My Reviews on a few "Healthcare" or is it "HealthSCARE" facilities?

"Our Newly Built ER"

TITLE:  Can't Care for a blood blister?

PROS:  I didn't have wait long

CONS:  The hole in my foot took 3 months to heal

As a patient with RSD/CRPS, I have to guard against this sort of care.  The physician asked me to roll over so she could see it better. That being my RSD leg, so what came next took 3 months to heal, also caused my RSD to spread, but was sickeningly painful, but is contrary to care of ANY blister (as the skin is the only barrier against infection or creating further injury), as with RSD, your affected part isVERY hypersensitive to PAIN, this provider was apparently unaware I am healed now--3 months later.  Steep price to pay.  I wound up bed/homebound for nearly 3 months with home health and 3 day a week home health.  I only  went to appease my PCP.  I DO know how to treat a blood blister-leave it alone & protect it.

The home Health Agency that Followed (I am too tired to get to my PCP)

TITLE:  Have a contingency plan; don't have rare or painful disorder

PROS: Animal Friendly & shower aides are awesome

CONS 

I informed them way ahead of time I was having a portacath placed.  However, as soon as this was done--I was, with NO NOTICE, promptly discharged-with no other arrangements made. My physician was not notified, nor was I--until AFTER the port was placed, and advertised services were NOT ONCE PROVIDED, unless it was a "Well, I am not supposed to," and you were made to feel so privileged that they did their jobs.  Wow!  They came into this knowing I had a rare and highly painful illness, and I had to loan the primary RN a book on it, and it was returned 1 week before discharge.  I told them my port was being place during mid---Feburary; the port was placed March 14; and I was IMMEDIATELY discharged of ALL services-no notice, no recommendations of other agencies that handle ports.

I SWEAR-IS IT A MINIMAL IQ FOR MED SCHOOL?

I posted this in FB ketamine *****:

I am seriously considering going to ER, I swear-I called the on call neurologist no go so far, but it's only been a little bit. I take Fioricet (minus codeine) with Tylenol and I have noise cancellation headphones, and swear to GOD-they used to be my stepdad's before when he had to wear hearing protection when working and I am close to that: wake up with headache: and she described it correctly when it's like getting smacked over your head.....and people cant get that NOISE hurts!!! A few fibro and you guys...makes you want to climb the dang wall-and the thing that makes me feel so bad is one noise is my CA TS, who I adore more than anything. I know Jessica's dad, and he told me that "well, if you don't WANT to do ketamine, I hear they've had success with hypnosis-try that. As for my daughter, she did it the 'ole fashioned way with ketamine." Knowing full well I have no resources to pay for it, stupid jerk. I am glad she seems to have turned out well. What do I have to mortgage? My $40 TV? Like the $150 this month I spent total on the small amount of the cream and the nasal spray. Now I can't pay my phone bill and that guy upstairs walks loud. Got call now that I have NO HELP because the agency (GENTIVA) won't even give you a home health aid--NO NOTICE!!
                                                                                         

UH, PAY ATTENTION!!!!!!

I have another doctor appointment (Oh, yay, the $75 I had left to my name, with which I  hoped to get some whole milk, A couple boxes of Instant Breakfast, etc--I now am supposed to spend $50 of it on cab fare to getting to yet another doctor appointment I will point out: in the same week--on the heels of spending $120 to go see the pain doctor for another spinal block (and not a terribly effective one: it helped the lower leg but I am getting NO relief from the dang thing by now, I am sorry to say.)

(that would be RSD at the top==and it's 24/7, 365

Now, the malnourishment has me with a constant case of poor wound healing,and blood sugars that bounce around to the point of sheer exhaustion, and no one does a darned thing about it since I was overweight before the surgery; well thanks cuz now I am:

• constantly weak to the point where I am dizzy just standing up, 
• I sweat like crazy and though my heart FEELS like it's racing-it isn't
• I suffer from hypotension and LOW heart rate--so even in wicked bad pain, my BP never is much higher than 90-100/50 and my heart rate is 58-60; I had an emergency spinal block and it was because my pain was so bad my heart rate is usually around 58.  It was 138.  My BP was at an all time high of 130/28--and wonder why people had a hard time believing I was in pain?  Or had RSD?  Guess I understand now.
• I get exhausted going to the bathroom.
• I I shake just doing simple tasks
• I have the runs (it happens)!!!!!!
• my foot is taking forever to heal
• my body won't respond to treatment

I lose almost 60 pounds--WITHOUT dieting; and people keep just CONGRATULATING ME.

I TALK AND PEOPLE THINK I AM "STONED" BECAUSE I CAN'T GET "NOURISHMENT TO MY DAMNNED BRAIN!!!"

You just tell me to eat.  I freaking can't do it, it ain't that damned simple!  You think I can pick up where prolonged RSD pain left off???

If someone would PAY ATTENTION and REALIZE THAT  even though my BMI had me as though it may have been high BEFORE the RSD came along-- DO YOU NOT UNDERSTAND AT ALL THAT I CAN'T "JUST DO THAT????"

YOU ASK ME, "WHAT IS THE PROBLEM?"

 It would be known as denial (and not on my part).  Sure as hell I am frustrated-I have been shouting this from the rooftops and who's listening.........hmmmm, only person I heard was the friend on the phone and my cat meowing real loud.  Denial that even someone people think is "heavy" can be malnourished.  And that can cause you to be barely able to move.

This did not happen overnight:

I THINK THIS HAS BEEN CLEAR ENOUGH.  I could get through this IF YOU WOULD HELP ME NOW AND NOT WHEN I END UP IN A DAMNED NURSING HOME---because some FOOL comes along and says

"Oh, she has to have 24 hour care--she can't even eat!

Then really--this is my LIFE we are talking about, not just something to joke about. Do you think that the fact I seriously considered going to the ER-but that was no more of a solution that spending $50 of my food money to see a doctor who can't help with this problem.  A simple one that even some perhaps use of the port-if I ever get the name of the surgeon.  That's my other chore today;

And I feel like I am having to climb Mount Everest--not Everett.

I used to look like this:

This was taken a week ago:

I look like SHIT-

PAY ATTENTION 
bottom right is still me.  Don't ask for, ah, hell, here's today: 

March 26, 2012

SECOND DRAFT OF KETAMINE LETTER

APPROVE KETAMINE FOR REFRACTORY RSD
Greetings,

I just signed the following petition addressed to: Medicare.

----------------

http://www.youtube.com/watch?v=7GHIQQQcROs  

(see bottom)
APPROVE KETAMINE FOR REFRACTORY RSD

Ketamine is growing in popularity, see this link for more information on the success that even the FDA has admitted to. Problem is the explosive growth of numbers of patients ending up on Medicare after use of their previous insurance is exhausted. Regular insurances, that's about $2Million in care before it runs out.
Previously controversial, it is proving less so:

http://rsdfoundation.org/en/Ketamine_Treatment.html

KETAMINE SAVES LIVES AND MONEY!!!!!

APPROXIMATE COST OF KETAMINE IN DOLLARS AND CENTS:

• A 3-4 day ketamine infusion, on average is about $2-3,000 per day-in hospital;
• at an outpatient or tertiary site, about $2,000 per day.
• One course of 3 day treatment; of which most patients undergo about 5-10 treatments would cost about $15-20,000

(the cost of the surgery, by the way that triggered my disorder WAS $17,500).


If that puts someone who requires well over (keeping in mind, my care for home health is not included as it is yet to be submitted) an average of $150,000/year for life, cost for a series of short-term ketamine treatment, costing in the end maybe $50,000-80,000 offers a shot at a life without the screaming agony of RSD which has even (though not crossed my own mind) driven some to suicide—as children.
Or I could get ketamine and WORK, AND BE MAKING $60,000-80,000 AND be PAYING INTO the system.

TELL THE GRIEVING PARENTS WHAT THEIR CHILD'S LIFE WAS WORTH, THAT YOU, MR. PRESIDENT, CAN'T SIGN A PIECE OF PAPER, REQUIRING MEDICARE, SAY TO BE COVERED IN ALL 50 STATES???

Why is ketamine so critical?

Approximately 1.5 million Americans suffer from CRPS/RSD in any given year.

Different kinds of pain in RSD
• in the beginning, the pain of RSD/CRPS is Sympathetically Mediated Pain.

Every time there is a 3 month delay in the start of treatments (first line) like spinal blocks, the pain becomes more of what is called INDEPENDENTLY MEDIATED PAIN (this means it originates no longer in the spinal nerves; but the brain itself.

3 months = 25% IMP & 75% SMP (still good chance at recovery with topical ointments, nerve blocks, etc.

6 months = 50% IMP & 50% SMP (multi-modal therapies must be used)

9 months = 75% IMP & 25% SMP

By 12 months, rule of thumb, almost 100% of RSD/CRPS pain is IMP.

http://www.rsdhope.org/imp--smp--crps.html

My treatment began in the 11th month, when about 92% of pain is IMP and it began with spinal block--as that is what MEDICARE has approved--not things that work for IMP (and far more difficult to treat=aka, becoming “refractory")….”

And yet, I must AGAIN be submitted to only Medicare approved treatments for RSD/CRPS THAT ARE "ALLOWABLE BY MEDICARE for WASHINGTON STATE.
Which means I did get to “skip to” spinal blocks. They provide about 3 days relief thus far. And I have not had one, and WILL NOT GET ANOTHER 3 DAYS of relief--which looks like an oasis at this point-UNTIL I HAVE A SURGICALLY IMPLANTED PORTACATH. I've had so much agony in my medical history; I HAVE NO IV ACCESS.

My RSD Specialist--who does this day in and day out, in terms of starting a simple IV, took 3 hours and countless sticks before a butterfly needle was used when at least a 20-guage-21-guage needle be used in case of emergency. WE WERE FORTUNATE. And I am used to being stuck: so the problem? Each stick has a very good shot at spreading the disease from my right leg to left arm, or if as is often the case, when done improperly--it can-a simple needle stick, cause, full-body RSD, which by definition is treatment-refractory.
A hospital may charge $2,000 just to place the catheter in the patient in day surgery.
This is not including fees from the surgeon for the initial consult (probably about $500 for the initial consult). No idea what fees are to actually place the port?

And I need TPN now.


REASONS TO NEED TPN:
Reasons I need the TPN are the following (the symptoms of the RSD being also a portion of it as well, adding to the expense--even though study review after review has repeatedly showed that patients do better at home in recovery from just about anything

Reasons in my medical history that I would likely need TPN:
• Malabsorption
• Surgery
• Reflux
• Malnutrition
• Chronic adhesive obstruction

THE BOTTOM LINE AT THE CURRENT TRAP:

Grand total in charges are (without TPN): (Roughly, including the $2,000 for each spinal block) are about $10,000/month

Add the TPN and take it up to $16,000 +/month OR $192,000/year.
Now do you see how so many end up on some form of public assistance? Most insurances have a lifetime cap of $2 mllion. At $192,000/year, it will provide respectable ca
For a time at least, average cost of home based TPN so that my body can heal.
• Have a prayer of fending off infection with a portacath
• Give me the energy level to be able to shower without assistance
• Build up a level of health where my body could withstand ketamine


At this rate, maybe I will live to see 50, maybe not-but unlikely.
o I make the most of it.
o BUT BECAUSE I LIVE IN WASHINGTON, NOT IN CALIFORNIA OR FLORIDA? EXCUSE ME, BUT THIS COUNTRY WAS BUILT ON EQUALITY.
o EQUALITY IN ALL 50 STATES.
.
I MUST FIND A NEW PRIMARY PHYSICIAN, BUT WHAT’S WRONG?
No physician wants to take me on as a NEW PATIENT because I am what is known as a "PROBLEM/VERY COMPLEX PATIENT."

Anywhere else I TURN (aka, away from the doctor who ignored what was "classic RSD Symptoms" which forced MY hand to step out of their system and go to a neurologist I KNEW could make the diagnosis.

By the time my chart landed (he is ONE of THREE doctors I know of that don't put a COMPUTER between them and their patients) on the desk of and their patients. Note the lack of COMPUTER chartng.

Right now, the only 3 I would recommend to anyone with RSD. HOW MANY PCP’S KNOW ANYTHNG ABOUT RSD? ONE WRONG MOVE practically, and you can damage them permanently—leavin

And maybe would allow someone in my condition, at 37, a chance of maybe even returning to work, should the restorative therapies be initiated ASAP, the cost of KETAMINE is a bargain since I was last employed as a Registered nurse,

Ketamine is a risk maybe, but numbers are piling up so that MANY other states, such as California and Florida allow Medicare reimbursement-NOT WASHINGTON.
But if the
• RSDSA
• RSD Hope Foundation
• RSD Foundaton,

Would all support ketamine in cases like mine, if my doctor recomends it as AN OPTION that MAY BE APPRORPRIATE-SHOULD THIS NOT BE AVAILABLE NO MATTER WHAT STATE I LIVE IN, WITHOUT MY HAVING TO TRAVEL OUT OF STATE WHERE
80% IS COVERED
20% IS ON MY LAP

WHEN MY HARD WORK FROM AGES 15 UNTIL MY LAST EMPLOYMENT IN WHEN my poor health forced me to finally give up a career that:
• I loved.
• Allowed me to be of SERVCE TO OTHERS the way I WANTED TO.
• Yes, it did pay well
• PLUS I spent 5 years in University WORKING and paying taxes and DOLLARS INTO instead of sucking dollars out

=====================================================================

Just ask yourself this, Mr. President, and Ladies and Gentlemen of Congress and the Senate:

Would you not want the same care in your state, if something happened to you, and you were not around to make sure that your CHILD, WIFE, HUSBAND, PARTNER, ETC, becane unable to work, not able to afford housing without a job of some kind, a CHANCE AT A LFETIME OF FREEDOM BE AVALABLE IN ALL 50 STATES?

DON'T ONLY MAKE IT AVAILABLE WHERE DOCTORS ARE ABLE TO, MAKE IT SO THAT DOCTORS ARE ABLE TO PROVIDE KETAMINE IN ALL 50 STATES.


$3.9 million PER patient. With how many of those 1.5 million with access to ketamine IF needed?

Sounds expensive to me to say “Aw, it’s only a small percentage of people, it’s gonna come out in the wash!”

Come and meet us:

Cost without ketamine is about $150,000-200,000/year for life.

Or $150K is a ONE TIME deal.

TPN and tube feeds or jobs with benefits, and productiveness to society-but equal opportunity MUST exist wthin healthcare

THIS IS OUR LIVES.


1.5 MILLION AMERICANS
or is it ONLY  1.5 MILLION AMERICANS



EFFECTIVENESS OF KETAMINE:
Case notes of 33 patients whose CRPS pain was treated by the inpatient administration of a continuous subanesthetic intravenous infusion of ketamine were reviewed at Mackay Base Hospital, Queensland, Australia.

A total of 33 patients with diagnoses of CRPS who had undergone ketamine treatment at least once were identified.

Due to relapse,
12 of 33 patients received a second course of therapy, two of 33 patients received a third.
• There was complete pain relief in 25 (76%),
• partial relief in six (18%),
• no relief in two (6%) patients.

The degree of relief obtained following repeat therapy (N=12) appeared even better, as all 12 patients who received second courses of treatment experienced COMPLETE relief of their CRPS pain.

The duration of relief was also impressive, as was the difference between the duration of relief obtained after the first and after the second courses of therapy. In this respect, following the first course of therapy,
• 54% of 33 individuals remained pain free for 3 months or more and
• 31% remained pain free for 6 months or more.

^ a b Goldberg ME, Domsky R, Scaringe D, et al. (April 2005). "Multi-day low dose ketamine infusion for the treatment of complex regional pain syndrome". Pain Physician 8 (2): 175–9. PMID 16850072.

OTHER OPTIONS FOR CRPS/RSD?

A spinal, or even a stellate ganglion bloock is going to help this?  I have full body RSD!

Or a spinal stimulator in the "new generations? Including the trial and implantation? Approximately $60,000 for the implantation!

"Uncomplicated" maintenance of a SCS is about $7,000/ year.

Complications include everything from bleeding, to spinal headache, leakage o flud, increased pain at the site—and as well as an implant pain, also—to which is:o Spread
o Infection
o Acute flare-up of the disorder, potentially causng serious seizures even:

This many complications--"uncomplicated” seems unlikely.

But it's being shoved at me--and hard.  I don't want the stimuator--but every pain patient's worry is two-fold:

• My doc will dump me if I say no.
• The peppering with questions is a turn-off

RSD-appropriate care is a thing of the past when the same care is not available in EVERY STATE......AND KETAMINE IS NOT EITHER.

WE DEMAND EQUAL HEALTHCARE IN EVERY STATE.  IT SHOULD BE EQUAL ACROSS THE BORDER!!!!

...Sign this petition, please, and DEMAND as a US citizen, and a REGISTERED VOTER and (even on disability in some form, we all do a TAXPAYER); that President Obama and our Congress/Senate give us EQUAL ACCESS IN ALL FIFTY STATES NO MATTER WHAT!!!--rather than forcing us to sell every last possession.

And let's point out a lifetime of remission from Ketamine treatment is cheaper than expensive Spinal Stimulators, and jabbing needles into the spines of those already in compromised health. Bring RSD/CRPS patients out of the dark into the LIGHT--Please: give us a chance, we have suffered enough,

To families and friends:

http://www.rsdhope.org/to-the-families--friends-of-rsd-patients.html  

What Many Pain and/or RSD/CRPS patients would like people to know:

http://www.rsdhope.org/what-would-you-like-your-family-to-know-about-crps.html  

EQUAL FOR THE "HAVE NOTS!!!!"

EQUAL FROM STATE TO STATE. IN ALL STATES—NO MATTER WHAT—NO EXCEPTIONS: IF MY DOCTOR SAYS I NEED KETAMNE, THAN WHAT---KETAMINE.

It's one more CHANCE we could have at not A LIFE, but LIFE

[Your name]

A WOMAN (AUS) LIVING WITH RSD/CRPS

THIS IS HOW I SEE RSD--->

RSD is the disease of "the crappy, bad, and worse," not the "Good, bad, and the ugll

FIRE AND ICE: They have failed anyone with PAIN OR CRPS/RSD

                  
It speaks for itself.  At least how I feel.

When did I invite the government into the doctor's office with me?

Never!  If the AMA would "grow a pair" and tell them to get out...we'd be in a dream world here in the US!

They talk about the "war on prescription drug abuse."

Try "War on abusing those in need of a prescription for pain-or that are:

IN FUCKING PAIN THEY COULDN'T BEGIN TO IMAGINE

Fuck my government!!!

I never did AT ANY POINT, once...SINCE HAVING ANY CHRONICALLY PAINFUL ILLNESS......INVITE THE STUPID PRICKS INTO MY EXAM ROOM WITH MY DOC-KISS MY FUCKING ASS WOULD CROSS MY MIND THESE DAYS!!!!

A FLUNKEY WITH A HIGH SCHOOL DIPLOMA AND A DRIVER'S LICENSE-AND MAYBE, JUST MAYBE IS THE ONE OR TWO YEARS OF "GENERAL STUDIES" (OR "POLITICAL SCIENCE IS MORE LIKE IT) TELLING OUR DOCTORS HOW TO WRITE PRESCRIPTIONS FOR SCHEDULE 2 NARCOTIC PRESCRIPTIONS FOR THOSE ON THEM: 

AS THEY ARE "SUPPOSED TO TAKE/DISPOSED OF THEM," 

NOT TO MENTION DECIDING:

WHAT MEDICATIONS ARE PRESCRIBED FOR WHAT CONDITIONS!!!!!  

AND TREATING PEOPLE ON THEM AS IF THEY ARE SO ADDICTED TO "THEIR PAIN MEDICATIONS" THAT WE MUST BE "CLOSELY MONITORED WITH HAIR SAMPLES AND RANDOM OR REGULAR UA'S.  

THE ONES WHO GET THE MOST SHIT FROM A GOVERNMENT WHO ARE PROFESSIONALS AT DOLING OUT SO MUCH OF IT--ARE THE ONES WHO PASS THEIR UA EVERY SINGLE TIME, WITHOUT FAIL.

THIS MAKES EVERY BIT OF SENSE TO ME-AS THE STUPID FUCKS WHO GOVERN HANDLING OF BEEF BEING INVOLVED IN THE HANDLING OF NARCOTICS! 

WHEN THEY GET ACCESS TO MY MEDICAL CHART AT WILL! SO IS IT THAT THE LAWS HIPAA APPLIES TO EVERYONE EXCEPT THEM??? 

THIS IS MY PAIN--SINCE I KNOW MORE THAN ANYONE (EXCEPT YOU, MR. FDA)

• My pain is too distracting that I have trouble carrying on a conversation with than five minutes, ANYONE
• I feel like I have been doused in lighter fluid and lit on fire.
• Then, someone grabbed the wrong pail, and instead of WATER to put it ouut, they threw grease on the fire;
• My pain exploded in size, strength, and the willingness to go out is ZERO.

WHEN I AM TOUCHED

• It feels like they've taken brillo pads, wire scrub brushes, and the like too me.
• And scrub my open, raw and bleeding wounds with them.
• This comes from the touch of my cats tail as he brushes by--or worse: when he jumps on my lap, just to cuddle.

SO--OPEN MY FILE-I'VE NOTHING TO HIIDE-EXCEPT ONE THING: MOST

Some days I function okay.  But since that ER doc filleted my foot?

Not so much.

I'm trying to not let it own me; but those "pain support sites;" even RSDSA's on FB led me to have to change my email account.  And delete my FB account.

This is what I am had done today

 

                                        Sympathetic Nerve Blocks:

There are three reasons to consider sympathetic blockade to facilitate the management of RSD / CRPS. First, the sympathetic block may provide a permanent cure or partial remission of RSD / CRPS. Second, by selectively blocking the sympathetic nervous system the patient (and physician) will gain further diagnostic information about what is causing the pain. The sympathetic block helps determine what portion of the patient's pain is being caused by malfunction of their sympathetic nervous system. Third, the patient's response to a sympathetic block provides prognostic information about the potential merits of other treatments. ^25-27

There is evidence that there might be a role for sympathetic blocks in preventing RSD / CRPS. A retrospective study demonstrated that the prophylactic use of sympathetic blocks in patients with a history of RSD / CRPS decreased the occurrence rate of the disease from 72% to 10% after re-operation on the affected extremity. ²⁸

If sympathetic blocks are not properly performed and evaluated, time and money will be wasted, and diagnostic-prognostic information will be lost. A good sympathetic block should increase the temperature of the extremity without producing increased numbness or weakness. The sensation of warmth tells the patient that they have had a sympathetic block. If the block causes numbness or weakness, more than just the sympathetic nerves were blocked and the patient will get an overestimation of the amount of their pain that is contributed by their sympathetic nervous system; hence, the diagnostic and prognostic value of the nerve block would be lost. The amount of pain relief and improvement in range of motion and in exercise tolerance should be noted by the patient and recorded by the physician. This information about the patient's response to sympathetic blockade will serve as a prognostic indicator for rehabilitation following the series of sympathetic blocks and it will help the patient decide if a permanent block (destruction of the nerve by sympathectomy) would be appropriate. Also, the information will aid in directing future medications in a more rational manner. Some patients will experience a "booster effect" with each sympathetic block, i.e. each successive sympathetic block in the series provides greater and greater pain relief and improvement in exercise tolerance. The maximum sustained benefit from a series of sympathetic blocks is usually apparent after a series of 3-6 blocks. Even if the original site is unresponsive to sympathetic blockade, future exacerbation of RSD / CRPS symptoms at the same site or at a distant site may be responsive to 1-3 sympathetic blocks. THE GOAL IS ALWAYS TO TREAT BUT DON'T OVER TREAT.

Sympathetic blocks are usually performed by a pain specialist trained in anesthesia. In experienced hands, these nerve blocks can be performed with minimal discomfort to the patient with or without IV sedation. Complications from sympathetic blockade are extremely rare. However, it is always possible for the local anesthetic to be inadvertently injected into a blood vessel or into the spinal fluid. If this should happen, the patient may temporarily become weak and lose consciousness. For safety reasons, sympathetic blocks are always performed under conditions where the vital signs (blood pressure and breathing) can be monitored closely. Patients should not eat for 6 hours prior to a sympathetic block. For further information about safety in performing nerve blocks refer to the web site for the Anesthesia Patient Safety Foundation: http://www.apsf.org/

A sympathetic block of the upper extremity is called a stellate ganglia block (SGB). The SGB is performed by inserting a small needle along side the windpipe (trachea). Patients are informed that they may notice a temporary change in the tone of their voice following the block because some of the local anesthetic may partially numb the vocal cords. They are also informed that they should sip fluids and take small bites of food immediately after the block. The numb ness around the vocal cords temporarily places the patient at a slight risk of coughing in response to drinking and eating. The patient may also notice a temporary drooping of their upper eye lid due to the SGB (Horner's sign). A sympathetic block of the lower extremity is called a lumbar sympathetic block (LSB). For patient comfort and safety, LSBs should be performed with the aid of a fluoroscope (X-rays). Videos of LSBs and SGBs being performed can be found below at the end of this section.

As noted previously in the Guidelines, there may be point-tender spots in the muscles of the affected region due to small muscle spasms called muscle trigger points (myofascial pain syndrome). The patient may obtain significant relief of the diffuse pain due to RSD / CRPS from a sympathetic block but the pain due to muscle trigger point(s) may persist. Local injection of local anesthetic into the trigger point region and/or application of physical therapy techniques after a sympathetic block may be necessary to provide further relief of pain.