[mxmxmxmxmxmx]

Hi, I'm starting to panic a bit as I've developed a nerve pain in my foot after a prolotherapy injection in my spring ligament (right in the arch of my foot) and my doctor is now out of state (and the darn front staff said they'll 'try to contact him' but won't give me his number) for a week and I've been reading about how vital early treatment for CRPS is. I need some help as for what to do right now and have a whole bunch of questions.

First, when they say 'early treatment' does this mean days, weeks, months, or what?

Who should I see (physiatrist, neurologist, directory of specialists) and what do I need to tell the front staff to get seen immediately (will mentioning crps get me seen immediately?), or should I try an emergency room? What should I expect them to/give me for the initial treatment?

What can I do until I can get an appointment myself besides not walking? Should I ice and/or heat my foot? Does ibuprofin actually help the nerve or just cover up pain?
I actually have some neurontin that was prescribed to rule out a nerve injury in a previous injury. Should I take it and will it stop the actual damaging mechanism? I read pentoxifylline mentioned in another post for calming down a nerve in early crps and preventing damage, does neurontin accomplish the same thing or only cover up the pain?



Ok, sorry for the initial rush of questions, here's a bit more background. I had the prolotherapy shot 2 weeks ago, which is basically a sports medicine treatment kind of like cortisone shots but with the opposite effect, rather than killing inflammation it creates some to trigger healing in the ligament. The injection itself was pretty painful, but didn't feel like he hit any nerves; however, one interesting note is that I did have a near fainting spell a few minutes after and I have never fainted before and have no issues with needles, which makes me wonder if my nervous system had/is overreacting to the trauma. I went home and the first week I feel just a slight tingle in one spot of my foot. A week later though the pain kind of opens up and I get tingling and burning pain from the medial heel to big toe (basically along the medial plantar nerve branch) and putting weight on the inner foot creates really sharp pains and has gotten a little worse each day, even though the ligaments are back to normal which is making me very worried. I know I don't have some of the crps symptoms like sensitive skin or temperature changes yet and am not sure how quickly these come on, but I don't want to take any chances and make sure this is treated promptly. Is 2 weeks soon enough to stop the progression?

[Jomar]

With your doctor out of town , is there a partner or another dr covering for him?

It could be an inflammation of some kind so if you can't find a RSD/CRPS knowledgeable dr , then at least the urgent care, or another dr of your choice just for a basic follow up, then if needed look for a more advanced dr for treatment.

It could be PN ,you might post/read on our PN forum also for input.
http://neurotalk.psychcentral.com/forum20.html

Is there any heat or swelling, or just the pain.
But a basic check would be good. RSD/CRPS usually isn't widely known about, so most likely the front staff wouldn't know what it was , unless they have pts with it already.
I don't know what kind of time frame it is , but I do know some have had to chase a dx for years , it's getting better but just depends on the dr and how updated he stays. I would estimate weeks to a couple months but not sure at all.

[RSDcandice]

I am not sure what area you live in(small townor bigger town)
im a small town gal, and i went to three ortho docs, a neurologist and a pain managment doctor before anyone could help me. The neuro was a great help, now he did a nerve test, and i wanted to kill him because of that but he and my pm are the reason i got dx.

[birchlake]

You are plenty early, so don't panic about that. But trying to understand this is a very good idea.

Neurontin is an often prescribed drug for neuropathic pain. I have been using it since my diagnosis of CRPS 4 years ago. It will not stop CRPS if that is root cause, but it often helps curb the symptoms.

An emergency room doesn't sound like an appropriate place for you. They often know very little about tricky problems.

Stay off ICE for sure; it is not good if it is CRPS.

You need to see a seasoned podiatrist that has experience with CRPS. Be point blank and ask the question about how much experience they have. It is VERY important.

Take it one step at a time. It's good that you are being proactive here, but don't get ahead of yourself. There may be another explanation for your symptoms. CRPS is very easy to misdiagnose. Both diagnosing you with CRPS when you don't have it, and also diagnosing you don't have it when you actually do. It is a very tricky condition.

Good luck and keep us posted!

[mxmxmxmxmxmx]

Thank you for the great responses so far!

Good to hear I have a little time to get in to see a doctor. All the articles about CRPS I've read describe the end stage symptoms but nothing about the early warning signs and timeframe of the progression. Does the pain/swelling/sweating all come one at once hard or does it start very gradual more like I'm experiencing, and if it's gradual how fast does it ramp up to the major pain/swelling/sweating?

I will look more into PN, too, thanks for bringing that to my attention. Maybe there's new scar tissue from the needle or it nicked a small nerve ending and damaged it or made it hypersensitive, but I assumed that would be a very local pain an not affect the whole bottom of my foot. Maybe that's what triggered my nervous system to go into a fainting spell from the shock and that area still hasn't calmed down. In either case, if I shouldn't ice and neurontin only covers the pain is there anything else I can do until my doctor gets back next week to calm down the nerves (besides minimal walking)? Lidocaine cream, nsaids/ibuprofin? Would physical therapy modalities like ultrasound, estim/tens, vibration make things better or worse?

Now what are the most important diagnostic tests I should inquire about? Is a standard EMG and a muskuloskeletal ultrasound/sonogram scan enough (I know my physiatrist that's away has those two things)? Or are there other tests I should ask about?

[birchlake]

I would definitely recommend NSAIDs (if you can tolerate them and haven't been told to avoid them) to help with both pain and inflammation. Along with my gabapentin, the next most important medication is Naproxen Sodium. You can buy generic off the shelf very inexpensively. It's the same formulation as Aleve, just cheaper. I use the 220 mg tablets; two of them will get you close to the 500 mg often prescribed dosage. Ibuprofen works, but it only lasts for about 2-3 hours and Naproxen Sodium will get many people 6-8 hours of relief. Best to take it with a little food as they can be hard on the stomach for some people.

As far as symptoms go, the one thing to keep in mind is that it is a very UNIQUE condition. So while you may have some of the same symptoms that the next person does, you might not too. And you should know that you do NOT need to have "all" of the traditional symptoms to get a diagnosis.

And this is something really important to commit to your memory: "CRPS is widely misunderstood, even by professionals". That is why you need to be treated and diagnosed by professionals who have experience. I'll bet I saw 10 doctors and professionals before I found a couple that knew CRPS and I was able to be diagnosed; mine was actually a group diagnosis......One doctor I saw never treated anyone with it and one doctor had only seen two cases in 26 years. To those, you say thank you and head for the door.

As far as tests go, you are going to get a whole lot of difference in opinion on that. Many (most) are not going to give you a conclusive yes or no answer. So because of the difficulty in testing for CRPS, I'm going to suggest you see a number of doctors and let them decide your path with testing.

Here are some links to CRPS articles I have bookmarked. Check them out; they might be helpful to you! The last link has a lot of very good information, even though Dr. Hooshmand is now retired.

http://www.podiatrytoday.com/article/2672

http://emedicine.medscape.com/article/1145318-overview

http://rsdrx.com/