vplants,
There are many medications he can try and should try before jumping to methadone, that is some scary stuff. I would ask if there was any other medications protocols you could try before jumping into methadone.
Has he tried any antidepressants? As crazy as it sounds, they do help. I took Elavil for a short period and it helped me sleep and reduced my pain. I developed tachycardia when we raised the dose. What about Lyrica or Neurotin? Has he treated the muscle spasms? I have the vasospasms, where the blood vessels in my arm spasm and It gets very cold. That is called ischemic pain and is the same pain you have when you have an angina or heart attack.
If your doctor isn't listening to you, maybe you should look for another one. That isn't always the easy thing to do because there may not be another one in your area. I live in a large city and was able to find another PM after I had a disagreement with my 1st PM. You should not suffer any reprecussions changing doctors, many are afraid to change PMs because they think it will look like doctor shopping.
About your friends, after you give them information about RSD, you should give them a copy of "The Spoon Theory" (http://butyoudontlooksick.com/navigation/BYDLS-TheSpoonTheory.pdf). It will help them to understand you life now.
Reta
Here is some information from RSD Foundation.org
Establish a written treatment protocol
Figure 2 illustrates a typical treatment protocol that was designed to rehabilitate the patient in the shortest possible time. Initiate the safest, simplest, and most cost-effective therapies first. If the patient fails to progress in mobilizing the extremity, it is essential to offer the patient a series of 3 sympathetic blocks immediately. The purpose of the sympathetic blocks is three-fold: to treat, to diagnose if the pain is sympathetically maintained and to provide prognostic information. The sympathetic block provides a prognostic indicator if sympathectomy or other treatment modalities would be the next appropriate step. Sympathetic blocks are discussed in detail below.
After the physician has completed a defined course of treatment (e.g. a series of 3-6 sympathetic blocks), it would be helpful to prepare an update report that would document the patient's response to the course of treatment. The report should reflect a basis for further treatment and it should address future rehabilitation needs. Sharing a copy of the update report with the patient will help ensure that all parties are kept informed. Sharing the report with the patient helps keep the patient and physician focused on achieving appropriate therapeutic goals. An update report should address five areas of care:
Procedures (e.g. nerve blocks)
Medications
Physical/occupational therapy
Psychosocial issues
New laboratory tests or consults
Medications commonly used to treat RSD / CRPS based on the type of pain include:
For constant pain associated with inflammation: Nonsteroidal anti-inflammatory agents (e.g. aspirin, ibuprofen, naproxen, indomethacin, etc).
For constant pain not caused by inflammation: Agents acting on the central nervous system by an atypical mechanism (e.g. tramadol)
For constant pain or spontaneous (paroxysmal) jabs and sleep disturbances;
Oral lidocaine (mexilitine - some what experimental)
For spontaneous (paroxysmal) jabs: Anti-convulsants (e.g. carbamazepine, gabapentin may relieve constant pain as well) 17-19
For widespread, severe RSD / CRPS pain, refractory to less aggressive therapies: Oral opioid.
The use of opioids (e.g. narcotics with names such as Darvon, Vicodin, Loratab, Percocet, morphine, codeine, etc) to treat RSD / CRPS is debated and there are potential hazards. Therefore, in order to ensure appropriate informed consent, it is recommended that the patient sign a doctor-patient "contract." A typical doctor-patient contract can be found by clicking on the link below.
http://rsdfoundation.org/en/en_clinical_practice_guidelines.html#Treatment
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vplants,
There are many medications he can try and should try before jumping to methadone, that is some scary stuff. I would ask if there was any other medications protocols you could try before jumping into methadone.
Has he tried any antidepressants? As crazy as it sounds, they do help. I took Elavil for a short period and it helped me sleep and reduced my pain. I developed tachycardia when we raised the dose. What about Lyrica or Neurotin? Has he treated the muscle spasms? I have the vasospasms, where the blood vessels in my arm spasm and It gets very cold. That is called ischemic pain and is the same pain you have when you have an angina or heart attack.
If your doctor isn't listening to you, maybe you should look for another one. That isn't always the easy thing to do because there may not be another one in your area. I live in a large city and was able to find another PM after I had a disagreement with my 1st PM. You should not suffer any reprecussions changing doctors, many are afraid to change PMs because they think it will look like doctor shopping.
About your friends, after you give them information about RSD, you should give them a copy of "The Spoon Theory" (http://butyoudontlooksick.com/navigation/BYDLS-TheSpoonTheory.pdf). It will help them to understand you life now.
Reta
Here is some information from RSD Foundation.org
Establish a written treatment protocol
Figure 2 illustrates a typical treatment protocol that was designed to rehabilitate the patient in the shortest possible time. Initiate the safest, simplest, and most cost-effective therapies first. If the patient fails to progress in mobilizing the extremity, it is essential to offer the patient a series of 3 sympathetic blocks immediately. The purpose of the sympathetic blocks is three-fold: to treat, to diagnose if the pain is sympathetically maintained and to provide prognostic information. The sympathetic block provides a prognostic indicator if sympathectomy or other treatment modalities would be the next appropriate step. Sympathetic blocks are discussed in detail below.
After the physician has completed a defined course of treatment (e.g. a series of 3-6 sympathetic blocks), it would be helpful to prepare an update report that would document the patient's response to the course of treatment. The report should reflect a basis for further treatment and it should address future rehabilitation needs. Sharing a copy of the update report with the patient will help ensure that all parties are kept informed. Sharing the report with the patient helps keep the patient and physician focused on achieving appropriate therapeutic goals. An update report should address five areas of care:
Procedures (e.g. nerve blocks)
Medications
Physical/occupational therapy
Psychosocial issues
New laboratory tests or consults
Medications commonly used to treat RSD / CRPS based on the type of pain include:
For constant pain associated with inflammation: Nonsteroidal anti-inflammatory agents (e.g. aspirin, ibuprofen, naproxen, indomethacin, etc).
For constant pain not caused by inflammation: Agents acting on the central nervous system by an atypical mechanism (e.g. tramadol)
For constant pain or spontaneous (paroxysmal) jabs and sleep disturbances;
Anti-depressants (e.g. amitriptyline, doxepin, nortriptyline, trazodone, etc) 1,6
Oral lidocaine (mexilitine - some what experimental)
For spontaneous (paroxysmal) jabs: Anti-convulsants (e.g. carbamazepine, gabapentin may relieve constant pain as well) 17-19
For widespread, severe RSD / CRPS pain, refractory to less aggressive therapies: Oral opioid.
The use of opioids (e.g. narcotics with names such as Darvon, Vicodin, Loratab, Percocet, morphine, codeine, etc) to treat RSD / CRPS is debated and there are potential hazards. Therefore, in order to ensure appropriate informed consent, it is recommended that the patient sign a doctor-patient "contract." A typical doctor-patient contract can be found by clicking on the link below.
July 7, 2011 - 11:51amhttp://rsdfoundation.org/en/en_clinical_practice_guidelines.html#Treatment
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