Complex regional pain syndrome (CRPS) describes excessive pain and inflammation of an arm or a leg following injury. The pain is much greater than would be expected; even a mild touch is excruciating. There are often other symptoms in the affected area, such as swelling, skin discoloration, changes in skin texture, changes to skin temperature, muscle weakness, and an inability to move that body part.
The severity and duration of symptoms vary from person to person. Some cases resolve quickly, others last years. Treatment is most effective if it starts early. Medications or therapies are customized to the individual’s situation. Some options include over the counter pain relievers, anti depressants, corticosteroids, topical analgesics, physical therapy, and alternative medicine.
Our office treats CRPS through two procedures: nerve blocks and spinal cord stimulation. With a nerve block, anesthetic is injected into the affected nerves to relieve pain. Nerve blocks are conducted in our office and may be repeated as necessary. In spinal cord stimulation, tiny electrodes are inserted along your spinal cord. A small electrical current is delivered into the spinal cord, which results in pain relief. Spinal cord stimulators are outpatient operations performed in the hospital. They are meant to be one-time only procedures.
Sympathetic Nerve Block
Sympathetic Blocks are used to treat and diagnose pain associated with CRPS. These injections are used for both diagnosing injury and treating the pain associated with it. It is believed that by blocking the sympathetic chain, which is associated with the flight or fight response, we can interrupt the cycle of CRPS pain. Sometimes, more than one injection is necessary to achieve sufficient relief. The most effective treatment of CRPS consists of a sympathetic block quickly followed by several sessions of physical therapy (focused on guided imagery and desensitization).
It is important that you have nothing to eat the day that you are scheduled for a sympathetic injection, and that you only have clear liquids up to 2 hours before, and nothing in the 2 hours prior to the injection. This injection is done sometimes under mild sedation. Please discuss with your physician if you are taking any anticoagulants or have a bleeding disorder.
Besides CRPS, the sympathetic blocks can be used to treat the following conditions;
Spinal Cord Stimulation
Spinal cord stimulation is a medication-free treatment of painful conditions including CRPS. The pain treatment is based on interruption of signals that transmit pain. Although the entirety of the science of why this treatment works is not understood, there are many studies proving that this treatment is helpful in relieving pain and improving the life of many, many patients.
Spinal cord stimulation involves insertion of a small device under your skin (usually the buttocks) which is connected to a thin wire that is placed along your spinal column. This is done in the operating room with anesthesia. Prior to this permanent placement, you will have a trial at our clinic where the thin wires are placed percutaneously, and attached to a stimulator that rests on your skin, secured with a dressing. to Our board-certified physicians, Dr. Ivie and Dr. Caballero, can help you decide whether this is a good option for you and explain the process in detail.