Hi, everybody:

I have RSD in my left knee/leg. This knee was operated on seven times already. According to my orthopedic surgeon, I might need another surgery in the same knee. He will know what he has to do only once he opens my knee up. However, he did mention I might need an osteotomy of valgisation, an ACL (Anterior Cruciate Ligament) reconstruction, and a medial meniscus transplant. If he has to do all these operations, I do not know if they can be done in one time, so as to avoid several surgeries.

The RSD pain I have in the left knee that will be operated on is SIP (Sympathetically Independent Pain). I will have general anesthesia so as not to feel any pain and twinges during the surgery. However, I am worried about the post operative pain I know I will undoubtedly feel. I have several questions:

1) Since my RSD pain is sympathetically independent, would a femoral nerve block be effective in controlling my post operative pain? What about other kinds of blocks, such as epidural nerve blocks? I was wondering if all these types of blocks would work since my RSD pain is sympathetically independent.

2) What kinds of pain relief methods could I use to not only control my post operative pain, but also to prevent my RSD and its pain from flaring up? What about pain control during physical therapy?

The anesthesiologists who work in the hospital where I will have my surgery do not know much, if anything, about RSD and its pain, so they cannot really help me, unless some of you have suggestions they could implement.

For the control of the post operative pain after several of my previous knee surgeries, I had a femoral nerve block. Unfortunately, these blocks did not help me very much and I could still feel a lot of pain. I was afraid to mention my pain to the nurses, since every time I did this, they dismissed my pain as being in my mind, probably because they thought the femoral nerve block was taking care of it, despite my denegations.

3) Do you think these femoral nerve blocks were ineffective because my pain was sympathetically independent or because I might have Central Pain Syndrome or centralized pain, according to some anesthesiologists?

4) By the way, what is the difference between Central Pain Syndrome and centralized pain?

Thanks for your information.

Who is treating your for your RSD? I know you stated the hospital that they want to do the surgery at they don't know about RSD. I think though having a pain doctor who does will be important. Even if it is not at the place you have the surgery but at least someone you can call and see after.
Also if I was suggested surgery of any kind I would be getting a 2nd,3rd opinion to make sure there were no other options. So I would suggest that as well
I have heard ketamine infusions being done after a procedure or surgery I think. Also more as needed meds.
For myself the block made my pain worse. So I can't give much feedback on that. I wish I could give you more advice. Hang in there

Hi, daniella:

My primary care physician is treating my RSD pain with Duragesic (fentanyl)and MSIR (morphine sulfate immediate release). My cardiologist is treating my RSD pain with Tambocor (flecaïnide). I also take Keppra for my epilepsy, but this anticonvulsant does not work on my RSD pain.

In the small island where I live, there is only one pain management doctor. I really do hate him for not believing I have RSD and severe chronic pain, despite all the medical certificates from doctors of different specialties I showed him. I even doubt he is qualified in pain management when he told me the new fentanyl patches, that do not have a reservoir, can be cut in two. He wants to send me to the cemetery to save public health insurance money because my RSD, epilepsy, and migraine treatment is very expensive; about U.S. $ 600 for their part; my co-pay is about U.S. $ 300. This is a total of U.S. $ 900 just for the medications. Then there are all the doctors fees... I miss my pain management doctor and my primary care doctor from the U.S.

I took several opinions from different orthopedic surgeons and, according to them, there is no way I can avoid the surgery. Even if I refuse to have it now because I do not want to lose my job (I need the money to pay for my medical care), these surgeons all clain I will have to have it one day, especially if I want to avoid a TKR (total knee replacement). If I have a TKR, how will I ever be able to continue skydiving, horsebackriding, waterskiing, and rock climbing, sports whiwh I am absilutely unwilling to give up? I even passed the virus to my two-year-old baby.

Quote: "I would suggest that as well I have heard ketamine infusions being done after a procedure or surgery I think." Are you saying these infusions are given through the catheter of a femoral nerve block (or other type of block) or are given through an IV line?

Quote: "Also more as needed meds." Are you talking about, for example, morphine immediate release? When I had my last two knee surgeries with a femoral nerve block (totally ineffective for the 6th surgery, partially effective for the 7th surgery), I took a morphine immediate release capsule because I could not stand the pain. The female nurse, who knew I had these pills and caught me taking them several times, treated me like a druggie and had my surgeon call a shrink for me. I kicked the shrink out of my hospital room, telling him my head and mind were fine, but not my knee and, consequently, I do not need a shrink, but the nurse does.

When I was sent to a physical therapy center, the male nurse who took care of me also knew about my having morphine pills, because the hospital's female nurse must have told him about them. When I signed the papers that showed my agreeing to doing physical therapy, I mentioned I did not want to see the shrink. The chief of all the doctors of this center came to see me to criticize what I had written. I told him the same thing which I told the shrink in the hospital (by the way, it is the same shrink). The male nurse seized my pills so I left this center.

Later, much later, when I saw a lawyer, he told me I could call the cops from the center to get my morphine pills back because what the male nurse did can be called "stealing". I obtained these pills with a prescription, I bought and paid for them in a pharmacy, so they legally belong to me and taking them without my permission is "stealing".

Quote: "For myself the block made my pain worse." I wonder if this was not the case with me also.

Quote: "I wish I could give you more advice. Hang in there." You already helped me a lot with all the information you gave me and I really thank you for your kind words. It is people like you that make my day.

This Neuro Talk Support Group is soooo wonderful because you do not get banned or edited just for posting your feelings or defending yourself against a person using the board and treating you like a druggie just because she did not like you taking narcotics. This happened to me with a famous board, which I will never, never use again.

Thanks again, daniella.