Phyllis -

Very sorry to hear of your predicament, just logged on last night for the first time in months. There is, however, one simple, effective and too often overlooked means of "first-aid" for those CRPS patients with fresh injuries.

I put this up a few months ago but it bears repeating: I lost my balance early one morning, only to trip of a stand-mounted fan, and thence to fall sideways - hard - striking the edge of a nearly 15" wide pounded metal temple bell, breaking two ribs in the process. A few hours later, I made my way to the hospital - quite concerned about spread - and the ER doc called my pain physician, who immediately suggested putting lidocaine patches directly on top of the injured area, before any secondary pain complications could set in. In fact, the first lidocaine patch was put on right in the ER. I then kept it up for two week, changing them twice a day, and guess what? They greatly cut down on the pain [read: afferent nerve signalling to the dorsal horn of the spinal cord, they genesis of both CRPS and spread].

It may not have been continuous regional anesthesia, but it was as good as anyone could come up with off-hand. And think about it: when was the last time you heard of lidocaine patches being used essentially as first-aid?

In fact, a good argument can be made that each case of "spread" secondary to a new injury, is in fact a fresh immune-modulated case of CRPS, on account of which treatments that may have long since lost their effectiveness, such as nerve blocks delivered under fluoroscopy - may have a new lease on life with respect to combating injury-induced spread. Please check out my post from February, in Ballerina's t.D.C.S. Update Could remission be within my reach and your's too? , which appears as Post No. 145.

And finally, speaking of tDCS, Ballerina had SPECTACULAR results in actually reversing injury-induced spread using incredibly inexpensive tDCS. Please check out her Post No. 148 of February 28th. It's a keeper!

And it's now my understanding there are now an ever increasing number of pain clinics/physicians that are adding this to their regime. And with literature out there like the following, who could blame them?

Anodal transcranial direct current stimulation of the motor cortex ameliorates chronic pain and reduces short intracortical inhibition, Antal A, Terney D, Kühnl S, Paulus W, J Pain Symptom Manage. 2010 May;39(5):890-903; and

Efficacy of anodal transcranial direct current stimulation (tDCS) for the treatment of fibromyalgia: results of a randomized, sham-controlled longitudinal clinical trial, Valle A, Roizenblatt S, Botte S, Zaghi S, Riberto M, Tufik S, Boggio PS, Fregni F, J Pain Manag. 2009;2(3):353-361.

I hope this is helpful. Bottom line: please call your MP doc in the morning. And if you don't have one, now is the time to move on it. In the meantime, an orthopedic/hand surgeon should be high on your list as well. If you have to go through a PCP, so be it. But for goodness sake, make sure whoever you see is cognizant of the risks of immobilization (casting) with CRPS, and do whatever you can to get a hold of some lidocaine patches: this one may be worth betting the farm.

Mike