Hi all,
Well I am at a loss, I went to my dr appt last and was told that I need to start seeing a pain management dr but until I am able to be seen by PM my ortho dr wrote a script for me called neurotrin (sorry for the spelling) and told me that this medication will take my pain away. BTW all this started because I got hurt at work, had 2 failed arthoscopic surgeries then recently had a high tibial osteotomy with complications so my surgeon had to do a 4 compartment fasciaotomy now I had really bad swelling,tingling sensation in my foot and VERY BAD PAIN. I am a 43yr old 6' male and Have cried more now they I have ever in my life thats how bad this pain is. Anyway, I need some advice because due to Workmans Comp playing games and not filling my script I have nothing to take besides Tylenol which doesnt do anything for me.
I am considering going to the local ER for pain management but I dont want to seem like a "junkie" if that makes any sense.
If anyone has any suggestions PLEASE let me hear them as I am at a lose and dont know what to do.

I am sorry to hear that you are having difficulties with your workers compensation insurance. It seems to be a common problem for those that have to deal with WC and I am hoping that this is not an indication of how things will go for you from here on out. Neurontin is a starting point for most of us and it is relatively inexpensive. It kind of surprises me that they do not want to cover it, but perhaps they are just waiting to see what the pain management doctor has to say first. I would like to say, don't be discouraged if Neurontin does not work at first. It is a medication that your body needs to adjust to and a proper dose worked up to. That is something that could take weeks to months to know if it does work for you or not. Unfortunately, that is one of the biggest problems with CRPS/RSD; what may work for me, does not necessarily work for the next person, and so a little trial and error is likely to be needed to find something that does work. For me, Neurontin did not help. Hopefully, once insurance starts approving scripts for you, it will work for you.

For some things to help you get through until your WC starts working with you, I am hoping that some others will come on here and give some ideas that have helped them. I know that some have found mild relief using over the counter lidocaine. For me, keeping my ankle elevated and warm, not hot, while trying to concentrate on my breathing during those tough times has helped more than once. Try learning some relaxation techniques, listen to some white noise, meditation, are all great tools to learn and use during those painful nights. I also changed my diet and cut out red meat, pork and dairy, which in my opinion has helped reduce my daily pain levels, but that took some time. I would also like to recommend reading through the RSD "lifesavers" sticky that is posted at the top of the RSD/CRPS forum home screen. In case you have not seen it yet, here is a quick link to get to it
RSD "lifesavers"

Hopefully, things have calmed down a little for you, or at least will calm down soon, and your WC will start helping instead of playing the waiting game. No matter what happens, hold on to hope. It may take some time to find things that work for you, but they are out there. It is just a matter of time and trial and error.

ERs are very difficult for pain management...and in my experience with RSD there's not much they can do anyway that will help me. I wasn't clear if you have been diagnosed with RSD/CRPS or not...but things that help me that don't require prescriptions are heat (heating pads, hot baths in epsom salts, staying away from anything cold, space heaters, heated blankets), TENS unit (helped when my pain was more in one spot and I could surround the area with electrodes...you can find one fairly cheaply on amazon), lidocaine patches (5% you need a prescription by you can get a 4% patch without one), and KEEP MOVING (not more than you can bare...but even small stretching exercises while seated or laying down are good). Also pay really close attention to what aggravates your pain and adjust. I use a cane and for a long time used a rolling walker (with 4 wheels and a seat) until my shoulder started acting up and I couldn't push that anymore. If mobility devices help...then use them.

As for WC...if you don't have a lawyer...get one now. Seriously...they play all sorts of games and an attorney is necessary. Even with one...it may not be a quick resolution to getting meds and dr visits covered. If you have your own insurance...use that in the mean time to get treated. It can potentially make things more complicated but it's worth it to get you treated as quickly as possible. If you do this...just keep copies of every receipt for reimbursement. Every state is different with WC...so you really need an attorney to help navigate all the rules in YOUR state and advise you. WC can and will lie to you, try to trip you up or twist your words, and there's no law saying they can't (not joking)...so protect yourself on that front.

Please ask about Low Dose Naltrexone and aqua PT in a heated, salt water pool. Regular PT imo makes CRPS worse. I gave up neurotin, due to excessive brain fog, but it did help with electrical pain which disturbed my sleep. Watch the animations on Neuroplastix (online)by Dr. Moskewitz, he's a pain expert.

Look into DIY mirror therapy. And check out Dr. Pradeep Chopra's You Tube videos on CRPS. He's a CRPS expert.

Last year at this time I was transitioning from crutches to a cane. I started dragging myself to a gym when I was cut off from PT by WC. I was at first only able to use a stationary bike for about 10 minutes at very low resistance, but now I can bike for an hour at a very high setting. Don't despair.

Thanks for the response,
As far as being diagonsed goes...my ortho dr is the one that said he "suspects" that I have all the classic signs. I do have an attorney for my wc which is doing everything possible for me, its not that wc does not pay for my scripts they just like to drag their feet on approving everything. It's not that I really even want to go to an ER it's just that I am in sooo much pain that I cant deal with it and since I cant get in to see the pain management dr's for 1 1/2mths (thats the earliest appt) and trust me I have been taking tylenol ive taken pretty much ever "otc" medication there is. I also go to PT 3xwk and also do at home PT. I have honestly never been soo depressed in my life.

It's always better to reach out and go SOMEWHERE if you need to. Whether that's your primary care doctor's walk in hours or ER...if it's really bad go somewhere and at least it's documented and gives you hopefully some kind of relief. The biggest issue I have with ERs is how many times I have left in WORSE pain and even MORE frustrated. But if you reach a point where you have hit your limit...go. If you can bring someone with you that is the best...someone who can help advocate for you and explain your pain/condition if possible. I was rear ended on the way home from work a few years ago and had to go to the ER because my pain sky rocketed...and I had to call my boyfriend at 1am from the hospital to have him come to help advocate for me because the docs just weren't getting it. He had to call someone to stay with our baby so he could come. It was terrible...but the doctors weren't getting that immobilizing me was making me WORSE and they kept trying to ice me and I was getting so mad that I don't think I was even making sense anymore because the pain was just out of control and I was terrified they would make me worse (and they did...but thankfully not too much worse).

I'm glad you have an attorney. The best advice I ever got when deal with work comp is to not worry about the things our of your control and focus on what you can control. Do your exercises when able (spread them out all day if you have to), try different things to see what provides even a little relief...added up those little bits can help make life bearable, and keep reaching out to people for support and help. But try very hard to not stress (I know dealing with WC that is hard)...but you have a lawyer to deal with that stuff. You work on the stuff that is in your control and take care of YOU. Sometimes keeping a journal of activities, pain levels, flare ups, etc can be very helpful to narrow down what things flare you up, what doesn't, when you have good days, what causes bad days, etc. Finding triggers can be key to making like better...because then you can figure out ways to work around them.

Take care and keep us posted.

Neurontin is a life-saver for me. My dosage is quite high (though not the limit), and so I have pain patches to take care of the rest, but with the Neurontin the ice in my legs went away. And it was like ICE, like being frozen solid 24/7 both legs fully.

I would just do what the doctor ordered until you can see a pain management doctor.

Has that happened yet, in the mean time?

Hi Rigman,

If you have the financial ability to go ahead and get the neurontin (which is inexpensive in generic form) by all means do! We have one member who uses WC for some things and her private insurance for others. I don't know if this has any repercussions but neurontin generic is cheap enough to pay cash for.

Consider asking also about the oral steroids. They too are inexpensive. Perhaps your ortho would consider prescribing them. You could just call. If they are unsure about it you can send them this.

Ask The Expert: Steroids for Complex Regional Pain Syndrome?

Standard CRPS dose for oral prednisone that I've seen in literature is 3x daily for ten days. I personally found this helpful for calming things down when I was acute. CRPS is a neuroinflammatory process, steroids do treat that.

Meanwhile are you on Vitamin C? 500mg daily helps fight free radicals. Anti-inflammatories like ibuprofen may be more helpful than tylenol. Your ortho might also be able to do a local nerve block to see if that helps. They have the ability to do that in the office under ultrasound guidance.

Are you on a call list for cancellations at the pain doctor? Is there anyone else in town to get you started? 6 weeks seems way too long. Early CRPS is an urgent pain situation. Call back, talk with the practice manager or assistant and explain the situation. Have your ortho call. Send your records over and file early patient forms. whatever it takes. In my experience, extreme acute pain that was untreated bumped me up on work-in lists for busy doctors.

good luck. I'm sending healing vibes,

Regarding the ER. I went many times, but found it to be worthless for any sort of pain treatment. For full disclosure I was treated like a drug seeker.

On one of those visits, after a negative reaction to two antibiotics and an inability to walk due to agonizing pain, (I was yet to be diagnosed for CRPS) an incidental brain aneurysm was discovered. I was sent home with no pain medication, crutches and a follow up appointment to discuss brain surgery.

There's an opiod epidemic in this country, so it is somewhat understandable that the ER staff are reluctant to treat persistent pain. Call your PCP, he might give you enough tramadol to tide you over until your PM appointment.

Look up voltaren gel, DMSO and frankincense neuropathy oil.

I had heard such. But surely they can look at your diagnosis and say, well, this patient is a LEGIT chronic pain patient.

It's harder of course when you're not diagnosed. Hence why I went without any type of pain medication to speak of for almost 3 years. Then the doctor eased Tramadol into my medicines to take, which in my case only took the sharpness off of the pain - but at least it was *something* that helped ease the pain a little.

I was in bed 24/7 without pain medication. Now I stay in bed until 10 (bedrest, not necessarily sleep from 7 AM until 10 AM). And the rest of the day I am up. Thanks to the pain medication. I still need rest. You do if you can barely walk so... but after almost 3 years, that's what you get.

They don't let a dog suffer! Why should people? Even with this going on.