Hannah -

Thank you for the information on your doc, I assume you've seen my private comments. But as to the to concept as a whole, one size doesn't fit all. And what might be appropriate for someone with either fresh onset or newly diagnosed RSD/CRPS may not be appropriate in other cases.

I too was in such a program on an out-patient basis, a little over a year into the disease, without the nerve blocks, where they had long-since lost their effectiveness. For want of a better word, much of it seemed irrelevant to my situation. It offered primarily conventional PT and its strengthening exercises, which I and a few other folks I know find to be death for RSD: far better are programs oriented around stretching and "nerve gliding" exercises. (And for that, you will want a therapist with the full on DPT degree: approx. 3 & 1/2 years of graduate school on top of a BS/BA.) And occupational therapy was pretty much a waste for me as well, but might be of greater assistance to others.

Nor did biofeedback set my life on fire. And as far as the psychotherapy goes, I likes the psychologist well enough, but at my exit interview he told me that I understood more about the relationship of physical pain and emotional responses coming in, than most people did upon completing the program: just as you suspect would be the case for you. But in that regard, a few months later I was to get a great deal more out of a $600 Mindfulness Based Stress Reduction (MBSR) class, a program set up over 30 years ago by Jon Kabat-Zinn at and still maintained by the Univ. of Mass. Medical School, bringing the skills of cultivating sensory clarity and equanimity from meditation and yoga (great for proprioceptive skills on which CRPS inherently does a number) to people primarily in chronic physical pain. For anyone interested, here's their homepage http://www.umassmed.edu/Content.aspx?id=41252, along with a search engine for locating trained teachers, worldwide http://w3.umassmed.edu/MBSR/public/searchmember.aspx.

But now let us get down to where pain physicians make their money, procedures. The program that was presented to you offered two: a trial of a SCS and weekly nerve blocks. While this may mot be the time and place to get into a weekly discussion of SCS, I at least hope you were advised that, even in the best case outcome, they work for no more than three years. See, Spinal cord stimulation for chronic reflex sympathetic dystrophy--five-year follow-up, Kemler MA, de Vet HC, Barendse GA, van den Wildenberg FA, van Kleef M. N Engl J Med. 2006 Jun 1; 354 (22): 2394-6 http://www.nejm.org/doi/full/10.1056/NEJMc055504.

And as to weekly nerve blocks, the literature has been pretty clear, in the absence of a fresh injury (including elective surgery where it they appear to have considerable prophylactic value) sympathetic nerve blocks rarely work more than a few months after the onset of symptoms. See, e.g., Efficacy of Stellate Ganglion Blockade for the Management of Type 1 Complex Regional Pain Syndrome, Ackerman WE, Zhang JM, South Med J. 2006; 99: 1084-1088 http://www.rsds.org/pdfsall/Ackerman...lion_block.pdf. We also have the following in straightforward language from the RSDSA:

Clinical Q & A: Can there be too many sympathetic nerve blocks for the treatment of CRPS?

By William E. Ackerman, III, MD

Yes and no. Not all CRPS patients respond to this therapy. If patients get transient relief, allowing them to participate in physical therapy or not have to increase their medications, sympathetic nerve blocks are indicated. If no relief is noted after two blocks, then why repeat them? The results will not be favorable. Sympathetic blocks must be performed early in this disease to be effective. At that time, 2 to 3 blocks are usually effective.

The longer the duration from the onset of CRPS until the first injection, the worse the results. For example, a patient with CRPS for 12 months will have poor results with a sympathetic block. However, if a patient receives an injection within the first 2.5 to 3 months, the results should be good. This is why an accurate diagnosis of CRPS must be made in a timely fashion. Failure to do so may condemn a patient to life-long severe pain.

A sympathetic nerve blockade, however, is not a totally benign procedure, with side effects that include elevated blood sugars, rash, itching, weight gain, soreness at the injection site, bleeding, seizures, and death. Blockades are also more efficacious with decreased vasomotor activity, but become less effective with increased vasoconstriction. Therefore, the effectiveness of a sympathetic nerve blockade is based on the duration of the symptoms and blood perfusion in the affected area.

RSDSA Review. Winter 2008.

http://www.rsds.org/publications/Ack...inter2008.html That said, if there is spread to a new extremity, some recent evidence suggests that the inflammatory processes are beginning anew - in that location - so that the clock for the effectiveness of sympathetic nerve blocks may be in effect reset, but only as to the new area of spread. [Reference available on request.]

Accordingly, if you have had CRPS for a year or more, and aren't experiencing spread to a new extremity, what's the point of an expensive program built around weekly nerve blocks?

Mike