I am getting very concerned as months are passing since my injury April 3, 2012 and I am only being treated with meds and PT. Can anyone recommend a good RSD / CRPS doctor in So Calif that does Lidocaine infusions? I am not interested in UCLA; USC does not do Lidocaine infusions. I have systemic symptoms - including all 4 limbs. Thank you!

Hi there. I was just curious, you seem to be having trouble with lidocaine infusions, I was just wondering how it affects your rsd. There are two different kinds of lidocaine, each lasts a different duration.

1) Lidocaine ("Plain")
When injected in or under the skin, prevents sensory nerves from firing by depolarizing sensory nerve axons (the electrical wires of the nerves).
Because plain lidocaine is water soluble, it rapidly flushes away with nearby blood capillaries and veins. The half life for 1 milliliter of plain lidocaine injected below the skin (subcuticular) is about an hour.

2) Lidocaine with epinephrine (LidocaineE)
Works the same as plain lidocaine, except the epinephrine causes all the blood vessels in the area to constrict for hours.
Without blood flow to the area, the lidocaine does not get flushed away.
Depending on the location and the amount injected, LidocaineE can have a half-life up to 6 hours.

So if you're treating your rsd with lidocaine it seems to me you would need an excessive amounts of injections to keep it under control and maybe thats why youre having trouble finding a doc who would do them. My doc gives me cortisone injections which isn't similar to lido but provides a couple months of pain relief. But hey if you're doing something new I'd love to hear what it is, I would give anything a try. Good luck and best wishes

Dr. Carden does Ketamine as well as other types of infusions. (310) 842-8668

Thank you Morgan. I am only being treated with meds and PT. I had read about Lidocaine and know almost nothing about it except what you just sent to me. I have only a Liocaine patch on my right foot as I injured it after the main injury and it works well so I figured I would look into Lidocaine infusions. I feel there must be something they can try for me since I am at about 4.5 months. My main injury was my left arm. 75% of my symptoms are on my left side with 50% on left arm and shoulder/back neckline. 25% symptoms on right side. I am very frustrated and getting worse.

I also have the lido patches. They're strictly topical but the reason they last so long is because they're topical. The mechanism in the patch has a slow release over 12 hr period. It only has 3-5 percent lidocaine for that matter. When it comes to injections, there is no slow release mechanism so the lidocaine just does it's thing then leaves. Im only a patient, not a doc, but I would recommend asking about cortisone which is a steroid but it lasts a very long time, along with meds, thearapys and the patches, really bumps down the pain. I got in with a pain management doc who seems to know his stuff and he has schedule all these things and more. Nerve blocks are next on the list.

Lidocaine is frequently in the "cocktail" when you undergo Stellate ganglion blocks. http://www.rsdrx.com/rsdpuz4.0/puz_41.htm

I do know that when Carden does SGB, he does them via fluoroscopy which is ESSENTIAL IMO. If I were in the early stages, I would fight for blocks AND Ketamine.

After undergoing a SGB have a very gentle massage performed asap!!! http://www.rsdrx.com/massage_therapy.htm

Just to add, SGB are pretty routine at pain clinics and you should have no problem finding a doc in San Diego to perform the procedure, just verify if they do them blindly or via fluoroscopy. The results should last longer and there is less risk of spread if done via fluoroscopy. I've gone through both types... The first via a pain center doc, the second via an ex spine surgeon. Very different procedures and results.

Many docs treat these just as diagnostic blocks. NOT what you want.

Thank you all for all of the helpful info! Today has been a bad pain day. As I write this I have intermittent burning/singing misfires throughout my body systemically - many on the left arm, including burning across my left ear & across my head, the top of my right foot keeps going numb, edema in 2 toes of both feet, & all day both hands change color rapidly from blotchy red & white to pale. My limbs, jaw, neck, head & trunk also jerk alot at night between the rest and sleep stage.
From what I have heard I think most people do not have it systemic like this? I suspect that is due to the electrical injury insult. I was electrocuted April 3 by a doctor during a medical test.

Lit Love - have you ever been treated by Carden? Or do you have close connections with anyone recently treated by Carden?

You said you are on meds, are you takeing neurontin or lyrica? They help somewhat with the burning and shooting nerve pain. Something narcotics don't seem to have a handle on.

Thank you Morgan. I am on neurontin 3000mg/day - it helps alot to slow the nerve misfires. Sajben also has me on Naltrexone 15mg/day and Dextromethorphan 120mg/day. I have no idea if the Nal works - she says it takes time; the Dex seems to work some... maybe. However, my symptoms keep spreading. The meds help with the pain but this syndrome continues to progress pretty rapidly.

I just got back from Northern Calif / Stanford. A friend got me in there for a consult. They are eager to have me begin their multi-dimensional program with PT, OT, Pain Psy around mid Nov / Dec (earliest timeslot they have for me). That is 7.5 to 8 mo from injury date.

May I ask what Doc in No Calif you have been quite pleased with?
Thank you again.