NeuroTalk Support Groups - Are Nerve Blocks really worth it?

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- Reflex Sympathetic Dystrophy (RSD and CRPS) (https://www.neurotalk.org/reflex-sympathetic-dystrophy-rsd-and-crps-/)

- - Are Nerve Blocks really worth it? (https://www.neurotalk.org/reflex-sympathetic-dystrophy-rsd-and-crps-/90221-nerve-blocks-worth.html)

Quote:

Originally Posted by fmichael (Post 525866)

Pete -

I agree that the data is sparce, but the is evidence that patients starting blocks within a few weeks of the onset of CRPS had significant relief lasting two weeks after the last injection. "Efficacy of Stellate Ganglion Blockade for the Management of Type 1 Complex Regional Pain Syndrome," Ackerman WE, Zhang JM, South Med J. 2006; 99:1 084-1088 at 1087, free full text at http://www.rsds.org/2/library/articl...lion_block.pdf

Patients who had early SGB treatment following
the onset of their symptoms had significantly better
pain relief following SGB therapy (r = 0.9).

This is consistant with studies strongly suggesting that low dose ketamine can have lasting effects, if and only if initiated within a few weeks of the advent of symptoms. For a good comparision of the results of several studies, see the "Discussion" section of "A Pilot Open-Label Study of the Efficacy of Subanesthetic Isometric S(+)-Ketamine in Refractory CRPS Patients," Kiefer RT, Rohr P, Ploppa A, et al, Pain Med. 2008; 9(1):44-54, 50- 53, free full text at http://www.rsds.org/2/library/articl...ohr_Ploppa.pdf. And for anyone who doubts that proposition, read one of the greatest studies ever published, "Subanesthetic Ketamine Infusion Therapy: A Retrospective Analysis of a Novel Therapeutic Approach to Complex Regional Pain Syndrome," Correll GE, Maleki J, Gracely EJ, Muir JJ, Harbut RE, Pain Med. 2004; 5:263-275, free full text at http://www.rsds.org/2/library/articl...V_Ketamine.pdf.

Something significant is clearly going on here.

Makes one want to have the level of care that I understand is available in Germany, where local anesthetic is pumped for some time into the affected area, immediately upon the advent of symptoms.

Mike

Mike
You are, as always correct.
See they didn't do this to me, until at least 7 years after the accident that initiated the RSD.
So, I forgot to add that into the "diagram" of treatment....
Yet, the blocks for my lower extremities, were on time, and did the same nothing.
It's all for one!
Each of us reacts differently.
I suppose
that
the best I mean to say is,
If it doesn't work for you,
don't keep going back, and back, and back!

You'll know after a try or two. I think?

That's all......

Pete
Asb

Thanks Mike!

This has been posted many times before, but for a great article, written for laymen, on the use of continuous regional anesthesia on the battlefield in Iraq, and the amazing results they have had with it, check out Silberman S. The Painful Truth. Wired Magazine. 2005 February;13(02). Available at http://www.wired.com/wired/archive/13.02/pain.html?pg=6.

And note to Karen: I just amended my last post (after Pete had captured it for his reply) to address the point on SIP that you had made earlier.

I had a series of 7 SGB in Boston at St. E's - the first was Christmas Eve, the last one was May 11th. When my doctor administered the last block, he used more medication than he had in previous blocks with the notion that it would be my last, because he was referring me to the Beth Israel where he thought I would be accepted into their low dose ketamine program (a disastrous appt for me - I still cry about the monstrous docs I had the misfortune to meet, and the fact that meds exist that can help me that I'll never be able to get. Life is truly not fair.)

In any case, the 7 blocks gave me about 6 months of relief from many of my symptoms. My life wasn't perfect, but it was so much better than it is now. Since the last block wore off, I am flaring out of control so that even my Methodone isn't helping my head pain much anymore. I took a medical leave of absence from work as of last friday.

The last block may have caused my RSD to spread to leg, or perhaps it was going to spread anyway - I'll never know. But I am sure that I now have RSD in my right leg.

I am heading back to St. E's on Tuesday. After I have an MRI of my back, I may have a lumbar block done. And perhaps I'll have another SGB done to help my head. I don't know if they'll do both. But I do know that I would rather live without the pain and other symptoms, even for a period of just 3 weeks, than live like this.

Sandy

I'm sorry to get in here late.

I just thought I would add some thoughts from my experiences.

In 2002-2003 I had numerous lumbar sympathetic blocks, so many I lost count. Yes they ultimately lost their effectiveness but I did have a terrific summer and made it through my wedding and honeymoon in a remission like state.

AJ, if it is possible to find a doctor who can give you a continuous week long peripheral block as described in the article Mike posted you may have a chance at keeping this monster at bay.

I wish you all the best.

MsL

Hi
I just wanted to add a short post to say that I don't exactly know what sort of blocks you had. If you had lumbar sympathetic blocks then you shouldn't have experienced any loss of sensation of movement if they were properly placed and carried out using a continuous x-ray to watch for the correct placement site.

Nerve blocks are not the same as these sympathetic lumbar blocks and are placed completely differently. They can cause loss of sensation.

I suggest you check the type of block you actually had done and, if you think it was suppposed to be a lumbar sympathetic block then try to find out if you can get someone else to do one for you (even just one) to see how you get on.

I beg to differ gymjunkie.

It is my understanding that a lumbar sympathetic block is just one of many various types of nerve blocks available.

AJ specifically asked about lower lumbar sympathetic blocks which I have experience with.

Quote:

What is a Lumbar Sympathetic Block?

Lumbar Sympathetic Block is an injection of local anesthetic in the "sympathetic nerve tissue" – the nerves which are a part of Sympathetic Nervous System. The nerves are located on the either side of spine, in the back.

What is the purpose of it?

The injection blocks the Sympathetic Nerves. This may in turn reduce pain, swelling, color, and sweating changes in the lower extremity and may improve mobility. It is done as a part of the treatment of Reflex Sympathetic Dystrophy (RSD), Sympathetic Maintained Pain, Complex Regional Pain Syndrome, and Herpes Zoster (shingles) involving lower extremity.

Perhaps I'm missing something but that sounds like a nerve block to me.

http://www.reddinganesthesia.com/LSB%20faq.htm

MsL

Mslday
There are all sorts of different types of nerve block that can be done for different reasons - both diagnostic and therapeutic. That was why I asked about the type of block the OP had had done. I think you have misunderstood since I was actually saying exactly the same as you - that there are many different types of nerve block done in different places, for different reasons and which produce different effects and potential side effects.

I have had the same type of block (lumbar sympathetic block) that you are describing so you are not the only one with experience to share here.

Follow-Up on Block

First I want to say thanks for all of the great feedback! All of you are awesome!!

Karen... you explained the SMP and SIP so perfectly (thank you!). I was at a loss on how to explain that part of our conversation but that is what he said he was concerned about... that the nerve damage was SIP. What he was talking about now makes perfect sense!

Anyway, one week since my (lower lumbar sympathetic nerve block) and I have had a change in my pain pattern but not the good change we had hoped for. The block has made my entire leg very angry… mornings it's subzero with purple toes and ankle then by afternoon, intense swelling, burning heat and the pain deep in my bones has been off the chart. The spasms and twitching has never been this bad. :(

He called me yesterday to get a 7 day progress report, he said that he feared I was not going to respond very well to the procedure but we had to complete the series of blocks (3/3) to know for sure that blocks will not help me. The next plan of treatment is RF - Radiofrequency Ablation/Lesioning. He is nationally known both in the US and Canada for this procedure and said he has had good responses with RSD patients with SIP nerve damage. He really thinks this will help me.

So, I am now researching this one (I guess I should start a new thread on this procedure)!:confused:

All I know is that the past 7 days have been really rough! I am so tired of hurting and was not expecting this type of negative response from my leg. I guess I am emotionally disappointed… This monster is wearing me out!!!! :eek:

Just from reading what y'all have posted, there's no way I'm going to have some (insert derogatory comment here) poke me to see what happens. Wow. Fer-get that. Ma pills pretty well set the pain back, and I'll be happy with that, thank you very much.

Greetings: I have had three nerve blocks and none of them have really helped me. the third one had a steroid in it and lasted about 1 wk. I don't believe that they are worth the time, discomfort and money unless they are working well for you. I have been using something that I got on the internet called DMSO. A fellow at my church said that he has been using it for pain relief for 40 years. If you can, get your doctor to give you some cortizone (10 to 1; mostly DMSO), it could help further. I haven't gotten the cortizone yet. I am 9 months into my RSD. Good luck to you.:)