Hi everyone,

I'm so glad I found this forum. I apologize for my lengthy post, but I'm desperate for help. I'm looking for advice and the doctors aren't being very helpful. My background is I have a history of RSD and severe Psoriatic Arthritis.

I had my first bout of RSD about 10 years ago in my left foot. It lasted a little over a year. I had two sympathetic nerve blocks and the second block seemed to put the RSD into remission.

A month ago, pain started in my left shoulder blade and upper arm coupled with weakness. I initially dismissed it as a psoriatic arthritis flare. Over the next two weeks, the pain quickly spread and now extends from my shoulder blade through my wrist. My left hand seems to be spared. It started out as a severe throbbing ache. Any movement of the arm greatly increased the pain. I tried to immobilize the arm into a sling, but any slight movement of my trunk, moves the arm, and causes incredible pain. When the pain gets severe, the arm (especially the forearm and wrist) turns ice cold and pale.

I went to my rheumatologist and he thought that it wasn't PsA related. He noted that my entire arm was swollen and there was a slight temperature difference. He prescribed a large blast of prednisone (60 mg for 3 days; 40 for 3 days, etc.) and pain killers. I took 4 days off and started to feel slightly better. I went back to work and in 30 minutes (with my arm in a sling), the pain became unbearable. I have a very good pain tolerance due to the psoriatic arthritis, so believe me when I say it was intense.

The doctor told me to take 10 days off work. I'm supposed to return on Monday, May 21st.

Despite being bedridden and taking medication, my arm is getting worse very quickly. In addition to the severe aches and shooting pains, I'm having constant, intense burning. It feels like someone is rubbing rough cloth over the worst sunburn of my life. If anything touches my arm, the burning and pain increase. Even water and air conditioning elicit severe pain. I'm also experiencing prickling, like someone poking hot needles into my arm. My hand and arm are very shaky. They shake at rest, and if I try to pick up something light like a pen, my whole arm wobbles so much that I inevitably drop it.

The pain is now constant and unrelenting. Vicodin barely touches the pain.

There is NO numbness or traditional pins and needles. My fingers have no pain. My neck has no pain. I've not had any significant injury, or any injury. I do have psoriatic arthritis though, which is like rheumatoid.

My concern is that I'm supposed to go back to work next Monday and I have no idea how I can possibly do this. I work in a library and my primary job is checking in and out books. That requires arm and trunk movement. Even if I put my arm in a sling and use my good arm, it still causes pain in my left arm. This is pain that I just can't handle while working. I can't take pain killers at work. Also, I can't drive with my arm like this or drive while taking pain killers.

I called my doctor again and he definitely thinks it's neurological; some type of neuropathy or MS. I had a brief MS scare a few years ago, but I had a head and neck MRI in February and there's no lesions (at least new ones). In February, the neck MRI didn't show any nerve impingement or disc herniation.

The doc is going to consult with the neurologist that ordered my MRI in February. He thinks there's a possibility that it's either MS related (though I have no diagnosis or lesions), neuropathy or the return of the RSD.

My question is: how do I make the doctor understand that I can't work like this? With my job, I have the option of going on short term disability for up to 6 months while getting 65% of my pay. However, I need a doctor's note.

The doctor still hasn't decided exactly what is going on, whether it's RSD or neuropathy, and I can't see them deciding or effectively treating me in a week, so I can return to my job. I feel like the doctor just doesn't understand how much pain I'm in.

How do I get the doctor to write me a note, so I can go on the short term disability until we get this problem under control? How do I make him understand that I can't function like this?

Does this sound like RSD or neuropathy?

Thanks so much for taking the time to read this.