Hi All,
I have seen this patient on prolonged pain medication for CRPS Type 1. The pain consultant suggested a stellate ganglion block. He agreed. But that was over 5 years ago.
Now he is being diagnosed as suffering from internal organ illnesses like reactive airway disease, atypical chest pain with SOB, cephalgia, myofascial pain, dysphagia, increased LFT, functional syncope, neurogenic bladder with IDC, depression and anxiety. All endorsed and verified by the pain consultant as REAL and not "something in your head" - except for the depression and anxiety which the patient has no knowledge whatsoever.
While consulting with the pain consultant, the patient sought a memo for show-cause as to why he has attained so many illnesses in just 5 years after a lapse of 30 healthy years. The memo was for other judgmental doctors who seem to dismiss the patient as a malingerer at its best.
Following this website on the CRPS stages -
http://www.rsdhope.org/crps-stages.html
It states that few or none ever reached Stage Four as it "involves internal organ".
In reality, this patient has already acquired the internal organ illnesses apart from the initial injury involving a mere wrist arthroscopy 5 years ago. The block was done 4 months later immediately after the patient was diagnosed as having CRPS Type 1.
Last week, surprisingly, this aggrieved patient showed me the pain doctor memo indicating that his CRPS Type 1 has been completely resolved with a single stellate ganglion block done only.
The memo also mentioned that now he acquires depression and anxiety apart from all the internal organs diseases involved which are not CRPS-related. This the patient found very disturbing as he has learnt to accept his CRPS condition from the first arthroscopy period before a SLAP operation was done 3 months after the "successful" block. He said he was impressed upon the complexities where internal organs involved are CRPS-related until he receives the memo.
CRPS is an evolving and constantly changing disease.Don't assume your Doctor knows everything there is to know about CRPS and especially about your individual case. It is a very difficult disease to treat (American RSD Hope, 2015)
My questions are -
As the name suggests - complex regional pain syndrome (CRPS), this disease is a very complex disease and has yet no known gold standard cure as yet
1-Is it true CRPS Type 1 can be cured totally?
2-Is it true CRPS Type 1 can just be cured by a single stellate ganglion block?
3-If the CRPS Type 1 patient acquired internal organ deficit post ganglion block, can it be said that the block is highly successful?
4-For this case, can it be said that the CRPS Stage 4 did not exist at all?
No sarcasm please, we are professionals and fellow researchers looking for answers. Thank you.
This syndrome is complex as its named,so in your case with a psychiatric patient it is really difficult to treat with single shot of ganglion block,be careful with his reactive airway disease and shortness of breath if complications occurred alongside!
Thanks Aboud ,
Agree with your suggestion.
Unfortunately the patient's ganglion was done but not claimed as "totally" cured then.
Only a year later the reactive airways and other internal illnesses ensued making it
"upgraded to Stage Four" as aforementioned.
The patient has never felt depressed or anxiety but positive though a tad disappointed all along despite all the oddities and not a psychiatric patient these 5 years.
But the recent memo indicated that the patient is "block-cured" of his CRPS except for his other organic diseases and his "psychiatric issues". A perplexed conclusion indeed.
Thanks Aboud ,
Agree with your suggestion.
Unfortunately the patient's ganglion was done but not claimed as "totally" cured then.
Only a year later the reactive airways and other internal illnesses ensued making it
"upgraded to Stage Four" as aforementioned.
The patient has never felt depressed or anxiety but positive though a tad disappointed all along despite all the oddities and not a psychiatric patient these 5 years.
But the recent memo indicated that the patient is "block-cured" of his CRPS except for his other organic diseases and his "psychiatric issues". A perplexed conclusion indeed.
Thanks Aboud ,
Agree with your suggestion.
Unfortunately the patient's ganglion was done but not claimed as "totally" cured then.
Only a year later the reactive airways and other internal illnesses ensued making it
"upgraded to Stage Four" as aforementioned.
The patient has never felt depressed or anxiety but positive though a tad disappointed all along despite all the oddities and not a psychiatric patient these 5 years.
But the recent memo indicated that the patient is "block-cured" of his CRPS except for his other organic diseases and his "psychiatric issues". A perplexed conclusion indeed.
Thanks Jan,
So it is highly unlikely that CRPS is "cured" by a single one-off shot.
But then again, given the obvious CRPS symptoms presented, how is it difficult to understand the basics of neuroinflammation and dystonia in such context?
Best regards.
Thanks Jan,
Being a system disorder, it is safe to assume that currently the complete cure for CRPS is still beyond our comprehension and that for as long as the contralateral to the lession signs of neuroinflammation still exists, CRPS can still be somewhat relieved but not cured as yet..
Appreciate your kind input. Best regards.
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