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Thursday, September 13, 2012

Complex Regional Pain Syndrome: Developing a Plan

I am treating many patients right now with a diagnosis of Complex Regional Pain Syndrome. It is a very difficult topic, and one I have known for a while I needed to present somewhat on my foot blog. It is a gross understatement to say I am treating them, since they can only be treated by a team of people since it is too complex. The most important person on that team is the patient, and they really call the shots. If you are given that diagnosis, also known as Reflex Sympathetic Dystrophy or RSD, and others, you are scared. The doctors and therapists who treat you are scared for you. The quicker the response that better, but even those whose diagnosis is made at a snail's pace can get better. I love to see these patients every 2 weeks since there is so much to do and get organized. The visits should be a constant exploration and expansion of these Mainstays of Treatment: Identifying the source of pain, completely eliminating the pain cycle, nutrition, rehabilitation of limb function, being as productive as possible, and handling comorbidities of anxiety and depression. I hope this summary does help those suffering make sure nothing is being forgotten, and every visit to the managing doc is as productive as possible. Rich

The Mainstays of Treatment are:

·       Identifying Source of Pain
1.      MRI/CT Scans
2.      Bone Scan
3.      Diagnostic Injections (local or back)
4.      Nerve Conduction Studies
5.      Lab Tests
§         Sed Rate
§         CBC
§         Free T4 and TSH
§         Vit B12 Levels
§         HgbA1c
§         Morning Fasting Blood Sugars

·       Completely eliminating/breaking the Pain Cycle
1.     Mechanical Means
§         Roll A Bout
§         AFO
§         Crutches
§         Tibia Wt Bearing Braces
§         Activity Modification
§         Custom Made Orthotics to stabilize an injured area

2.     Oral Medications
§         Anti-Seizure (ie Lyrica)
§         Anti-Depressant (ie Nortriptyline)
§         Others through Pain Management Specialists

3.      Topical Medications/Applications (should be gels for ease of application)
§         Warm Compresses
§         Non Painful Massage
§         Parafin Wax
§         Chinese Herbs
§         Lidoderm Patches
§         Neuro-Eze
§         Multiple Compounding Medications which include (usually not all of these):
ü      Ketamine 10%
ü      Clonidine 0.2%
ü      Gabapentin 6%
ü      Baclofen 2%
ü      Nifedipine 2%
ü      Lidocaine 2%

4.     Alternative
§         Biofeedback (Thermal to increase circulation)
§         Hypnosis
§         Meditation
§         Accupuncture (can be to opposite limb or ear)

·       Nutritional (next 3-12 months)
1.      Lipoic Acid 300mg 2x/day
2.      Acety-L-Carnitine 2000 mg/day
3.      Inositol 500-1000mg/day
4.      Vit B6 50mg/day
5.      Vit B12 1000mg/day
6.      Vit E (up to 1,600units/day)
7.      Thyroid Natural Supplements

·       Rehabilitation of Limb Function
1.      Lower Extremities (keep strong as long as painfree)
2.      Core (support feet and legs from above with less pressure on feet overall)
3.      Cardio (improve overall circulation and health)
4.      Whole Body (must address physical, emotional, spiritual sides together)

·       Being as Productive as Possible (while nerves are healing) Can Help Nerves Heal Faster
1.      Part Time Work
2.      Volunteer
3.      Projects

·       Dealing with CoMorbities of Anxiety and Depression

Possible Sources of Information/Support/Inspiration
ü      American Chronic Pain Association
ü      American Academy of Pain Management
ü      Reflex Sympathetic Dystrophy Syndrome Association
ü      How To Cope With Pain blog

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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.