Complex Regional Pain Syndrome

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Difficult-to-Diagnose Pain Condition Needs Early Intervention

Posted by Scott Gottlieb
 
Paula Abdul has been open about the difficult-to-diagnose pain syndrome she has been battling for 25 years. The former “American Idol” judge announced in 2005 that she has Complex Regional Pain Syndrome, in the hopes of bringing awareness to the obscure, often misunderstood, condition. According to a USA Today article published, she said after the announcement her occasionally hyper-animated behavior on the show was caused by her joy at finally being pain-free; she had found the right medication. CRPS is chronic pain that usually results from trauma to a nerve after an injury: falls, strains, sprains, burns or even bruises. Someone who has undergone surgery or had a stroke is also at risk. Fortunately, it is not very common; in my practice, only 8 percent of our patients have CRPS. While the condition can afflict anyone, including children and teens, it generally affects women in their 40s. There is no known cause of CRPS and it has gone by many names over the past 150 years. The USA Today article said it was first described by a doctor treating soldiers with cannonball injuries in the Civil War: Causalgia. It has had several other names since then, including algodystrophy, Sudeck’s Atrophy, variable pain syndrome, shoulder-hand syndrome and more recently and perhaps the most common: reflex sympathetic dystrophy. There are two kinds of CRPS: Type 1 and Type 2. The leg, arm hand or foot are the most affected body parts. For example, if someone hurts his toe, the pain can radiate through the entire foot and leg even after the toe is healed. For some reason, the sympathetic nervous system gets the wrong signal and supports the painful response to the injury. Unfortunately, there is no single test for CRPS. The diagnosis is based primarily on physical exam findings. The pain is often described as a sharp stabbing pain, electrical current or tingling sensation. Light touch or movement can be very painful for someone with CRPS. Also there are often changes around the affected area, such as a change in skin color, temperature, and excessive swelling and sweating. In some cases, it can attack the bone and muscle. The prognosis is different for each patient. Some get relief if it is treated very early. (Treatments range from anesthesia injections to electrical stimulators implanted in the spine). If the diagnosis is delayed, the disorder is harder to treat and the condition may become irreversible. About Dr. Scott Gottlieb: Dr. Scott Gottlieb is a pain management expert and the founder of Gramercy Pain Management. He is the director of Pain Management at New York Eye and Ear Infirmary (NYEE) and has treated over 3,000 patients. Dr. Gottlieb is board certified in both pain management and anesthesiology. He has offices in both Manhattan and Montebello, N.Y. in Rockland County.

Debunking Myths About Epidural Injections

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Although the term “epidural” is commonly associated with an injection given to women during labor, an ESI (epidural steroid injection) can be used as a relief for many different circumstances of pain in both men and women. An epidural injection is a procedure that is typically used to help alleviate neck and back pain (in addition to arm and leg pain) caused by inflamed nerves.

How it works:

An epidural steroid injection essentially involves bathing an inflamed nerve root in order to decrease the irritation of the nerve root that is causing pain. Despite the simplicity of this common practice, there are many myths and concerns associated with the beneficial procedure.

During the steroid injection, a needle (the size of a thick strand of hair) and syringe are used to enter the epidural space and deposit small amounts of long-lasting steroids around the inflamed spinal nerve. The simple method is performed through fluoroscopic guidance; the viewing instrument is used to visualize the local anatomy during the injection. Afterward, the needle is placed into the epidural space, targeting the inflamed area with a maximal amount of steroids, thereby minimizing exposure of the rest of the body to the steroids.

What to expect:

Although many myths have projected the idea that ESIs are an instant cure for pain, the injections are not an overnight fix to the enduring discomfort of a patient. The epidural, however, generally helps the patient resume his or her normal activities by alleviating the pain so that the patient can proceed to seek physical therapy to slowly strengthen and heal the area that has caused them discomfort.

The effects of ESIs are different with every patient as some injections provide long-term relief of up to a year and others experience short-term relief consisting of a few weeks to a small number of months. It is usually suggested that no more than three ESIs are administered within a 6 month time frame.

Those receiving an ESI for back and nerve pain will have their vital signs examined and pain relief will be assessed frequently throughout the procedure. If there are any possible side effects from the medicine, the anesthesiologist on duty will be involved. Similarly to the symptoms experienced by women during an epidural for labor pain, some possible side effects include drops in blood pressure, itching, and nausea/vomiting depending on the amount of dosage received by the patient.

Keep in mind:

While ESIs are a useful non-surgical treatment for many patients, they are not right for everyone. Those suffering from infection, bleeding problems, or spinal tumors are not recommended candidates. It’s important to note that as with any type of injection, there are some risks associated with ESIs.  Some major risks include bowel and bladder incontinence, infections, headaches caused by epidural punctures, nerve damage, and bleeding.

An anesthesiologist will be involved in the management of this procedure to ensure the best possible outcome in providing pain relief, minimizing side effects, and ensuring your overall safety. However, it is important to assess the risks and benefits of an epidural steroid injection with your doctor to help determine if this treatment plan will be right for you. This form of pain management may also not work for everyone. If the injection does not provide relief, a new treatment may be better suited for you.

 

About Dr. Scott Gottlieb:

Dr. Scott Gottlieb is a pain management expert and the founder of Gramercy Pain Management.  He is the director of Pain Management at New York Eye and Ear Infirmary (NYEE) and has treated over 3,000 patients. Dr. Gottlieb is board certified in both pain management and anesthesiology. He has offices in both Manhattan and Montebello, N.Y. in Rockland County.