I would agree. It is not entirely possible to know if ones pain is SIP or SMP as there is no definative test for such. SGB's are a "way" to sometimes help deliniated the issue. And I would hardly agree to any statement that one SGB is diagnostic of one type or the other. I can't make the call for you, but at least for me, I needed close to 6 or so SGB's before I could make the decision that they definitively worked for me or did not. And while I am not pain-free, my pain is much better than it was in comparison to the pre-SGB days. I get SGB's (2-3 at a time) about every 4 or 5 months. I feel (trending) better in the 1 month post-block and then variable at 2-3 months post-block and then miserable by 3-4 months. And then just like the movie "Groundhog Day," I get another series and life goes on in a better way. I understand that everyone's experience is different and I am both happy and (feel) guilty that my situation temporarily improves with intervention while others do not but I guess my point is that one should not shoot down the procedure after only one attempt!

wow! 6 of them...ugh I would hate that. My dr. (mind you this is just his opinion) doesn't feel that it's productive to do so many he said he will only do 2 on rare occasions 3 blocks, before moving on to other treatment plans. I don't know how he ranks in the nation/world but he is "one of the best" CRPS/RSD treatment docs in my town.
I absolutely LOVE the Physical therapist he's sent me to. He studies and goes to conferences/lectures on CRPS and I LOVE his positive attitude. He gives me such hope that I CAN overcome this with hard-work and determination to get better! He has worked with a LOT of CRPSA patients in my town and believes we caught mine early enough to make a real difference, as long as the RSD doesn't go haywire.

I was wondering if your doctor talked about P/T (gentle mind you) while using some form of numbing agent/ anesthesia to make sure you're not in severe pain while doing P/T. He has a plan to trick my brain into realizing there isn't anything hurt so my body needs to stop trying to "protect" itself. basically do as many exercises/motions that you can slowly building up, trying to get your brain to respond to NORMAL movements that do not have pain, so your nerves and brain quit responding to the pain signals. I don';t know how that works for later stage patients, but he said it has a high success rate for patients in the "acute" stage.

Hi Emily,

I should clarify....I received initially 3 over several weeks and then a few weeks later 3 more at the beginning. Then from my best recollection I received 2-3 every 3 to 5 months. That's where I am at now; 5 years into it. And I am not sure what "other treatment" plans look like for you but for me they started talking spinal cord stimulator which sounds oh-so-much more invasive than a little ole stellate block from time to time! Yup, I got the raised eyebrow treatment from some who thought 8 or 9 SGB's total were excessive. But they don't walk in my shoes so screw 'em!

What you and everyone else will (or should) tell you is that their own experience is unique, generally, and all will have some personal pattern of relative relief that they have fallen into. So while I might think your PM doc is a jack-*** for his minimalistic approach, others may call HIS ideas excessive!

I can only share what has worked for me and if I had stopped at 2 or 3, I would have gone postal-crazy long ago!

As far as how my PT went, I had a cervical fusion, 3 months later a shoulder reconstruction for whom the ortho severely damaged my brachial plexus; starting the CRPS. It was very early during the shoulder PT that I knew something was heinously afoul as just the action of the therapist touching my forearm sent me into fits of hysteria and tears. Sixteen ES vicodine a day didn't touch the pain and I got almost no sleep for months. I sent myself to the neurologist at 3 weeks out of concern of the atrophy and motor loss not to mention the pain and after very abnormal EMG results, he recommended PM so at 5 weeks I got started on SGB's. I too feel fortunate at an early diagnosis (I cheated on expediting the diagnosis as I am/was also a health care provider) so I didn't wait the usual many months to start effective therapy.

Dubious
Oh geez you have been through the ringer!! I hope you find SOMETHING the help at least make the day bearable!! You are CORRECT everyone is different in their symptoms/treatment! I thought it was funny as the other day my PCP finally admitted he had no idea how to treat this and is referring me out finally!!! lolol I could've told him he didn't know but Doctors don't tend to like that! Shessh....I hope you get "better" soon or at least have your symptoms retreat a little!

Almost everyone that has had the disorder for any length of time has been through the ringer... I'm not trying to lessen Dubious' experience at all, just noting that this is the reality of RSD. Unpleasant procedures and meds, that have to be experimented with to determine which gives (or does not give) the highest quality of life. And at different time periods, based on mental health, burnout, increased or decreased coping mechanisms, living and job situations, will dictate which course to follow at that particular time. There just is no one size fits all. The SCS scares me, but some have had great success with it.

I think Lit Love is on the money with the comments that all of the experimentation and unpleasant stuff is life with CRPS. That is simply the reality of living with this condition in anything other than a mild form for any length of time. It's also true that at different periods in the course of the condition, different management strategies will be needed.

From my research, the current view amongst the leading CRPS researchers and clinicians in relation to sympathetic blocks is exactly as Emily's specialist described it to her. The view seems to be very much turning away from doing endless repeated blocks to doing only 1-3 and largely using it as a diagnostic tool. It's not used as a diagnostic tool to determine how the pain is mediated though, it is used as a diagnostic tool to determine whether CRPS is present or not. The general body of opinion seems to be that if a patient receives any pain or other symptom relief (other than for the period of a few hours whilst the local anaesthetic in the block is working) then this is a 'bonus' rather than an expected outcome.

I wouldn't be surprised to see treatment guidance in the future placing far less emphasis on carrying out multiple sympathetic blocks. I suspect that they will increasingly be seen to have minimal value as a CRPS 'treatment'. Of course there will always be individuals for whom multiple blocks will be a helpful part of longer term treatment but for the typical majority, I think it will be different.

In much the same way, it has become much clearer that as more work has been done using SCS with larger numbers of patients, there are typical CRPS patients who are likely to get benefit and patients who won't. The patients for whom they are generally most effective are those where their symptoms are confined to one limb. Patients with pain in multiple limbs are much less suitable for SCS implantation because they typically have much poorer outcomes. As increased information becomes available, it at least allows everyone to make more informed choices.

I guess my reply to the last several posts would be in agreement that there is not one way or even several ways to address CRPS. Each of us has our own road we have traveled, by trial and error or blind luck and no controlled study, RCT or anyone else's opinion will change what we have already empirically found to individually work for us!

While I don't at all agree with neurochic that SGB's will run their course and be shelved (there are still many of us with SMP that respond therapeutically in addition to diagnostically), but I will submit that there are certainly those who simply are SGB failures and repeat procedures should not occur. None of us are the same!

And Litlove, there is nothing you can say that changes my amazingly positive experiences (as much as I hate the SGB process, it worked for me). Emily, thanks for the kind wishes...I have been dealing with this since early 2008 and am truly thankfull after reading about others worse off than me. I comparatively consider myself fortunate even though I have lost much (as have we all).

I guess my summation is that I am not at all impressed with medical science or professional talking heads (I understand, having been educated as such and participated in both the research side and medlegal process) since CRPS research is administered by no one who has ever experienced what we have been through yet the "experts" will tell us what we all need or can have! Reminds me of managed care/work comp/national health care...sorry, I can't go there....

I'm definitely repeating myself in part from other posts, but here is why I have an issue with what EA's anesthesiologist stated, the skill of the doc, and the meds used can make a huge difference. Those with suspected SIP can receive Depro Medrol as a part of the cocktail, and this can help. I've experienced blocks done poorly, I've experienced blocks done well technically (with and without Depro Medrol) and the DM made a difference of a day's relief as opposed to 3 weeks relief.

Just because the trend is going away from blocks with certain experts, it can be one of the few options offered to many that don't live near someone offering newer treatments. Insurance will approve blocks. If someone can't go out of pocket in the critical early stage window, this might be one of the few options for them.

I also trust a few of my docs that claim they have had success when they've done blocks early and aggressively. I personally think I'm long past the stage that they'll help lessen my symptoms enough to justify them alone. But, a SGB helped me get through surgery without spread. And I have substantial enough relief to have my doc requesting a tandem of SGB and a Ketamine Infusion.

Those of us that have had RSD for a lengthy period are without question those that have had the worst response to treatment. The RSD experts often see these worst cases. So, the same approach is not always required.

I don't think the Pain doctors themselves know exactly why SGB's help CRPS pain. However, it seems to be they are being dictated to by insurance companies, and unless you are Rich as Croceus to be paying for everything yourself, one's medical treatment is somewhat affected by what your medical insurance provider guidelines.

Most Med Ins companies want to see 6 SGB's before they will entertain the thought of a Spinal Cord Stimulator or some other really expensive treatment like a pain pump. It has some positive predictive value that the device would work.

I dont know who told you that but that is not correct at all. Many PM drs will only do 1-3 SGB's. I have seen some paitents however have better controled pain with the SGB's and I personally know a paitent that has had atleast 11 if not more to controle her pain for RSD. And others the blocks dont work at all. Every paitent is diffrent!

As for the insurence, again i dont know where you got that info. My Dr knew i wouldnt do any injections and he offerd right off the bat to go ahead with a SCS and it was not going to be any insurance issue if thats the way i wanted to proceede.