Treatment for RSD of the hand

  : Hello-
  : I just had my second nerve block for hand symptoms(burning, prickling pain etc.) The first block was a month ago. I have been taking Elavil 10 mg daily for 2 months. So far I have not noticed any real difference in pain relief or skin/color changes. The fingers do feel warmer. Yesterday, the day after the block, I went for a brisk walk in the cold to see how it felt. I experienced the worst burning and tingling ever, which went away once I went into indoors. This type of intense sensation never occurred before. Was it a normal respnse to the block? How long should I expect befre noticing any real improvement? Will the visual skin conditions go away after the pain goes away, and how long would this normally take to happen? I realize that each patient responds differently, and there is no set time table. I'm supposed to have the third block in a week and a half, then they will evaluate the hand. What other types of medications and treatments would be available? The nurse mentioned a "rhizotomy" which would chemicaly treat the nerve area-what is this? I have had these symptoms for more than a couple of years. I had a thumb ligament repair, carpal tunnel and joint release, more joint releases and web contracture, and another carpal tunnel repair. The RSD tropic symptoms have been visible for about 3 years, and burning and prickly sensation developed, and was concurrent with carpal tunnel. I really want to get this under control, as my PT says that my thumb joints could be released after all the pain goes away. I have very little active joint ROM. Am I going in the right direction and can the RSD help ao that my hand will feel and look better? Thanks so much.    
  
  HAS MY QUESTION BEEN OVERLOOKED? I WOULD REALLY APPRECIATE HELP!!
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Dear Susan,
thanks for the question and sorry for the delay in responding.
Nerve block works almost immediately in some patients but certainly if it is going to work at all by the end of the day, you should feel some improvement in pain. There is also epidural injection and of course the sectioning of the nerve if all else fail. Here at the Cleveland Clinic we have one of the best comprehensive pain management program.
We also perform spinal cord stimulation using implanted electrode in refractory cases. Most recently we are doing peripheral nerve stimulation, again this involve putting an electrode very close to the nerve, done in the operating room. If you would like to be evaluated here  please do not hesiatate to contact us, 1-800-CCF CARE.
Good luck.