RSD and Lumbar Sympathetic Block
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RSD and Lumbar Sympathetic Block
byrd45 Mon Jan 05, 2009 7:11 pm
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From: byrd45 (Original Message) Sent: 8/18/2005 8:56 AM
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From: <NOBR>byrd45</NOBR> (Original Message) Sent: 7/18/2005 12:31 PM
Hi everyone,
I thought this week we could discuss Lumbar Sympathetic blocks since Digar had some questions about it. I had one block like this done and it did help my symptoms but was short lived because I couldn't stay home and take it easy as they wanted me too. Workers Comp insisted on me going to a series of interviews and it really messed up my treatment at that time. I haven't had another since then. Anyway, I found the following explanations of lumbar blocks for RSD online:
What is a Lumbar Sympathetic Block?
Lumbar Sympathetic Block is an injection of local anesthetic in the "sympathetic nerve tissue" – the nerves which are a part of Sympathetic Nervous System. The nerves are located on the either side of spine, in the back.
What is the purpose of it?
The injection blocks the Sympathetic Nerves. This may in turn reduce pain, swelling, color, and sweating changes in the lower extremity and may improve mobility. It is done as a part of the treatment of Reflex Sympathetic Dystrophy (RSD), Sympathetic Maintained Pain, Complex Regional Pain Syndrome, and Herpes Zoster (shingles) involving lower extremity.
How long does the injection take?
The actual injection takes only a few minutes.
What is actually injected?
The injection consists of a local anesthetic (like lidocaine or bupivacaine). Epinephrine (adrenaline) or Clonidine may be added to prolong the effects of the injection.
Will the injection hurt?
The procedure involves inserting a needle through skin and deeper tissues (like a "tetanus shot"). So, there is some discomfort involved. However, we may numb the skin and deeper tissues with a local anesthetic using a very thin needle before inserting the actual block needle. Most of the patients also receive intravenous sedation and analgesia, which makes the procedure easy to tolerate.
Will I be "put out" for this procedure?
No. This procedure is done under local anesthesia. Most of the patients also receive intravenous sedation and analgesia, which makes the procedure easy to tolerate. The amount of sedation given generally depends upon the patient tolerance.
How is the injection performed?
It is done either with the patient lying on stomach. The patients are monitored with EKG, blood pressure cuff and blood oxygen-monitoring device. Temperature sensing probes are also placed on your feet. The skin on back is cleaned with antiseptic solution and then the injection is carried out. Fluoroscopy (X-rays) is used to guide the needle(s) in the proper position.
What should I expect after the injection?
Immediately after the injection, you may feel your lower extremity getting warm. In addition, you may notice that your pain may be gone or quite less. You may also notice some weakness and/or numbness in the leg – which is temporary.
What should I do after the procedure?
You should have a ride home. We advise the patients to take it easy for a day or so after the procedure. Perform the activities as tolerated by you. Some of the patients may go for immediate physical therapy.
Can I go to work to work the next day?
Unless there are complications, you should be able to return to your work the next day. The most common thing you may feel is soreness in the neck at the injection site.
How long the effect of the medication lasts?
The local anesthetic wears off in a few hours. However, the blockade of sympathetic nerves may last for many more hours. Usually, the duration of relief gets longer after each injection.
How many injections do I need to have?
If you respond to the first injection, you will be recommended for repeat injections. Usually, a series of such injections is needed to treat the problem. Some may need only 2 to 4 and some may need more that 10. The response to such injections varies from patient to patient.
Will the Lumbar Sympathetic Block help me?
It is very difficult to predict if the injection(s) will indeed help you or not. The patients who present early during their illness tend to respond better than those who have this treatment after about six months of symptoms do. Patients in the advanced stages of disease may not respond adequately.
What are the risks and side effects?
This procedure is safe. However, with any procedure there are risks, side effects, and possibility of complications. The most common side effect is pain – which is temporary. The other risk involves bleeding, infection, spinal block, epidural block, and injection into blood vessels and surrounding organs. Fortunately, the serious side effects and complications are uncommon.
Who should not have this injection?
If you are allergic to any of the medications to be injected, if you are on blood thinning medications (e.g. Coumadin
, Plavix, Ticlid), or if you have an active infection going on near the injection site, you should not have the injection.
I also found this:
Lumbar Sympathetic Plexus Block (LSB)
A plexus is a group of nerves. A LSB is the injection of local anesthetic (like Novocain) in your low back (lumbar) region around the lumbar sympathetic plexus, a group of nerves that control blood flow in your legs, as well as pain sensations. A LSB may be performed if your leg pain is thought to be sympathetically mediated, neuropathic, or ischemic from blocked arteries. A LSB is both diagnostic as well as therapeutic, meaning that in addition to determining the cause of your pain, the block may treat the pain problem as well. Sympathetic pain results from the inappropriate activation of sympathetic nerves. This can result from any type of injury, large or very small, such as a paper cut. For whatever reason, sometimes these nerves are activated and result in a chronic pain syndrome. This syndrome is referred to either as Complex Regional Pain Syndrome (CRPS type I and II). These used be called RSD (reflex sympathetic dystrophy) and causalgia. Often the skin becomes very sensitive, often changes color and temperature, and is associated with severe spontaneous pain at times. If left untreated, it can become somewhat permanent. Medications may not be effective. The appropriate treatment involves temporarily blocking these sympathetic nerves with local anesthetics either once, or multiple times if needed. It is not known why temporarily blocking these nerves re-sets the nerves back into their normal state, thus treating the pain syndrome. Neuropathic pain is similar to sympathetic pain, but without the skin color and temperature changes. It also can respond to sympathetic blocks. Ischemic pain results when muscle and skin tissue are starved of blood flow, meaning oxygen. Blocking the sympathetic nerves can increase blood flow to the tissue.
An IV will first be placed in your arm. You will be placed prone (face down) on the fluoroscopy table. Your low back will be cleansed with an antiseptic and then numbed. The doctor will use X-ray to help guide the needle and then will inject a very small amount of dye to confirm correct placement of the needle before injecting the local anesthetic. The procedure will take about 30 minutes. A Band-Aid will be applied to the injection site and you will be taken to the recovery area. A nurse will review your discharge instructions with you before going home
I hope this helps explain things to anyone going through this now or in the future. I would definitely consider having another one done if it was offered because during the first day following my procedure I did see relief. I just wish I could have had it last longer. I think by resting, like they had wanted me to, I would have had a longer lasting result. If you have any comments or personal experiences with Lumbar Sympathetic Blocks just add them to this post. As always I would love to hear from you.
Robyn
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From: byrd45 Sent: 8/18/2005 8:57 AM
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From: <NOBR>Rittlemom1</NOBR> Sent: 7/18/2005 2:37 PM
Hi everyone, I just thought I would share my experience with these blocks. I had two a week apart. The first one lasted four hours, the second eight hours. They were great for that short time but as Robyn said they did not last. I also had the epidural block for seven days, I hated every minitue of that and later found out it was not monitered properly and I was not given the proper education about it so it was seven miserible days for nothing. I will be getting another epidural block that will stay in for six weeks and be monitered weekly, this is at a entirely different facility and done by a doc that specializes in RSD. It will be done in conjunction with a surgeon that will be working on my knee, removing screws and kinda cleaning up the area and then manipulating it. I will start therapy right away, 5x a week for two weeks and then 3x aweek for 4 weeks. sounds a bit grueling to me.LOL I do want to add that my blocks were done exactly as described in Robyns post except I have since discovered he was extremly stingy on the sedation, it was like have a IV inserted for no reason. I have since had 3 going on 4 Ganglion blocks done at the new place and it is wonderful!! I found none of these to be traumatic, I did however freak a little bit on the first ganglion as I had no idea what I was in for. lol I guess my advise for what it's worth is, these are fairly simple and fairly safe procedure to go through so why not give them a try, there are those out there that got remission after, so who knows who the lucky one will be. The procedures only get more envasive after that so go for the lesser and see what Gods plan is for you!! lol if anyone is facing this treatment course I would be glad to share anything I can . I do believe these sound much much worse than they are!! Hope your all having a good monday and the week only gets better for you. I am worn out I had a bone scan today and it tired me out. I can't believe I have become such a wimp!!! hug all around, kathy
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From: <NOBR>byrd45</NOBR> Sent: 7/19/2005 11:25 AM
Hi Kathy,
I wish you luck with your procedure! Let us know how it goes for you and I hope you see alot of pain relief from it!
Love,
Robyn
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From: digar Sent: 7/19/2005 3:03 PM
Well folks, as my luck would have it, I went in for my 2nd reinforcement, the Dr. was having problems getting the meds to go through the catheter. They started taking tape off, removing the cath. little by little only to find that the catheter was clotted all the way through! They wound up removing the whole thing & now I'm back at square one! I'm waiting to hear from my main pain Dr. (the one I had today was his associate) so we can do it again. I may have to have an epidural cath. Aaaaargh! This is taking a toll on my husband - he works 3rd shift & has been taking me here and there w/ very little sleep. He's been pretty good about it though, grumbling to a minimum! This is starting to take a toll on me also - seems to get a bit more difficult to smile & laugh at least once a day as I suggest others to do. Oh well, I kind of feel like that cat hanging on a tree limb in the poster that says "Hang in There Baby!" - oops almost smiled there! Will keep you posted on my continuing saga, "As the Pain Block Turns"
Diane
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From: <NOBR>byrd45</NOBR> Sent: 7/20/2005 6:52 AM
Hi Diane,
That just stinks! I am so sorry to hear that you had so many problems. Keep that positive attitude you sure do have the right idea! I will be hoping and praying that the second time around works out perfectly. Best of luck and keep us informed.Fingers crossed and holding breath lol.
Love,
Robyn
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From: GalenaFaolan Sent: 7/20/2005 3:11 PM
I'm one who had a horrible time with this block. I was forced into getting it by work comp when I didn't want to anyway. I had to give in and agree to having it done once.
Well, I did and it messed me up so bad. The people there didn't treat me very well after it was done. Still mad about that. Anyway, I was in severe pain not 2 minutes down the road and cried all the way home. I couldn't walk at all and had to be carried upstairs and back and forth to the bathroom as well for the first 2 days after. My pain level was between 15 and 20 non stop. I could not sit up for more than a minute, couldn't walk more than a few steps and tossed and turned causing even laying down hurt The pain spread into my lower back too and it was horrible. Finally after 2 months, it all finally calmed down and went back to "normal" pain again.
Thankfully no one insisted on me going back cause I said I didn't care what they did, I'd not subject myself or my family to that again.
Just goes to show you never know what will happen and we're all different when it comes to this stuff. From all the research I've done, it's not wise to keep getting blocks anyway. They damage the nerves even further and eventually leads to scar tissue where you keep getting injected. It leads to more damage that is unnecessary. Just my 2 cents though and I'm glad if someone gets relief from it for an extended period.
Love and Hugs,
Karen J
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From: <NOBR>irisheyes0720</NOBR> Sent: 7/20/2005 9:37 PM
thanks for the info I had one done about a month ago didn't have the pain like you did but didn't stop the pain I've been having either. I'm supposed to have another one but after reading your last paragraph I'll hae to think twice. Hope you are feeling better now Irish
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From: GalenaFaolan Sent: 7/20/2005 10:49 PM
Thank you Irish. I had that done last year, but it still bothers me to think of the whole experience. Thank goodness I'm done with work comp now and away from that crap. I feel better in that I'll never have it done, but in the past few months it has spread into both arms. So now I'm full body. *sigh* Just can't win!!!
Love and Hugs,
Karen J
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From: byrd45 (Original Message) Sent: 8/18/2005 8:56 AM
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From: <NOBR>byrd45</NOBR> (Original Message) Sent: 7/18/2005 12:31 PM
Hi everyone,
I thought this week we could discuss Lumbar Sympathetic blocks since Digar had some questions about it. I had one block like this done and it did help my symptoms but was short lived because I couldn't stay home and take it easy as they wanted me too. Workers Comp insisted on me going to a series of interviews and it really messed up my treatment at that time. I haven't had another since then. Anyway, I found the following explanations of lumbar blocks for RSD online:
What is a Lumbar Sympathetic Block?
Lumbar Sympathetic Block is an injection of local anesthetic in the "sympathetic nerve tissue" – the nerves which are a part of Sympathetic Nervous System. The nerves are located on the either side of spine, in the back.
What is the purpose of it?
The injection blocks the Sympathetic Nerves. This may in turn reduce pain, swelling, color, and sweating changes in the lower extremity and may improve mobility. It is done as a part of the treatment of Reflex Sympathetic Dystrophy (RSD), Sympathetic Maintained Pain, Complex Regional Pain Syndrome, and Herpes Zoster (shingles) involving lower extremity.
How long does the injection take?
The actual injection takes only a few minutes.
What is actually injected?
The injection consists of a local anesthetic (like lidocaine or bupivacaine). Epinephrine (adrenaline) or Clonidine may be added to prolong the effects of the injection.
Will the injection hurt?
The procedure involves inserting a needle through skin and deeper tissues (like a "tetanus shot"). So, there is some discomfort involved. However, we may numb the skin and deeper tissues with a local anesthetic using a very thin needle before inserting the actual block needle. Most of the patients also receive intravenous sedation and analgesia, which makes the procedure easy to tolerate.
Will I be "put out" for this procedure?
No. This procedure is done under local anesthesia. Most of the patients also receive intravenous sedation and analgesia, which makes the procedure easy to tolerate. The amount of sedation given generally depends upon the patient tolerance.
How is the injection performed?
It is done either with the patient lying on stomach. The patients are monitored with EKG, blood pressure cuff and blood oxygen-monitoring device. Temperature sensing probes are also placed on your feet. The skin on back is cleaned with antiseptic solution and then the injection is carried out. Fluoroscopy (X-rays) is used to guide the needle(s) in the proper position.
What should I expect after the injection?
Immediately after the injection, you may feel your lower extremity getting warm. In addition, you may notice that your pain may be gone or quite less. You may also notice some weakness and/or numbness in the leg – which is temporary.
What should I do after the procedure?
You should have a ride home. We advise the patients to take it easy for a day or so after the procedure. Perform the activities as tolerated by you. Some of the patients may go for immediate physical therapy.
Can I go to work to work the next day?
Unless there are complications, you should be able to return to your work the next day. The most common thing you may feel is soreness in the neck at the injection site.
How long the effect of the medication lasts?
The local anesthetic wears off in a few hours. However, the blockade of sympathetic nerves may last for many more hours. Usually, the duration of relief gets longer after each injection.
How many injections do I need to have?
If you respond to the first injection, you will be recommended for repeat injections. Usually, a series of such injections is needed to treat the problem. Some may need only 2 to 4 and some may need more that 10. The response to such injections varies from patient to patient.
Will the Lumbar Sympathetic Block help me?
It is very difficult to predict if the injection(s) will indeed help you or not. The patients who present early during their illness tend to respond better than those who have this treatment after about six months of symptoms do. Patients in the advanced stages of disease may not respond adequately.
What are the risks and side effects?
This procedure is safe. However, with any procedure there are risks, side effects, and possibility of complications. The most common side effect is pain – which is temporary. The other risk involves bleeding, infection, spinal block, epidural block, and injection into blood vessels and surrounding organs. Fortunately, the serious side effects and complications are uncommon.
Who should not have this injection?
If you are allergic to any of the medications to be injected, if you are on blood thinning medications (e.g. Coumadin
, Plavix, Ticlid), or if you have an active infection going on near the injection site, you should not have the injection. I also found this:
Lumbar Sympathetic Plexus Block (LSB)
A plexus is a group of nerves. A LSB is the injection of local anesthetic (like Novocain) in your low back (lumbar) region around the lumbar sympathetic plexus, a group of nerves that control blood flow in your legs, as well as pain sensations. A LSB may be performed if your leg pain is thought to be sympathetically mediated, neuropathic, or ischemic from blocked arteries. A LSB is both diagnostic as well as therapeutic, meaning that in addition to determining the cause of your pain, the block may treat the pain problem as well. Sympathetic pain results from the inappropriate activation of sympathetic nerves. This can result from any type of injury, large or very small, such as a paper cut. For whatever reason, sometimes these nerves are activated and result in a chronic pain syndrome. This syndrome is referred to either as Complex Regional Pain Syndrome (CRPS type I and II). These used be called RSD (reflex sympathetic dystrophy) and causalgia. Often the skin becomes very sensitive, often changes color and temperature, and is associated with severe spontaneous pain at times. If left untreated, it can become somewhat permanent. Medications may not be effective. The appropriate treatment involves temporarily blocking these sympathetic nerves with local anesthetics either once, or multiple times if needed. It is not known why temporarily blocking these nerves re-sets the nerves back into their normal state, thus treating the pain syndrome. Neuropathic pain is similar to sympathetic pain, but without the skin color and temperature changes. It also can respond to sympathetic blocks. Ischemic pain results when muscle and skin tissue are starved of blood flow, meaning oxygen. Blocking the sympathetic nerves can increase blood flow to the tissue.
An IV will first be placed in your arm. You will be placed prone (face down) on the fluoroscopy table. Your low back will be cleansed with an antiseptic and then numbed. The doctor will use X-ray to help guide the needle and then will inject a very small amount of dye to confirm correct placement of the needle before injecting the local anesthetic. The procedure will take about 30 minutes. A Band-Aid will be applied to the injection site and you will be taken to the recovery area. A nurse will review your discharge instructions with you before going home
I hope this helps explain things to anyone going through this now or in the future. I would definitely consider having another one done if it was offered because during the first day following my procedure I did see relief. I just wish I could have had it last longer. I think by resting, like they had wanted me to, I would have had a longer lasting result. If you have any comments or personal experiences with Lumbar Sympathetic Blocks just add them to this post. As always I would love to hear from you.
Robyn
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From: byrd45 Sent: 8/18/2005 8:57 AM
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From: <NOBR>Rittlemom1</NOBR> Sent: 7/18/2005 2:37 PM
Hi everyone, I just thought I would share my experience with these blocks. I had two a week apart. The first one lasted four hours, the second eight hours. They were great for that short time but as Robyn said they did not last. I also had the epidural block for seven days, I hated every minitue of that and later found out it was not monitered properly and I was not given the proper education about it so it was seven miserible days for nothing. I will be getting another epidural block that will stay in for six weeks and be monitered weekly, this is at a entirely different facility and done by a doc that specializes in RSD. It will be done in conjunction with a surgeon that will be working on my knee, removing screws and kinda cleaning up the area and then manipulating it. I will start therapy right away, 5x a week for two weeks and then 3x aweek for 4 weeks. sounds a bit grueling to me.LOL I do want to add that my blocks were done exactly as described in Robyns post except I have since discovered he was extremly stingy on the sedation, it was like have a IV inserted for no reason. I have since had 3 going on 4 Ganglion blocks done at the new place and it is wonderful!! I found none of these to be traumatic, I did however freak a little bit on the first ganglion as I had no idea what I was in for. lol I guess my advise for what it's worth is, these are fairly simple and fairly safe procedure to go through so why not give them a try, there are those out there that got remission after, so who knows who the lucky one will be. The procedures only get more envasive after that so go for the lesser and see what Gods plan is for you!! lol if anyone is facing this treatment course I would be glad to share anything I can . I do believe these sound much much worse than they are!! Hope your all having a good monday and the week only gets better for you. I am worn out I had a bone scan today and it tired me out. I can't believe I have become such a wimp!!! hug all around, kathy
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From: <NOBR>byrd45</NOBR> Sent: 7/19/2005 11:25 AM
Hi Kathy,
I wish you luck with your procedure! Let us know how it goes for you and I hope you see alot of pain relief from it!
Love,
Robyn
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From: digar Sent: 7/19/2005 3:03 PM
Well folks, as my luck would have it, I went in for my 2nd reinforcement, the Dr. was having problems getting the meds to go through the catheter. They started taking tape off, removing the cath. little by little only to find that the catheter was clotted all the way through! They wound up removing the whole thing & now I'm back at square one! I'm waiting to hear from my main pain Dr. (the one I had today was his associate) so we can do it again. I may have to have an epidural cath. Aaaaargh! This is taking a toll on my husband - he works 3rd shift & has been taking me here and there w/ very little sleep. He's been pretty good about it though, grumbling to a minimum! This is starting to take a toll on me also - seems to get a bit more difficult to smile & laugh at least once a day as I suggest others to do. Oh well, I kind of feel like that cat hanging on a tree limb in the poster that says "Hang in There Baby!" - oops almost smiled there! Will keep you posted on my continuing saga, "As the Pain Block Turns"
Diane
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From: <NOBR>byrd45</NOBR> Sent: 7/20/2005 6:52 AM
Hi Diane,
That just stinks! I am so sorry to hear that you had so many problems. Keep that positive attitude you sure do have the right idea! I will be hoping and praying that the second time around works out perfectly. Best of luck and keep us informed.Fingers crossed and holding breath lol.
Love,
Robyn
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From: GalenaFaolan Sent: 7/20/2005 3:11 PM
I'm one who had a horrible time with this block. I was forced into getting it by work comp when I didn't want to anyway. I had to give in and agree to having it done once.
Well, I did and it messed me up so bad. The people there didn't treat me very well after it was done. Still mad about that. Anyway, I was in severe pain not 2 minutes down the road and cried all the way home. I couldn't walk at all and had to be carried upstairs and back and forth to the bathroom as well for the first 2 days after. My pain level was between 15 and 20 non stop. I could not sit up for more than a minute, couldn't walk more than a few steps and tossed and turned causing even laying down hurt The pain spread into my lower back too and it was horrible. Finally after 2 months, it all finally calmed down and went back to "normal" pain again.
Thankfully no one insisted on me going back cause I said I didn't care what they did, I'd not subject myself or my family to that again.
Just goes to show you never know what will happen and we're all different when it comes to this stuff. From all the research I've done, it's not wise to keep getting blocks anyway. They damage the nerves even further and eventually leads to scar tissue where you keep getting injected. It leads to more damage that is unnecessary. Just my 2 cents though and I'm glad if someone gets relief from it for an extended period.
Love and Hugs,
Karen J
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From: <NOBR>irisheyes0720</NOBR> Sent: 7/20/2005 9:37 PM
thanks for the info I had one done about a month ago didn't have the pain like you did but didn't stop the pain I've been having either. I'm supposed to have another one but after reading your last paragraph I'll hae to think twice. Hope you are feeling better now Irish
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From: GalenaFaolan Sent: 7/20/2005 10:49 PM
Thank you Irish. I had that done last year, but it still bothers me to think of the whole experience. Thank goodness I'm done with work comp now and away from that crap. I feel better in that I'll never have it done, but in the past few months it has spread into both arms. So now I'm full body. *sigh* Just can't win!!!
Love and Hugs,
Karen J
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