There are some papers that show catching RSD early and treating it with calcium channel blockers may prevent long term issues or spreading:
from http://www.ncbi.nlm.nih.gov/pubmed/9...ubmed_RVDocSum

Of course, the trick here is for accurate early diagnosis!

Lidocaine is another calcium channel blocker.

Everything I am finding on Lidocaine states that it is a sodium channel blocker. (not calcium)
http://books.google.com/books?id=bwi...#PRA1-PA154,M1

Do you have any links I could read, Sandel?

Ohh my... Sory you are right lidicaine is a sodium channel blocking agent.
Thank you Mrs. D

How to Initiate and Monitor Infusional
Lidocaine for Severe and/or Neuropathic Pain:

http://www.supportiveoncology.net/jo...es/0201090.pdf

Be well friends,
~ Sandra

Dear "Ain't So Bad" & other readers,

My seven months of CRPS can't hold a candle to those of you who have been struggling for many years. What an awful disease! But I have already learned that "aggressive" isn't always good.

My CRPS surfaced 3 months after knee reconstruction surgery. I'd already been in PT for a month, gritting my teeth through the necessary pain, and the patella was healing properly. Then things started to go haywire. Who knows why the CRPS popped up when it did? The PT & I didn't know what was happening. Exercises that had worked before were now creating more - and displaced - inflammation & pain. I'd always looked forward to the post-workout icing, but now it caused a painful sensation. I agreed to the PT's request to try 2 sessions of deep muscle massage, but that resulted in increased inflammation, & even widened the area of pain. She called the orthopedist & we put everything on hold until some tests could be done.

Two sympathetic nerve blocks positively diagnosed CRPS/RSD. I received an injection of cortisone, which gave me 2 pain-free weeks. When it wore off the pain was back, and the CRPS had spread about 4 inches higher ... to the site where the needle had been inserted!

But back to PT anyway, because the mantra really is "keep on moving." This time it was hydrotherapy, for which I still go 3x/week. It's an effective & soothing way to exercise the muscles. Oh, and no more ice. Check this out:
CRPS/RSDS PATIENTS SHOULD NOT BE TREATED WITH ICE. NOT EVER!
NOT ICE, NOT HOLD/COLD THERAPY, NOTHING DEALING WITH ICE AND THE AFFECTED CRPS/RSDS AREA.
NEVER.
EVER.
IT CAN MAKE THE CRPS/RSDS WORSEN AND/OR SPREAD.
THIS IS EXTREMELY IMPORTANT TO KNOW AND TO SHARE WITH YOUR PHYSICAL THERAPIST.
Ice will only cause the blood vessels to shrink more, reducing the blood flow to the extremities and increasing the pain. Patients can actually have their CRPS/RSDS go into the next stage from repeated application of ice packs.
Please let your Physical Therapist know this, for your sake and others.
For the medical reasoning behind this, please follow this link for one of the better explanations;
rsdhope.org

At this point I will share that I am 59 and also have Parkinson's. Even before being diagnosed with PD 11 yrs ago, I was an advocate of yoga & stretching. When the CRPS surfaced I was already very limber, and it's the one type of exercise I have continued to practice consistently at home. It's all gain and no pain. For me, hydrotherapy and gentle stretching several times a day are far more useful than any aggressive modalities. (I do use an exercise bike)

The "less is more" also applies to massage. Deep muscle massage exacerbates CRPS. Instead, my massage therapist gently works the the non-affected parts of my body, and does reiki on the affected areas (an energy modality where her hands hover just above my skin.) So far it's helping to prevent cramping & to maintain good blood circulation without aggravating the hot spots.

My take on exercise and PD & CRPS is that you can work your muscles without beating yourself up. Yoga is both prevention & intervention for cramping muscles. Focused breathing helps control pain ("helps," not erases), and also assists in relaxation. It's helped me through my Parkinson's. I can only hope it will also minimize the progression of the CRPS ... or dare I hope, halt it.

If you want to try but don't know where to begin, just buy a stretching DVDs & pop it in your TV. (The "stretch" is more impt than particular yoga poses). Some DVDs are better than others - I hesitate to recommend - and you may have to try a few to find the right fit for you. But by all means, do try this mind/body approach!

Bari

3 phase bone scan is the best to determine rsd

Dear electdon -

Your statement is partially correct, as applied to the acute case of CRPS in the upper extremities, and even then the results are not infallible. See, e.g., Diagnosis of post-traumatic complex regional pain syndrome of the hand: current role of sympathetic skin response and three-phase bone scintigraphy, Pankaj A, Kotwal PP, Mittal R, Deepak KK, Bal CS, J Orthop Surg (Hong Kong). 2006 Dec;14(3):284-90, ONLINE TEXT @ http://www.rsds.org/2/library/articl...kaj_Kotwal.pdf

Department of Orthopedics, All India Institute of Medical Sciences, Ansari Nagar, New Delhi, India.

Abstract
PURPOSE: To evaluate the role of sympathetic skin response (SSR) and three-phase bone scintigraphy (TPBS) in the diagnosis of complex regional pain syndrome (CRPS).

METHODS: 60 patients with CRPS of the hand were recruited. TPBS was performed using a bolus injection of 20 mCi of Tc-99m methylene diphosphonate in an antecubital vein and blood flow (first phase) image, blood pool (second phase) image, and delayed (third phase) image obtained. Patients were considered to have CRPS when the blood pool and blood flow images showed diffuse asymmetric uptake, or when the delayed image indicated increased asymmetric periarticular uptake. SSR was measured simultaneously in the affected and unaffected hands. Standard surface electromyogram disc electrodes were applied to the palm and dorsum of both hands. Electrical stimuli were applied to the skin at the base of little and ring fingers of the unaffected hand. Patients were considered abnormal when response was absent or the peak-to-peak amplitude was <50% of the contralateral hand in at least 2 readings.

RESULTS: The delayed phase of TPBS tested positive in all; the first and second phases tested positive in 54 (90%) and 56 (93%) of the patients, respectively. Four of the 6 patients with a negative first phase had had symptoms persisting for more than 6 months, and the other 2 for about 3 to 6 months. No patient presenting within 3 months had a negative scan. SSR was absent in 16 (27%) patients and normal in 44 (73%). 11 (79%) of 14 patients who presented more than 6 months after symptom onset displayed an abnormal SSR, while only 10% of those presenting within 3 to 6 months and 11% of those presenting within 3 months had an abnormal SSR. 12 (75%) of the 16 patients with abnormal SSR had associated decreased sweating, compared with 2 (4.5%) of the 44 patients with a normal SSR.

CONCLUSION: TPBS is a very sensitive corroborative test to confirm the clinical suspicion of CRPS during the initial stages, but not in late cases. SSR can be used to document the sympathetic dysfunction in cases having an associated sweating abnormality and may have some diagnostic value in late cases of CRPS, when TPBS is less reliable.

PMID: 17200530 [PubMed - indexed for MEDLINE]

http://www.ncbi.nlm.nih.gov/pubmed/17200530

However, when applied to the lower extremities, an altogether different picture emerges. See, generally, Increased soft-tissue blood flow in patients with reflex sympathetic dystrophy of the lower extremity revealed by power Doppler sonography, Nazarian LN, Schweitzer ME, Mandel S, Rawool NM, Parker L, Fisher AM, Feld RI, Needleman L, AJR Am J Roentgenol. 1998 Nov;171(5):1245-50 at 1248:

Bone scintigraphy is, however, only 60% sensitive for lower extremity reflex sympathetic dystrophy and is more likely to be positive in the later clinical stages. [Emphasis added.]

ONLINE TEXT @ http://www.ajronline.org/cgi/reprint/171/5/1245 and citing, Scintigraphic patterns of the reflex sympathetic dystrophy syndrome of the lower extremities, Intenzo C, Kim S, Millin J, Park C, Clin Nucl Med. 1989 Sep;14(9):657-61:

Division of Nuclear Medicine, Thomas Jefferson University Hospital, Philadelphia, Pennsylvania 19107.

Abstract
Thirty-two patients with clinical signs and symptoms of the reflex sympathetic dystrophy syndrome (RSDS) of the lower extremities underwent Tc-99m MDP bone scintigraphy. Twenty-three patients had abnormal scan findings consistent with RSDS, while the scans of the remaining nine patients were normal. Of the 23 patients with abnormal scans, 19 demonstrated increased periarticular activity on early and delayed images, while 4 patients demonstrated decreased activity in the affected limb.

PMID: 2791420 [PubMed - indexed for MEDLINE]

http://www.ncbi.nlm.nih.gov/pubmed/2791420

I, for one, with bi-lateral lower extremity CRPS was burned by false-negative 3-phase bones studies taken roughly 6 months after the onset of my CRPS. In fact, the only thing approaching a significant "test result" early on in the course of the disease was my subjective reporting of going into an almost 10 day remission following the administration of my second lumbar sympathetic block, which, in contrast to the first attempt a week earlier, was applied bi-laterally.

And speaking of blocks, the key in all of this is early intervention and treatment. In a fresh cash of CRPS it is often possible to knock it out with an aggressive series of sympathetic blocks. And specifically in the the arm or hand, a Stellate Ganglion Block, a procedure in which under fluoroscopy a large amount of a local anesthetic (with or without a supplemental steroid) is injected by a pain specialist or an interventional radiologist at the top of the back, approximately where the cervical and thoracic spines transition; and for children the procedure would almost certainly be done under mild sedation. But there, time is absolutely of the essence. See, Efficacy of Stellate Ganglion Blockade for the Management of Type 1 Complex Regional Pain Syndrome, Ackerman WE, Zhang JM, South Med J. 2006; 99:1084-1088, ONLINE TEXT @ http://www.rsds.org/2/library/articl...lion_block.pdf:

Abstract
INTRODUCTION: The purpose of this study was to examine the efficacy of stellate ganglion blockade (SGB) in patients with complex regional pain syndromes (CRPS I) of their hands.

METHODS: After IRB approval and patient informed consent, 25 subjects, with a clinical diagnosis of CRPS I of one hand as defined by the International Association for the Study of Pain (IASP) criteria, had three SGB's performed at weekly intervals. Laser Doppler fluxmetric hand perfusion studies were performed on the normal and CRPS I hands pre- and post-SGB therapy. No patient was included in this study if they used tobacco products or any medication or substance that could affect sympathetic function. The appropriate parametric and nonparametric data analyses were performed and a p value <0.05 was used to reject the null hypothesis.

RESULTS: Symptom onset of CRPS I until the initiation of SGB therapy ranged between 3 to 34 weeks. Following the SGB series, patient pain relief was as follows: group I, 10/25 (40%) had complete symptom relief; group II, 9/25 (36%) had partial relief and group III, 6/25 (24%) had no relief. The duration of symptoms until SGB therapy was: group I, 4.6 +/- 1.8 weeks, group II, 11.9 +/- 1.6 weeks and group III, 35.8 +/- 27 weeks. Compared with the normal control hand, the skin perfusion in the CRPS I affected hand was greater in group I and decreased in groups II and III.

DISCUSSION: The results of our study demonstrate that an inverse relationship exists between hand perfusion and the duration of symptoms of CRPS I. On the other hand, a positive correlation exists between SGB efficacy and how soon SGB therapy is initiated. A duration of symptoms greater than 16 weeks before the initial SGB and/or a decrease in skin perfusion of 22% between the normal and affected hands adversely affects the efficacy of SGB therapy. [Emphasis added.]

PMID: 17100029 [PubMed - indexed for MEDLINE]

http://www.ncbi.nlm.nih.gov/pubmed/17100029

See, also, Complex regional pain syndrome type I: efficacy of stellate ganglion blockade, Istemi Yucel, Yavuz Demiraran, Kutay Ozturan, Erdem Degirmenci, J Orthopaed Traumatol (2009) 10:179–183, ONLINE TEXT @ http://www.ncbi.nlm.nih.gov/pmc/arti...Article_71.pdf

And the truth of the matter is that no single test can substitute for the clinitian's judgment. See, The incidence of complex regional pain syndrome: A population-based study, de Mos M, de Brijn AGJ, Huygen FJPM, Dieleman JP, Stricker BHC, Sturkenboom MCJM, Pain 2007;129:12-30, at 20:

Limitations in our study are related to the absence of a gold standard for the diagnosis of CRPS. As observed in the specialist letters, physicians focused on vaso- and sudomotor and motor-trophic signs, whereas the presence or absence of sensory and neurological symptoms was not frequently reported.

ONLINE TEXT @ http://www.rsds.org/2/library/articl..._pain_2006.pdf

And indeed, it is only the prompt exercise of informed judgment by an experienced clinitian that can make seeming magic like this possible: A Unique Presentation of Complex Regional Pain Syndrome Type I Treated with a Continuous Sciatic Peripheral Nerve Block and Parenteral Ketamine Infusion: A Case Report, Everett A, Mclean B, Plunkett A, Buckenmaier C, Pain Medicine 2009 Sep;10(6):1136-9. Epub 2009 Sep 9, ONLINE TEXT @ http://www.rsds.org/2/library/articl...n_Plunkett.pdf

Mike

Hi,

In my own opinion in some case like my own, I have CRPS 2, dx RSD and treatment is based on what type you have 1 or 2. PT was not the treatment for me is was only making it worse and it was torture, but until I found the proper doctors it was hell. Now that my RSD is somewhat under control I still have to deal with the 2 part. CRPS 2 is RSD with nerve damage. I had a serious accident had nerve damage too more than just one nerve and have titanium in my arm. So I don't just thinks it's a matter of just the RSD if it was it might be easier to correct. For me my RSD symptoms are still there and flare as a normal RSD person but the PN and the nerve damage is just as bad and very hard to correct.

From what I have read carpel tunnel surgery is a very easy way to get RSD. I would maybe get a second opinon.I have never heard of the acholol test, but think about it, your skin is pourus, if you pour acholol on it if there is one little break in the skin of course it's going to burn? I would question that. Maybe a very good teaching hospital I don't truly trust these pain clinics. Again, only my opinion. I have been through searching for doctors who will give me the right answers or at least be honest and have some real understanding of RSD. Which I did not find right away. But since 2004 to current I am with my same doctors who fixed my arm and the same Pain Managment Spec. I would not change I have to travel into Manhattan which for me could sometime be a 2-3 hour trip one-way due to traffic. If the president is in town I change my appt. I'll just never get there.

So to end we all want to feel better and get back to what life used to be so we have know choice but to trust these doctors. But it's better to wait and find the correct doctor then pick one who says he knows what he is doing and really does not. I came so close to having procedures done by different doctors that would of definitly have made be worse. I think a slow conversative approach is better. Believe me it was hard to think this way in the beginning because my whole life had changed and to be honest I just could not handle it. It was my husband and father would kept saying let's just get one more opinion and that last one was the one. Thank god for family.

Good luck Gabbycakes