[jeffburns]

hi all. i have had a realy bad day today.so much pain.i dont think i had this much pain in over a year.i went to work for two hours but could not do it and had to go.home.i can take pain but today i could not even walk.some times it is so hard to go on sometimes,but i have to for my wife and kids becaus i love them so very much.thank you for being there for me everyone.some times it helps to vent some.

[fmichael]

Originally Posted by jeffburns

hi all. i have had a realy bad day today.so much pain.i dont think i had this much pain in over a year.i went to work for two hours but could not do it and had to go.home.i can take pain but today i could not even walk.some times it is so hard to go on sometimes,but i have to for my wife and kids becaus i love them so very much.thank you for being there for me everyone.some times it helps to vent some.

Dear Jeff -

If it's any consolation, where you've had RSD for about 5 years, at least in my own experience and that of a number of others - at least those who have not seen "spread" beyond the initial limb - the worst of the pain should be starting to burn itself down to a more managable level about now.

Was there something unusual about the last 24 - 48 hours that might have triggered the flair? Anything from off the chart emotional stress to the inadvertent use of a medication that works by constricting the flow of blood in small vessels, Sudafed and certain other cold remedies (all containing pseudoephedrine) being a prime case in point. And on the last point, check out the thread Colds and RSD http://neurotalk.psychcentral.com/sh...d.php?t=119595

If I could throw out a quick lifeline, while Dextromethorphan (DM) is mentioned (okay, by me) in the Colds and RDS thread PLEASE check out a couple of more threads that went up in December, 2010, Dextromethorphan working for burning pain http://neurotalk.psychcentral.com/sh...d.php?t=140566 and Dextromethorphan prescribed for pain http://neurotalk.psychcentral.com/sh...d.php?t=140398

Where you are having what sounds like horrific pain that isn't responding to whatever therapy you're receiving, I would urge you to consider asking your physician about getting DM at prescription strength, where it's nothing if not relatively cheap. And as in testament to its effectiveness with the sort of pain that's at issue in RSD/CRPS, we have "A qualitative systematic review of the role of N-methyl-D-aspartate receptor antagonists in preventive analgesia," McCartney CJ, Sinha A, Katz J, Anesth Analg. 2004 May;98(5):1385-400, ONLINE TEXT @ http://www.anesthesia-analgesia.org/.../1385.full.pdf:

Abstract
We evaluated in a qualitative systematic review the effect of N-methyl-D-aspartate (NMDA) receptor antagonists on reducing postoperative pain and analgesic consumption beyond the clinical duration of action of the target drug (preventive analgesia). Randomized trials examining the use of an NMDA antagonist in the perioperative period were sought by using a MEDLINE (1966-2003) and EMBASE (1985-2003) search. Reference sections of relevant articles were reviewed, and additional articles were obtained if they evaluated postoperative analgesia after the administration of NMDA antagonists. The primary outcome was a reduction in pain, analgesic consumption, or both in a time period beyond five half-lives of the drug under examination. Secondary outcomes included time to first analgesic request and adverse effects. Forty articles met the inclusion criteria (24 ketamine, 12 dextromethorphan, and 4 magnesium). The evidence in favor of preventive analgesia was strongest in the case of dextromethorphan and ketamine, with 67% and 58%, respectively, of studies demonstrating a reduction in pain, analgesic consumption, or both beyond the clinical duration of action of the drug concerned. None of the four studies examining magnesium demonstrated preventive analgesia. IMPLICATIONS: We evaluated, in a qualitative systematic review, the effect of N-methyl D-aspartate antagonists on reducing postoperative pain and analgesic consumption beyond the clinical duration of action of the target drug (preventive analgesia). Dextromethorphan and ketamine were found to have significant immediate and preventive analgesic benefit in 67% and 58% of studies, respectively.

PMID: 15105220 [PubMed - indexed for MEDLINE]

http://www.ncbi.nlm.nih.gov/pubmed/15105220

And as noted in the threads mentioned above, DM is available over the counter in essentially a pure form (with a trace amount of flavoring) in Zicam® Cough Max Cough Spray (Dextromethorphan HBr - a short acting form). For those who need something that will last the night, there's Delsym® Cough Suppressant, in which the DM HBr is apparently bound in a time delay medium, unfortunately it's also loaded with a lot of corn sweeteners, preservatives, as well as other stuff you probably wouldn't want to take on a regular basis. (That said, I would suggest avoiding the various Delsym "Night Time" products, where they contain additional active ingredients.)

Possibly because DM is also known (with some people more than others) to strengthen ("potentiate") the effect of opioids, I have found that 120 mg/day of DM HBr (coincidentally, the maximum recommended daily dose of either Zicam Cough Max or Delsylm Cough Suppressant) has been enough to knock out any flair I've come across in the last year or so. And to that end, if you are on any narcotic, I would suggest starting out at no more than the pediatric dose of 60 mg/day and seeing how it goes from there.

For what it's worth. Can we say that it's at least worth discussing with your doctor? That said, this is only one therapy, and there are more than enough to go around. As in, for instance, the group of non-technical article collected on the RSDSA "Treatment" page at http://www.rsds.org/3/treatment/index.html

Feel better.

Mike

[Sonny1]

Hi Jeff, sorry about all of the pain you & most folks on here are dealing with. Sometimes I find just yelling (at the mirror, my husband etc) helps reduce some pain. Getting stressed really spikes my levels not to mention all of the other weird symptoms I have. Although I am not any kind of doctor or information guide to any of this, I am human and know the feelings of deperation and defeat....having said that....WE must all accept our worst days, let them be, BUT make tomorrow a better day someway somehow. I am ever so grateful for this forum and its members for getting me through some of the hardest times I have experienced in my lifetime, mainly because they know this is real. It may not make sense to a lot of people (and I am glad for that because that means they do not have this monster disease) it makes sense to all of us, so keep fighting, keep venting and keep sharing your experiences with us, it does help!!!

[lorigood243]

Hi Jeff

such great advice from folks here. i just wanted to say that if the pain becomes over whelming call your doctor and tell him you want to go to the ER and you need to be admitted for a couple days to get over this hump of pain. sometimes your body gets worn out from juggling all the different pain issues and the stress makes the meds not work as well. no need to suffer or be extra brave for your family. get help now!
hugs
lori



QUOTE=jeffburns;758083]hi all. i have had a realy bad day today.so much pain.i dont think i had this much pain in over a year.i went to work for two hours but could not do it and had to go.home.i can take pain but today i could not even walk.some times it is so hard to go on sometimes,but i have to for my wife and kids becaus i love them so very much.thank you for being there for me everyone.some times it helps to vent some.[/QUOTE]