© Therapeutic Pain Management Medical Clinic 2016 - Site created by Dr. Dhruva 1335 Buenaventura Blvd, Ste 100, Redding, CA 96001. T: (530) 247-7246; (530) 24-7-P-A-I-N.   F: (530) 245-0849   email: mail@TPMclinic.com
Therapeutic Pain Management Medical Clinic (TPM) Improving Quality of Life
  RSD (Reflex Sympathetic Dystrophy)/CRPS (Complex Regional Pain Syndrome) FAQs The   following   Frequently   Asked   Questions   and   the   answers   are   for   the   RSD/CRPS.   The   following   material   is   given   as   general   information   only,   and   is   not   to   be considered as medical advice or consultation. The information was prepared by Dr. Dhruva. What is RSD/CRPS? RSD/CRPS   is   a   condition   some   people   will   develop   where   the   pain   persists   beyond   the   normal   expected   duration,   pain   is   out   of   proportion   to   the   injury,   pain   is associated   with   swelling,   stiffness,   color   changes,   coldness,   excessive   sweating   of   the   affected   area,   and   increased   sensitivity   to   touch,   pressure   or   painful stimulation. Do I have to have all of the above to have the diagnosis of RSD/CRPS? No, but the majority of the patients will have several (if not all) of the above symptoms. Is there a test to prove or disprove that I have RSD/CRPS? No, there is no single diagnostic test.  The diagnosis of this condition is based upon your symptoms, history of injury/surgery, and clinical evaluation. Why did I get RSD/CRPS? There   is   no   satisfactory   explanation   why   some   people   get   this   and   some   don’t.      It   is   not   hereditary,   infectious,   or   contagious   etc.   People   who   develop   RSD/CRPS may be prone to developing this condition after injury or surgery. What can cause this? In   majority   of   the   cases,   injury   (such   as   sprained   ankle   or   knee),   or   surgery   (such   as   Carpal   Tunnel   Surgery,   knee   arthroscopy)   is   the   precipitating   event   of   this condition. I have been diagnosed as having RSD/CRPS in my right ankle/leg, can it spread to other areas? Unfortunately, untreated RSD can in some cases spread to other areas of the same limb, as well as other limbs.  There is no predictability of this spread. How can this be treated? The   main   treatment   of   this   condition   is   continued   use   of   the   affected   limb   to   maintain   mobility,   strength,   improve   blood   flow   and   prevent   atrophy.      This   is achieved   with   patients   continuing   to   use   the   limb   to   their   best   ability,   while   we   control   your   pain   and   other   symptoms   with   medications   and   injections   –   as necessary. Why can’t I just have pain killers so that I can use affected the limb? Painkillers   (pain   meds)   are   a   part   of   the   whole   treatment   regimen.      This   condition   has   “neuropathic   pain”   and   traditional   painkillers   alone   will   not   control   the pain. What medications are helpful for treatment? For   most   patients,   anti-seizure   medications   such   as   Neurontin   or   Lyrica,   pain   medications   such   as   Cymbalta   or   Tramadol   (Ultram),   and   other   medications   such   as Elavil,   Lidoderm,   etc   are   prescribed.      Not   all   benefit   from   the   same   medications.      The   treatment   is   aimed   at   controlling   neuropathic   pain   and   reducing sympathetic nerve hyperactivity. Why do have color, temperature changes and increased sweating? This   condition   usually   is   associated   with   random   hyperactivity   of   “sympathetic   Nervous   System”.      The   sympathetic   nerves   normally   control   temperature,   blood flow, and sweating.  Increased activity of these nerves therefore causes these symptoms. So what are sympathetic nerve blocks? (Lumbar or Cervical)? These   blocks   are   injections   of   local   anesthetics   (like   Novocain)   to   make   the   sympathetic   nerves   non-functioning   for   several   hours.      The   sympathetic   nerves,   which control   lower   limbs,   are   located   in   the   back   and   the   ones   controlling   upper   limbs   are   located   in   the   neck   (Stellate   Ganglion   Blocks).   Please   see   FAQs   on   Stellate Ganglion Blocks or Lumbar Sympatheitc Blocks. Will these injections cure me? No,   the   injections   alone   by   themselves   will   not   “cure”   your   condition.      These   injections   are   performed   so   that   while   the   sympathetic   nerves   are   made   temporarily non-functional,   you   can   use   your   affected   limb   quite   actively   –   to   increase   mobility   and   get   muscle   strength   back.      Most   of   the   time   the   blocks   are   followed immediately by vigorous physical therapy. Will the injections help all patients with RSD? They   are   generally   is   beneficial   for   patients   who   have   significant   hyperactivity   of   the   sympathetic   nerves.      Some   of   the   RSD/CRPS   patients   may   have   normal activity of sympathetic nerves and so these injections may not be beneficial for them. What is my prognosis?  Will I be cured? It is difficult to say. However, in general, if the treatment is initiated within the first 6 months of injury, the prognosis can be favorable. Is there anything I can do to improve my condition? Yes,   it   is   extremely   important   to   avoid   any   further   injury   to   affected   limb,   avoid   painful   physical   therapy,   and   avoid   additional   surgery   –   unless   absolutely necessary.  If you need to have surgery, please talk to your surgeon and anesthesiologist about options to prevent flare-up of your RSD/CRPS. Are there other treatment options – other than pills and injections? Yes,   Spinal   Cord   Stimulation   is   quite   beneficial.      Evidence   based   medicine   now   has   shown   tremendous   benefits   with   this   type   of   treatment.      However,   it   involves implanting wires etc and is expensive.  So, it is generally used when other treatments fail.
© Therapeutic Pain Management Medical Clinic 2016 Web designed and  created by Dr. Dhruva
Therapeutic Pain Management Medical Clinic Improving Quality of Life
  RSD (Reflex Sympathetic Dystrophy)/CRPS (Complex Regional Pain Syndrome) FAQs The   following   Frequently   Asked   Questions   and   the   answers   are   for   the   RSD/CRPS. The   following   material   is   given   as   general   information   only,   and   is   not   to   be considered   as   medical   advice   or   consultation.   The   information   was   prepared   by Dr. Dhruva. What is RSD/CRPS? RSD/CRPS   is   a   condition   some   people   will   develop   where   the   pain   persists   beyond the   normal   expected   duration,   pain   is   out   of   proportion   to   the   injury,   pain   is associated   with   swelling,   stiffness,   color   changes,   coldness,   excessive   sweating   of the    affected    area,    and    increased    sensitivity    to    touch,    pressure    or    painful stimulation. Do I have to have all of the above to have the diagnosis of RSD/CRPS? No,   but   the   majority   of   the   patients   will   have   several   (if   not   all)   of   the   above symptoms. Is there a test to prove or disprove that I have RSD/CRPS? No,   there   is   no   single   diagnostic   test.      The   diagnosis   of   this   condition   is   based upon your symptoms, history of injury/surgery, and clinical evaluation. Why did I get RSD/CRPS? There   is   no   satisfactory   explanation   why   some   people   get   this   and   some   don’t.      It is   not   hereditary,   infectious,   or   contagious   etc.   People   who   develop   RSD/CRPS may be prone to developing this condition after injury or surgery. What can cause this? In   majority   of   the   cases,   injury   (such   as   sprained   ankle   or   knee),   or   surgery   (such as   Carpal   Tunnel   Surgery,   knee   arthroscopy)   is   the   precipitating   event   of   this condition. I   have   been   diagnosed   as   having   RSD/CRPS   in   my   right   ankle/leg,   can   it spread to other areas? Unfortunately,   untreated   RSD   can   in   some   cases   spread   to   other   areas   of   the same limb, as well as other limbs.  There is no predictability of this spread. How can this be treated? The   main   treatment   of   this   condition   is   continued   use   of   the   affected   limb   to maintain   mobility,   strength,   improve   blood   flow   and   prevent   atrophy.      This   is achieved   with   patients   continuing   to   use   the   limb   to   their   best   ability,   while   we control    your    pain    and    other    symptoms    with    medications    and    injections    –    as necessary. Why can’t I just have pain killers so that I can use affected the limb? Painkillers   (pain   meds)   are   a   part   of   the   whole   treatment   regimen.      This   condition has “neuropathic pain” and traditional painkillers alone will not control the pain. What medications are helpful for treatment? For   most   patients,   anti-seizure   medications   such   as   Neurontin   or   Lyrica,   pain medications   such   as   Cymbalta   or   Tramadol   (Ultram),   and   other   medications   such as    Elavil,    Lidoderm,    etc    are    prescribed.        Not    all    benefit    from    the    same medications.        The    treatment    is    aimed    at    controlling    neuropathic    pain    and reducing sympathetic nerve hyperactivity. Why do have color, temperature changes and increased sweating? This   condition   usually   is   associated   with   random   hyperactivity   of   “sympathetic Nervous   System”.      The   sympathetic   nerves   normally   control   temperature,   blood flow,   and   sweating.      Increased   activity   of   these   nerves   therefore   causes   these symptoms. So what are sympathetic nerve blocks? (Lumbar or Cervical)? These    blocks    are    injections    of    local    anesthetics    (like    Novocain)    to    make    the sympathetic   nerves   non-functioning   for   several   hours.      The   sympathetic   nerves, which   control   lower   limbs,   are   located   in   the   back   and   the   ones   controlling   upper limbs    are    located    in    the    neck    (Stellate    Ganglion    Blocks).    Please    see    FAQs    on Stellate Ganglion Blocks or Lumbar Sympatheitc Blocks. Will these injections cure me? No,   the   injections   alone   by   themselves   will   not   “cure”   your   condition.      These injections    are    performed    so    that    while    the    sympathetic    nerves    are    made temporarily   non-functional,   you   can   use   your   affected   limb   quite   actively   –   to increase   mobility   and   get   muscle   strength   back.      Most   of   the   time   the   blocks   are followed immediately by vigorous physical therapy. Will the injections help all patients with RSD? They   are   generally   is   beneficial   for   patients   who   have   significant   hyperactivity   of the    sympathetic    nerves.        Some    of    the    RSD/CRPS    patients    may    have    normal activity   of   sympathetic   nerves   and   so   these   injections   may   not   be   beneficial   for them. What is my prognosis?  Will I be cured? It   is   difficult   to   say.   However,   in   general,   if   the   treatment   is   initiated   within   the   first 6 months of injury, the prognosis can be favorable. Is there anything I can do to improve my condition? Yes,   it   is   extremely   important   to   avoid   any   further   injury   to   affected   limb,   avoid painful    physical    therapy,    and    avoid    additional    surgery    –    unless    absolutely necessary.        If    you    need    to    have    surgery,    please    talk    to    your    surgeon    and anesthesiologist about options to prevent flare-up of your RSD/CRPS. Are there other treatment options – other than pills and injections? Yes,   Spinal   Cord   Stimulation   is   quite   beneficial.      Evidence   based   medicine   now   has shown   tremendous   benefits   with   this   type   of   treatment.      However,   it   involves implanting    wires    etc    and    is    expensive.        So,    it    is    generally    used    when    other treatments fail.