HA! Pain meds do not make rsd spread, the pain signals traveling from screwed up nerve ending to our spine and back again makes it spread!!!!!

Keep saying no to WC!!! I have known quite a few people who went to these so-called pain clinics and they were treated like crap. They were in agony, no one cared. There is NO reason whatsoever for you to "detox" off your meds, ever! Not to do this. It serves no purpose at all except as torture. It is modern day torture!

It's all just BS. I'm so sorry they're doing this to you. Wish I had more to give you than *hugs* but I know you appreciate them. :-)

*Lots and Lots of Big Hugs*

Karen

Dear Jannelle -

Whike I agree with everyone else that there is no evidence linking narcotics to RSD spread, you should be aware that there is plenty of evidence to support the proposition that too much opioid consumption may result in a condition called hyperalgesia, which "has been recognized as a potential form of central sensitization in which a patient's pain level increases in parallel with elevation of his or her opioid dose." See, Significant pain reduction in chronic pain patients after detoxification from high-dose opioids, Baron MJ, McDonald PW, J Opioid Manag. 2006 Sep-Oct;2(5):277-82, free full text at http://www.rsds.org/2/library/articl...n_McDonald.pdf, the abstract of which follows:

Opioid tolerance is a well-established phenomenon that often occurs in patients taking opioids for the treatment of chronic pain. Typically, doctors need to periodically elevate patients' opioid doses in an attempt to manage their underlying pain conditions, resulting in escalating opioid levels with only moderate to negligible improvement in pain relief. Recently, opioid-induced hyperalgesia has been recognized as a potential form of central sensitization in which a patient's pain level increases in parallel with elevation of his or her opioid dose. Here, we report a retrospective study of patients undergoing detoxification from high-dose opioids prescribed to treat an underlying chronic pain condition which had not resolved in the year prior. All patients were converted to ibuprofen to manage pain, with a subgroup treated with buprenorphine during detoxification. Self-reports for pain scores were taken at first evaluation, follow-up visits, and termination. Twenty-one of 23 patients reported a significant decrease in pain after detoxification, suggesting that high-dose opioids may contribute to pain sensitization via opioid-induced hyperalgesia, decreasing patient pain threshold and potentially masking resolution of the preexisting pain condition.

PMID: 17319259 [PubMed - indexed for MEDLINE]

That maybe what they were referring to. But the question becomes whether your narcotic use is high enough to tigger even hyperalgesia in the first place? (And keeping in mind that if your therapists have any connection with the University of Washington, they will definitely be of the "grin and bear it school of thought.)

Ind fact, instead of complete withdrawl form opioids, the more enlightened view seems to be that of opioid rotation, where when a level of a narcotic (Oxycontin, Morphine, Fentanyl, etc.) is no longer working, instead of increasing the dose and inviting more problems, you're just switch out the one narcotic to another, without increasing the overall amount of opiods you're on. See, e.g., Opioid rotation from high-dose morphine to transdermal buprenorphine (Transtec) in chronic pain patients, Freye E, Anderson-Hillemacher A, Ritzdorf I, Levy JV, Pain Pract. 2007 Jun;7(2):123-9. Heinrich-Heine-University Clinics, Moorenstrasse, Düsseldorf, Germany. enno.freye@uni-duesseldorf.de

And here's the abstract:

Opioid rotation is increasingly becoming an option to improve pain management especially in long-term treatment. Because of insufficient analgesia and intolerable side effects, a total of 42 patients (23 male, 19 female; mean age 64.1 years) suffering from severe musculoskeletal (64%), cancer (21%) or neuropathic (19%) pain were converted from high-dose morphine (120 to >240 mg/day) to transdermal buprenorphine. The dose of buprenorphine necessary for conversion (at least 52.5 microg/h) was titrated individually by the treating physician. No conversion recommendations were given and the treating physician used his or her own judgment for dose adjustment. Pain relief, overall satisfaction and quality of sleep (very good, good, satisfactory, poor, or very poor), and the incidence and severity of adverse drug reactions over a period of at least 10 weeks and up to 1 year was assessed. Following rotation, patients experiencing good/very good pain relief increased from 5% to 76% (P < 0.001). Only 5% reported insufficient relief. Relief was achieved with buprenorphine alone in 77.4%, while 17% needed an additional opioid for breakthrough pain. Sleep quality (good/very good) increased from 14% to 74% (P < 0.005). Adverse effects were reported in 11.9%, mostly because of local irritation, did not result in termination of therapy. Neither tolerance nor refractory effect following rotation from morphine to buprenorphine was noted. Conversion tables with a fixed conversion ratio are of limited value in patients treated with high-dose morphine.

PMID: 17559481 [PubMed - indexed for MEDLINE]

I hope this is helpful. And good luck!

Mike

Jennelle,
I feel for you. I am dealing with WC too right now. I have never had pain meds, I am left to deal with it on my own. I was told the only thing the pm Dr could do for me was nerve blocks. After 6 of those and only lasting about a wk and a half it all came back worse. Now he has put me on Lyrica. As I was increasing the dosage my tremor was getting worse (pm Dr claims he knew nothing of a tremor-nothing written in his notes yet the PT,hand spec. and nurse during one of the nerve blocks all saw it)he then decreaed the dosage but now today wants to double it. I am still in PT but both the Dr and WC ins co. said finish in 4 more sessions. I do have a lawyer now that I am going to call tomorrow, the therapist thinks I should also have been on anti-inflammatories and something to deal with the pain and that I need more therapy. I still don't have full function in my hand but the Dr doesn't even check that. WC sucks. I am scheduled for an FCE in 2 wks so they can see what I can do, so they can get me back to wk and off wc I guess. I am planning on getting in to my pcp and seeing what they say (not sure who will cover that;my ins or wc?). I feel like I have no say in my care either.

Back to your problem; I wouldn't go to the pain clinic. Get your lawyer and pcp to speak up. I have to try doing the same for myself, I'm just not good advocating for myself. My rsd has spread from my original injury in my thumb to my hand and all the way up my arm and I haven't had narcotics.
I'm just wishing I would wake up from this nightmare.

Hi stressout,
I can't tell you how disturbed I am over your WC care of you, or rather lack of car. The only option they gave you were the blocks. That means to me, they are responsible for the outcome of the blocks.-----spread of RSD. There are many on the forum that have had bad results from blocks. In my opinion this PM Dr. doesn't know what he is doing. He doesn't sound confident in his treatment. Everyone knows how important it is to take care of the pain and sleep. Our condition worsens without these two elements being taken care of. Meds do not spread RSD! period As far as physical therapy, it was only because of physical therapy, I got the use of my left arm back after surgery and getting RSD the day following surgery. It took 100 treatments. They wanted to operate on my shoulder, but I said NO. I had private insurance. This was about after 50 treatments. and I was paying for 50 massage treatments to soften my shoulder and get more out of the p.t. I called my insurance company and told them my rehab Dr. that I was sent to after the surgery induced RSD sent me to orthopedic surgeon and he wanted to break my shoulder during surgery. I told them I would still need physical therapy after 'this' surgery. I told them I choose to have p.t. and massage therapy for my frozen shoulder and I could choose surgery or massage therapy with my pt. The agent said just a minute----came back to phone and said send your massage therapy bills to us, we'll pay them. I'm glad you have an attorney. WC is doing you a great disservice, actually putting themselves liable for your worsening condition. Document everything that goes on with your Drs., like your spasms and them not being in the notes. That's not OK
It's not OK that you are not given pain meds for RSD. There are others meds too, that my Dr. has given me to reduce nerve pain. Anti=depressants help greatly with nerve pain. anti-seizure meds help with nerve pain and can completely do away with spasms, jerks electric jolts, anti-anxiety meds help greatly to reduce anxiety and keep your system calmer, thus pain is reduced. I have not increased my 'pain' med, vicodin in strength or amount in over 5 years. Because I'm sleeping good now, my Dr. cut my anti=anxiety med in half, and I'm taking 5 vicodin instead of 6.
I'm sorry you are having to deal with WC, but let your good attorney take the stress off you and call the shots. Keep a record of what he needs to know, and tell him what is happening. Being in pain creates more pain and activity of the sympathetic nervous system, like spread. Hope the best for you, stay with us, we all need support. Soft hugs, loretta smiley face