Unfortunately, nerve pain problems can arise after surgery, and this can sometimes be the case with carpal tunnel surgery. RSD, also known as complex regional pain syndrome (CRPS) can be a challenging pain problem to have. The sooner something like CRPS gets evaluated and treated, the better, so seeing some type of specialist for nerve pain problems like this is a really good idea. Comprehensive treatment is often needed to help reduce pain, sensitivity, and restore function back in the hand.View Thread
I have seen situations like this arise many times with patients over the years, and I certainly understand your frustration. How can a physician who makes a cursory evaluation really know what you are capable of doing on a consistent basis? In many cases, when it comes to disability claims, decisions get made off of the records without an actual evaluation taking place.
More scientifically assessing for impairment or disability due to the presence of pain can be difficult because of the subjective nature of pain. But there are some assessments to be aware of that can help. For example, a functional capacity evaluation can be done by a PT or OT specially trained to assess what a person can and can't do. This tests often take many hours to complete and are based on specific measurements. One of the drawbacks is that even though they are objective, they still don't really show if the patient can do what is measured 8 hours a day, 5 days a week. As far as cognitive function goes, there are tests that can be done to measure performance. In addition, the medical opinions of your doctors should be given a lot of weight since they know you better than a one-time examiner. Vocational counselors can also be consulted, in some cases, to assess for employ-ability.
I hope this information helps navigate this situation.View Thread
Trying to lose weight and exercise more with a bad knee pain can be a real challenge. I do have a couple of recommendations to consider, and, of course, please remember to consult with your doctor before starting any new exercise program.
Cycling- This could mean using a stationary bike, recumbent bike, or riding outdoors depending on what is tolerated the best. Cycling can give the legs a good workout and provide some cardio/weight-loss exercise.
Pilates- Either on a mat or a reformer with an experienced instructor. A lot the exercises can help build strength and improve balance without you having to put a lot of pressure on your sore knee.
While exercise is really important, I think sticking to a healthy eating plan is critical for weight-loss.
Once you get over the hump, your body will start to feel better and hurt less.
Find something you enjoy- you will be more likely to exercise regularly if you are having fun doing it.
Partner up- having somebody to work out with can help keep you consistent.
Symptoms of burning pain in the feet is often a sign of neuropathy. Peripheral neuropathy is usually associated with some type of change in normal nerve function and the feet are often particularly sensitive. In cases where the neuropathy is due to a treatable condition, the symptoms can improve with treatment of the underlying cause.
I would recommend seeing a physician who can do a work-up of possible causes as a next step.View Thread
Unpleasant itching and the desire to scratch is sometimes referred to as pruritus. Pruritus can have many different causes including medical conditions like kidney disease and medication reactions. One of the mechanisms that can create this unpleasant itching is the release of histamine from cells inside the body. Certain medications, including opioids, can increase the release of histamine in the body, and therefore serve as one potential cause of itching. Again, there could be other causes as well, so scheduling a follow up with your doctor to discuss this as well as other potential causes makes sense as a next step.View Thread
One thing I often tell my patients is that we don't know everything in medicine, and we certainly don't have all of the answers when it comes to complicated pain problems. In fact, it is estimated that for 90% of patients with low back, the causes are not really understood. Just because doctors don't know all of the answers is no reason for others to make you feel that your pain is any less "real" or problematic than anyone else's. Trust me when I say you are not alone, and there are many many others out there trying to better manage their pain, too.
While it may be frustrating when you can't get better answers or solutions from others, that doesn't mean you can't work with different practitioners to develop your own self-management program to help you feel better and function better. For example, some physical therapists may be better than others at working on more chronic back pain problems. Some patients find alternative treatments to be a big help, like tai chi, yoga, Pilates, acupuncture, or even mindfulness-based meditation. A simple daily walking program is often beneficial, as well.
Remember to first go over anything new with your doctors before starting new treatments. Good luck!View Thread
I have a colleague who does a lot of work with IV ketamine, and she was kind enough to forward me these considerations if you are considering this type of treatment:
Recs for a patient to gain access to ketamine infusions in general. I would say the following: 1. Email our coordinator at Ketamine@FreedomPainHospital.com . We need the volume and will get appropriate patients in ASAP ok, seriously, here would be my tips"026 1. Make sure they are being treated by a provider who is familiar with complex regional pain syndrome (if they are being treated for CRPS) 2. Get a referral from their primary treating physician to be treated with Ketamine. 3. Make sure they do not have any contraindications to Ketamine treatment. All of our patients require a psychiatric clearance and a cardiology clearance. In addition, the following are exclusion criteria: hyperthyroidism, increased intracranial pressure, sub-aortic stenosis, pregnancy, neurogenic bladder, liver dysfunction with elevated LFTs, and some others. These are off the top of my head ( I am traveling to LA this morning and am on the move right now), but I can certainly access my protocol tonight and get you the complete list of contraindications. 4. Obtain Ketamine infusions at a location that has a relatively high volume and / or a good familiarity with Ketamine infusions. There are many dosing protocols out there, and choosing a provider with experience and familiarity with potential adverse effects will lead to a better experience for the patient. 5. Common adverse effects for the patient: nausea, headache, vivid dreams, insomnia 6. We recommend being on a total daily morphine equivalent of 120mg or less. There is some thought that opiates interfere with the ability of Ketamine to reduce central sensitization. We do not require that patients get completely off of opiates prior to infusion. Some patients choose to do so on their own because they believe it puts them at a higher chance of pain remission. Of course, I support decreasing opiates whenever possible. 7. Some centers will offer daily outpatient infusions, and some will offer inpatient infusions. Each has own set of pros and cons. Inpatient: 3-5 days. Shorter, continuously infused. NPO status maintained, and bed rest with bathroom privileges usually the only activity. Outpatient: 10 days (M - F x 2 weeks). 4 hours each day. Able to go home at night. Able to eat lunch and dinner. Able to ambulate. If traveling from out of town, the increased length may be seen as a negative.) 8. Active online community with CRPS support groups. May be a good idea to connect with others who have been through Ketamine infusions.
Annette also brought up the mirror box. We have found this to be a very helpful tool for our CRPS patients.View Thread
The active ingredient in the Butrans Patch is buprenorphine, which does have some partial activity on the opiate receptor. These are the same receptors that traditional narcotic-based pain killers would act on, like the hydrocodone, for example. As a result, there can be withdrawal symptoms when discontinuing buprenorphine from your system. Withdrawal symptoms can be extremely uncomfortable in some cases, but they usually subside over a period of days. There are certain medications that can help dampen the withdrawal symptoms until they eventually disappear, including clonidine and ondansetron.
While experiencing withdrawals can be very difficult to deal with, it isn't typically considered to be otherwise medically dangerous. Nevertheless, it is very important to work out your specific plan with your doctor before making any medication changes.View Thread
It sounds like you are continuing to have nerve pain from the original injury. Nerve pain, also known as neuropathic pain, is usually triggered by some type of injury to the nervous system, and it sounds like you had significant peripheral nerve damage at the time of the injury. Common descriptions of nerve pain include burning, stinging, shooting, or electrical pain symptoms.
The coldness is not unusual in this type of situation, and it suggests some dysfunction in the autonomous nervous system which regulates blood flow to the skin. Sensitivity to touch is also not uncommon, and it reflects nerve conduction channeling linking pain to light touch receptors, which can happen with certain nerve pain problems.
Surgery is often not the answer, but some simple things that you can try at home include contrast baths with warm and cold water and moving your foot around in a bowl of uncooked rice to desensitize the skin. There are other treatments like this that a physical therapist could help you with. There are also medications that can be considered for nerve pain that you could talk to your doctors about.View Thread