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Saturday, April 18, 2015

Post Cortisone Shot in CRPS patient: Email Correspondance


Dr Blake's comment: This patient developed CRPS after a cortisone injection for a neuroma. She has had quite a journey with many ups and downs. Calmare Pain Therapy has been crucial in her treatment to quiet the nervous system. This email was followup to a cortisone shot I just gave her to shrink down a Morton's Neuroma left foot now that her symptoms are not systemic, but more local. We both realize that the neuroma was producing a chronic amount of neural tension in her body, and needed to be somehow addressed. 

Dear Dr Blake: 
It went very well! The pain stayed away all that day till 5 pm (shot given around 10 am was a mixture of local anesthetic 0.5% Sensorcaine and long acting Cortisone Kenalog 10).

Since then I have had some minor flare, but less flare than with any other shot in the past (including pre-CRPS shots)! Only a few cruel "zings" up the leg, and locally increased burning in a 2-inch diameter around the injection site, and also strong burning in 3rd and 4th toes. But completely tolerable.

I think the flare is calming down today and by this weekend I'll be completely in the "benefit" stage of it. I hope it allows me to walk longer/farther and increases my standing tolerance too.

From my lay-person experience, I recommend the combo of Synera patch 30 minutes before injection (placed on the top and bottom of her foot)and a single 5 mg dose of Valium for anyone who has CRPS or you think is at risk of CRPS—just to minimize the sympathetic activation around the experience. Maybe add 10 mg of Nortriptyline the night before and the night after, for even more suppression of nerve pain, so that the CRPS cycle doesn't get started.

Thank you so much for all your care and expertise. You are the only person I would ever let inject my foot!

Would you tell me what drugs/dose were in my shot? (see above--1 ml of each). I am considering an occipital nerve root block next week, and the doctor wants to know how much cortisone I got this week to make sure it's not too much in my body (even though in a totally different place).

I'll report in next week to let you know the longer-term benefits of the shot.

With much gratitude,

Further patient comment:

     Hi Dr. Blake,

I am doing well now.

It took about two and a half weeks for the flare from the shot to calm down! Longer than I expected. But the amplitude of the flare was not bad, so I was not in cruel agony like in past years. 

So now I will see if I can up my walking tolerance even more, and/or begin to wear a shoe. The Oesh brand shoes do seem really good for neuromas, you might want to check them out. But my foot is still hypersensitive enough that I dread wearing any shoe. Still, I know it is not ideal mechanics to walk in flip flops—there is some constant toe flexion to hold the shoe on—so it would be better if I could wear a closed shoe, or at least a sandal with a strap around the heel, if I could find one with a comfortably cushioned footbed.

I just met with one of the directors of the pain dept at Kaiser to see if I could get them to buy a Scrambler machine, but there are all the same obstacles there. I'll let you know if I make any progress on that front.

Hope you are well!

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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.