How quickly should Stim be considered?

[SageCraft]

I have two younger gentleman both referred to me for CRPS of the upper extremity, 6 weeks post surgery. One after a thumb surgery, the other after rotator cuff repair. They're both fairly miserable, on opioids/Gabapentin and doing PT. SGB's have been very helpful but only for a few days. I can see both of them requiring a Stim but it hasn't even been 2 months post-op. How aggressive are you guys with this in terms of time frame?

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[lobelsteve]

15 bid prednisone x3 weeks to start. Should have been done prior to opiates or sgb.

 

[pastafan]

Mirror therapy should be tried.

Reestablishing the Connection: Using Mirror Therapy to Reduce Pain and Improve Movement

Not all smoke and mirrors: mirror therapy for Complex regional pain syndrome

 

[Orin]

I like to let the surgical wound heal first

Generally by the time they get to me though, it's already 6 - 12 months down the road. I would be comfortable being aggressive with a temporary PNS like SPR's Sprint that is not a permanent implant, but I would recommend waiting 6 - 12 months after ensuring the patients are actually engaged in appropriate PT, have failed multiple medication classes, and are fully engaged in psychology/CBT.

Opioids are a bad idea for CRPS

 

[Orin]

Speak of the devil and the tweets will come!

 

[NOSfan]

I have two younger gentleman both referred to me for CRPS of the upper extremity, 6 weeks post surgery. One after a thumb surgery, the other after rotator cuff repair. They're both fairly miserable, on opioids/Gabapentin and doing PT. SGB's have been very helpful but only for a few days. I can see both of them requiring a Stim but it hasn't even been 2 months post-op. How aggressive are you guys with this in terms of time frame?

You may consider repeating SGB with the addition of IV Vit C (3-4gms)......anecdotally have been amazed with this combo.

 

[Orin]

You may consider repeating SGB with the addition of IV Vit C (3-4gms)......anecdotally have been amazed with this combo.

I have been doing oral Vit C (1000 mg/day x 60 days) for patients, and counseling them to use it pre/post surgical events due to the risk of CRPS recurrence

 

[tmvguy03]

I have been doing oral Vit C (1000 mg/day x 60 days) for patients, and counseling them to use it pre/post surgical events due to the risk of CRPS recurrence

This is a great idea- I've always recommended Vit C prior to procedures as well.
I will say, once CRPS has developed the cat is out of the bag. How often do oral neuropathic agents/opioids/SGB etc make a long lasting difference though...I say stim as soon as possible rather than kick the can down field for 6-12 months of frustrating treatments, what do you have to lose? I mean that's the role of a trial...

 

[BobBarker]

I think it is pretty clear some of these guys are being paid to mention products on social media like the kardashians and beauty products

 

[SSdoc33]

the RTC patient does not have CRPS. they just need more/better PT and maybe an intra-articular injection. see it all the time. unless their hand is blue/purple and not really moving, it probably isnt CRPS

 

[SommeRiver]

Adhesive capsulitis mimics CRPS frequently, and I see pts with CRPS end up with AC frequently. I wouldn't consider cervical stim unless it is OBVIOUS it is CRPS. Cervical stim is just a different ballgame for me. The risks are higher.