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Sunday, May 26, 2013

Integrated Solutions to CRPS Conference Notes (Part II)

I had a great time learning from these very dedicated people to help patients with Complex Regional Pain Syndrome, aka RSD (Reflex Sympathetic Dystrophy).

Integrated Solutions to CRPS 
May 10, 2013
 San Francisco, California

Integrated Solutions to CRPS is a conference created for people just like you. Individuals with CRPS, friends, family, and caregivers of the CRPS community are invited to attend. The RSDSA, along with the help from generous sponsors, has assembled a friendly forum where you and experts in the CRPS field will spend the day sharing valuable information and exploring new solutions to help manage CRPS.  You will have the opportunity to talk to and network with members of the RSDSA and others who experience what you do, day after day.

My notes (continued):

2 deg temp difference between the good and bad extremity is a common diagnostic tool early in the syndrome, with the injured side either hotter or colder

Patients often complain of the symptom of disturbed body perception
Www.trendconsortium.nl is an incredible website to explore for help from the netherlands
50,000 new cases per year in the US
Tests not helpful (including xrays, MRIs, Nerve Conduction Tests)
The physician carefully taking a detailed history and performing a physical examination is the best diagnostic test     

It is very important to Start immediately treating the condition
This is a syndrome typically treated by Pain Management Specialists (Physiatrists, Anesthesiologists, Neurologists)

Treatment is for restoring function, not pain reduction. The emphasis has to be on getting back a life lost with this incredible pain. True suffering occurs with CRPS. 
PT must start below level of pain, then progress slowly and gradually. 

What type of medications can help?
Glial Cell Attenuators are needed to calm down the inflammation in the Glia cells.    Minocyline, propentofylline are glial cell attentuators that can help.

Opioids increase glial cell activity--patients taking opioids initially feel much improvement, then need more and more and more without gaining relief. Important to get CRPS patients off opioids. 

Low dose naltrexone good 1 to 4.5 mg as a glial cell attenuator with little to no side effects

IV Ketamine is the main stay of invasive treatments
    Many ways to administer, orally most side effects since have to take higher dose
Usually IV Ketamine in an Infusion center starting with  low dose over a 4 hour period. The dose is gradually increased  over 10 days. The effect is documented. 
Booster at 2 weeks for 1-2 days and then at 4 and at 6 weeks

Patients should be given sublingual Ketamine for flare
http://rsdadvisory.com/ketamine-iv-vs-nasal-spray-or-sublingual/

Topical Ketamine only helps initially when the pain is just starting and not when gets into CNS (called centralization), yet it does help skin lesions that may develop at any time during the process

Nerve blocks low help, potential of harm
SCS  (Spinal Cord Stimulators) are painful and expensive , 30% complications
    Improve quality of life for 2 years only

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Thank you very much for leaving a comment. Due to my time restraints, some comments may not be answered.I will answer questions that I feel will help the community as a whole.. I can only answer medical questions in a general form. No specific answers can be given. Please consult a podiatrist, therapist, orthopedist, or sports medicine physician in your area for specific questions.