Might be getting CRPS, what do I need to do?
August 16, 2012 3:46 PM   Subscribe

Might be getting CRPS, what do I need to do?

Hi, I'm starting to panic a bit as I've developed a nerve pain in my foot after a prolotherapy injection in my spring ligament (right in the arch of my foot) and my doctor is now out of state (and the darn front staff said they'll 'try to contact him' but won't give me his number) for a week and I've been reading about how vital early treatment for CRPS (complex regional pain syndrome) is and some common early symptoms to what I have. I need some help as for what to do right now and have a whole bunch of questions.

First, when they say 'early treatment' does this mean days, weeks, months, or what?

Who should I see (physiatrist, neurologist, directory of specialists) and what do I need to tell the front staff to get seen immediately (will mentioning crps get me seen immediately?), or should I try an emergency room? All the health articles on the topic I found say that treatment should be early and aggressive, but nothing on what exactly is done to stop the progression; what should I expect them to/give me for the initial treatment?

What can I do until I can get an appointment myself besides not walking? Should I ice and/or heat my foot? Does ibuprofin actually help the nerve or just cover up pain?
I actually have some neurontin that was prescribed to rule out a nerve injury in a previous injury. Should I take it and will it stop the actual damaging mechanism? I read pentoxifylline mentioned in another post for calming down a nerve in early crps and preventing damage, does neurontin accomplish the same thing or only cover up the pain?

Ok, sorry for the initial rush of questions, here's a bit more background. I had the prolotherapy shot 2 weeks ago, which is basically a sports medicine treatment kind of like cortisone shots but with the opposite effect, rather than killing inflammation it creates some to trigger healing in the ligament. The injection itself was pretty painful, but didn't feel like he hit any nerves; however, one interesting note is that I did have a near fainting spell a few minutes after and I have never fainted before and have no issues with needles, which makes me wonder if my nervous system had/is overreacting to the trauma. I went home and the first week I feel just a slight tingle in one spot of my foot. A week later though the pain kind of opens up and I get tingling and burning pain from the medial heel to big toe (basically along the medial plantar nerve branch) and putting weight on the inner foot creates really sharp pains and has gotten a little worse each day, even though the ligaments are back to normal which is making me very worried. I know I don't have some of the crps symptoms like sensitive skin or temperature changes yet and am not sure how quickly these come on, but I don't want to take any chances and make sure this is treated promptly, especially because it seems like the area is expanding a bit, even pressing near the tibial nerve up my shin sends some shocks down now. Is 2 weeks soon enough to stop the progression?
posted by mxmm to Health & Fitness (4 answers total)
I AM NOT A DOCTOR.... below is just things i have found researching. This is not medical advice. Taking prescription medicine without a doctors or pharmacist knowledge is dangerous.

wik and the mayo clinic both say treatment is best within 3 months. Wiki link and hit prognosis. mayo clinic link

My understanding of neurontin (gabapentin) is that it can help with this, but it is a treatment not a cure. It's mechanisms of function are on the brain level not at the site of injury.

Many website list prolotherapy as a treatment of CRPS including the journal of prolotherapy Perhaps that could shed some doubt. I cant seem to find a case of prolotherapy causing CRPS, just mentions of its use to aid to CRPS.

Studies about CRPS seem to show a very high correlation to women age 20 to 35, a link to smoking has been accepted, and usually upper body trauma but not always. Additionally the trauma is usually a broken bone of some sort, wrist and arm being mentioned often. Diagnosis has been as low of age 2 though, and it can affect both women and men. incidents of CRPS have been as high as 26 (i rounded) for every 100k persons and as low as 5)

Also, descriptions of the pain associated with CRPS say severe pain, immobilizing pain, that the pain is worse then the initial injury...meaning this hurts more then breaking your arm or leg. If this at later stages or initially, is not mentioned, but should be noted.
posted by couchdive at 4:42 PM on August 16, 2012

Thank you for the great info, couchdive. Yea, my pain isn't at that bad crippling level right now (thankfully), but I am worried that it is worsening. What seems to be missing from all these articles is whether that severe pain comes all at once in the first few weeks (in which case I could worry less that it's CRPS) or if it starts with mild to moderate shooting/burning and builds over the 3 months (in which case I need to aggressively get it diagnosed and treated soon). Any accounts of typical early stage pain progression would be great.
posted by mxmm at 5:01 PM on August 16, 2012

mxmm, you have pain in your foot. I think you are jumping to conclusions that it is CRPS based on Dr. Google. There are other reason for having foot pain, especially after you just had an injection into your foot. If your doctor is away, then ask to speak to the doctor on call for his or her service. If this is a sports medicine doctor and you have a primary care doctor, talk to your primary care doctor.

I really don't recommend going to the emergency department for this, unless you truly think it is necessary for some reason. IANYD.
posted by treehorn+bunny at 9:07 PM on August 16, 2012 [2 favorites]

By the way, I should add that having pain for 1 to 2 weeks is barely going to even meet the definition of "chronic pain" which is a prerequisite for CRPS (not to mention all the other symptoms that you don't have). I wanted to mention that because you asked if 1 to 2 weeks is "early enough to stop the progression" - it's hardly enough time to even be diagnosed with chronic pain, much less go through the rigmarole of medical appointments and tests and treatments that you would need to be diagnosed with and to address a chronic problem. I hope that helps to allay your fears a bit.
posted by treehorn+bunny at 9:15 PM on August 16, 2012

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