I was already very limber, and it's the one type of exercise I have continued to practice consistently at home. It's all gain and no pain. For me, hydrotherapy and gentle stretching several times a day are far more useful than any aggressive modalities. (I do use an exercise bike)

The "less is more" also applies to massage. Deep muscle massage exacerbates CRPS. Instead, my massage therapist gently works the the non-affected parts of my body, and does reiki on the affected areas (an energy modality where her hands hover just above my skin.) So far it's helping to prevent cramping & to maintain good blood circulation without aggravating the hot spots.

My take on exercise and PD & CRPS is that you can work your muscles without beating yourself up. Yoga is both prevention & intervention for cramping muscles. Focused breathing helps control pain ("helps," not erases), and also assists in relaxation. It's helped me through my Parkinson's. I can only hope it will also minimize the progression of the CRPS ... or dare I hope, halt it.

If you want to try but don't know where to begin, just buy a stretching DVDs & pop it in your TV. (The "stretch" is more impt than particular yoga poses). Some DVDs are better than others - I hesitate to recommend - and you may have to try a few to find the right fit for you. But by all means, do try this mind/body approach!

Bari