Originally Posted by Neurochic

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.