Question re cortisone injected into RSD-affected limb

Sandson

You doctor is probly giving this injection in order to determine if your RSD is SMP. Symphathetically Mananged. If your RSD is SMP managed than you will be able have benefits from block shots.

Skooze

Hi sealover! I like what Sandson wrote, but I wonder if that determines if your RSD is SMP or IMP(independent maintained pain). I thought the nerve blocks determined this, not the cortizone shots. I've had both, the first being the cortizone shots, which gave me severe musscle spasms in the RSD shoulder, in 5/2000. Oral cortizone also made me naseous. They thought I was alergic to cortizone. On 2/01, they tried lidocaine injections, which didn't help me either. About this time I was showing signs of RSD, yet no one mentioned it to me. They thought my neck surgery would resolve my nerve damage and pain on 12/01. 2 months later the RSD came back when I started physical therapy. Temp changes, excruiating pain & I couldn't stand to be touched on the RSD upper extremity. My neuro requested nerve blocks then, which wc denied for 10 months. Finally the employer's IME Dr. seen me & said I had RSD, & ordered the nerve blocks. I had 1 on 11/02, & 1 on 12/02. When they didn't work, probably because it was too late, then my neuro siad that confirmed that I had IMP, and not SMP. I copuld be wrong, anyone else with any input?
Aloha Skooze

sharon1030

Hi Sealover,

I think Sandson is referring to the sympathetic blocks. Cortisone injections, as far as I know, can't determine if someone's pain is sympathetically maintained or independent. I don't know if it's the actual cortisone that could flare up the RSD or the injection itself. Any type of trauma (an injection is in that catagory), no matter how small it might seem, can cause RSD to flare. I've had a few cortisone shots. If my pain got any worse, it calmed down in the days following. I guess it all depends on what they want to give you the cortisone for and how bad that is. If you weigh your pain and try to figure out which pain is worse; the RSD pain or the pain coming from whatever needs the cortisone, you might be able to decide if you should risk the shot. If the RSD pain's worse, I wouldn't get the shot. If the pain for which they want to give you the shot is worse, it might be worth a try. If I remember correctly, you still don't know for sure if you have RSD. That's makes this whole thing a bit more difficult. I usually can tell the difference between my RSD pain and pain coming from some other mechanical source. Hopefully, you can too. Otherwise, ignore everything I just wrote . Good luck.

Sharon

sealover

Thanks for the responses so far.

Sharon, yes, I am the person who still doesn't know for sure if I ever had RSD. I haven't written on this board in a little while, but it's nice to be remembered! You are right in that a cortisone injection is not used as a diagnosis tool for RSD. It makes sense that injecting the injured body part may cause RSD to flare...whether it's due to insertion of a needle and/or the medicine that gets injected that causes problems...I don't know. I've read a lot about RSD, and there's still much I don't understand.

Actually, I had received a cortisone shot in the injured foot on my first visit to that doctor at which time he suspected that the foot showed signs of RSD. He gave me a 2nd injection in the injured foot a month later when RSD still was not confirmed and I still had symptoms of RSD. The cortisone inevitably made a mess of my foot! We still do not know if I ever had RSD that went into remission and, at this point, I can't worry about it anymore, but I still am having problems with the foot due mostly to having the two cortisone injections, and it's been almost a year since my injury. I am back in physical therapy and have a TENS unit for pain. I'm going to have an ultrasound test and my 3rd MRI.

I would really like to know if a doctor should NOT inject an injured body part with cortisone if RSD is suspected. Can getting an injection in an injured limb that is showing signs of RSD have a negative affect on the injured limb? I thought I had read on Dr. Hooshmand's website that having an RSD-affected body part injected is not recommended, but I'll have to go back to his website and read over all the tons of info when I have more time.

My best to all.

hatemyrsd

I recalled reading a puzzle on RSD and Cortisone and I will copy the entire puzzle here. A Cortizone injection into the wrist will flare up RSD if you have it.

Personally, I WOULD NOT allow anyone to shoot cortisone in me before they actually rule RSD in or out. I had 3 cortisone injections before they admitted I had RSD and it did do quite a bit of damage and reaked havoc. I bleed in that arm quite a bit more than I should. I put my hand in my pocket and when I pull it out a vein has ruputured and the skin ends up tearing. They claim it is reaction from the cortizone!!! I have had Bier blocks, which have been quite effective, unless I get STUPID and overdue myself. The last one did not even leave the huge bruising. Yea

I know too, I have read several articles that say a cortisone injection can rupture weak ligaments and other things.

sealover

"hatemyrsd," thanks for posting that info from Dr. Hooshmand's website.

I also found the following may offer a clue (I'm still trying to learn more):

RSD Puzzle #113:
Nerve Blocks For RSD Spread

Question:

Dear Dr. Hooshmand,

I was wondering if nerve blocks are worthwhile performing to a brand new site of RSD or is the new site of spreading (in this my case husband’s hands from feet) already independent or once the new site is there is it mediated pain?

Answer:

1. Spread of RSD refers to spread of all signs of RSD to another part of the body.

2. Referred pain is just that. It is a pain referred to a remote area, but it is not the same as spread: In spread all four features of RSD are spreading (pain, spasm of muscles and cold extremity, inflammation, and insomnia and agitation.)

Referred pain should be treated with paravertebral nerve blocks, epidural blocks or trigger point injection.

In either case, the hand or foot, knee or ankle should not be treated with direct insertion of needle for purposes of any nerve block or trigger point injection. The needle insertion only flares up the regional pain and aggravates the RSD.

H. Hooshmand, M.D.

hatemyrsd

Your very welcome.

I have a nurse who does my IV's for the Bier blocks. Everytime she sticks me with the needle it burns like heck. One day she said it just dawned on her the reason it burned so bad going in was because of the RSD itself.

Sharon - how can you tell of it is your RSD flaring or just a regular pain??

Thanks, Lou

Sandson

Sealover:

I see that my answer was kind of in the ballpark. So, those cortisone injection could have been trigger point injections. The patient's reaction to the shot will determine course of treatment.

feelbad

just wanted to throw in my wonderful experience with cortizone inj.I had a cortizone injection along with an aspiration to remove fluid from behind my R kneecap.I also have a rather large bakers cyst behind this knee.well about 15 min after the injection it felt like someone had just turned on a flippin blow torch inside of my knee!! i had always had some pretty intense burning on the knee but it had always felt like it was more on the surface burning as opposed to any real deep burning,but this was way down deep and was flaring at way over a ten!i will never ever have another one.i also cannot have the bakers cyst removed,which is causing its own set of horrid problems,as my ortho said he would be very afraid for me in that it could really send my pain levels through the roof.so, I have to live with this mess in my knee for now.I just wanted to give you a peek at my experience with cortizone.That intense deep burning is still there and pretty constant now, but has dropped down at least about a point or two(on good days)and is a little more tolerable.But I still get those nasty flare ups from hell.good luck.Marcia

Baileysmum

Hi there

Just thought I'd share my story too.

For the first 3 years of my rsd, it was just in my right arm, stopping at an imaginary t-shirt sleeve line, if you know what I mean, just above my elbow.

However, I then developed shoulder impingement syndrome in the rsd side shoulder. I had one cortisone needle and it was great, I had 2 weeks of total pain relief in my shoulder. But the next three caused more pain than relief, with pain shooting down my arm as the injection took place, and chronic rsd pain in my hand and forearm for days afterwards. After the 4th I said No More, but I was too late. Now my pain is the same from fingers to neck. The two pains, the shoulder and rsd, used to be very different, now its all the same. I believe the cortisone needles and not the shoulder impingement caused my rsd to spread up through my shoulder, the side of my neck, and front and back area of my shoulder bones.

So I think care does have to be taken when getting cortisone needles into your rsd affected limb. If it doesn't give you any pain relief, maybe its not worth the risk having more. I did a lot of research after the 1st and 2nd needles, and read that dr's should never do more than 4 cortisone shots, as it can weaken the blood vessels etc in the joint and cause huge damage in there, whether you have rsd or not.

x Kate

sealover

feelbad & baileysmum,

I'm so sorry to read about your bad experiences with cortisone. Doctors should be more careful about using cortisone when other less invasive treatment options are available. They should clearly explain the possible side effects of cortisone and allow the patient to make an informed decision about receiving cortisone injections. Also, doctors should be even more cautious about using cortisone injections when dealing with a patient who may have RSD.

My doctor's first line of treatment (when he believed I had RSD) was cortisone shots...I was naive then and didn't know the damage that cortisone could cause. I don't know why he didn't at least give me a pain killer to get through the pain instead of shooting my foot with cortisone. I hate to say that maybe it's about making more money...doctors can't make money prescribing medication, but they make money giving cortisone injections.

Well, the cortisone definitely destroyed the fat pad in my foot which is a really awful thing to happen. My doctor even wanted to inject me a 3rd time with cortisone within 3 months! But by that time, I had noticed the start of the damage and didn't go back to him again. My foot would be doing so much better today (and perhaps it would be perfectly fine) had I not been given the injections. If I go out and do errands, it takes me another full day of bed rest to recover from the pain in my foot. The only time I'm not in pain is when I've woken up from a long sleep. But once I start walking, the pain begins.