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New RSD
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New RSD

I was diagnosed with RSD 3 week ago after having medial and ulnar nerve surgery. (It was supposed to be a simple carpel tunnel release and cubital tunnel transportation).  My orthopedist said my nerves were severely damage. I developed severe pain (burning like on fire, severe sensitivity, frequent muscle spasms, ice cold hand, and severe swelling to name a few) 5 days after surgery. I haven't slept more than 2-3 hours at a time since surgery. I have had 1 SNB, intense physical therapy 3 x week, using TENS unit for 60 mins tid. The nerve block helped for 3 hours, then the pain returned with a vengeance.  I have Epilepsy so I was already on Neurontin 600mg tid, this was increased to 600 mg am & at noon and 900 mg qhs. I'm allergic to Lyrcia (severe rash with lesions).  I tried Oxycontin, hydrocodone, and Demerol with no relief. I am now on MS Contin 15 mg q am 30 mg q hs, as well as morphine sulfate 30mg 1/2 prn (usually tid) for break-through pain. Additional meds include Dilantin 200 mg bid, Zofran 4mg q 4 hr prn. My question is... am I on to much morphine? This is the only medication that allows me to get out of bed.  
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I don't know if you are on too much Morphine, that would have to be a question for your dr. I can tell you that nerve pain only really responds to meds like Lyrica and neurotin. The opiates are not going to alleviate nerve pain, they work differently. Maybe your doctor can gradually increase your neurotin dose again. I hope you get to feeling better!
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Avatar_f_tn
Hello Ellen038,

Thank you for your response.  Do you suffer from RSD? My question was more in the area of what is a good/safe dose of Morphine for maintaining chronic pain.  I know each person is different but figured there was a standard dose. I do not work with pain meds, nor have I ever taken them.  Also, being a nurse myself and aware of RSD, I completely disagree with opiates not helping nerve pain. I believe only people who are diagnosed with it could truly understand how severe the pain is and what helps them. Research on RSD is so poor after all. Anyway, I've tried Percocet, Demerol, and Lorcet but they did not help.  However, after starting MS Contin & MS for breakthrough pain, I can at least get out of bed and walk around.  The issue is it only lasts for a max of 6 hours.  I continue to sleep 3 hours max per night since my surgery 2 1/2 weeks ago.  I also need something to make it through physical therapy. I have never been on pain meds before so I needed some guidance.  As far as my Dr., he is an orthopedist and tells me to take what ever makes me comfortable with a limit of 200mg daily. I so early in my recovery he's not ready to refer me to a pain clinic.  BTW... I'm allergic to Lyrcia and my Neurontin is maxed because of elevated LFT's.  I do appreciate your comments.  Thank you.
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Avatar_f_tn
No I do not have RDS but I have nerve damage in my leg since 2006. The orthopod I saw and pain management I see say that Lyrica and neurotin are the meds for treatment. It may be different in your case since you already take as much as you can. I can tell you that I was started out on 30mg morphine sulfate and I was allergic to it. I've been on oxicontin, fentanyl&norco combo. So I would guess that 30mg morphine would be a starting dose. Please feel free to message me. I will help you any way I can.
I hope you feel better soon!!
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1855076_tn?1337118903
I developed rsd in my left hand, wrist & arm up to the elbow after having joint replacement in my thumb joint.  The implant they used failed & I wound up having 9 operations & procedures.  Very heavy doses of narcotics just took the edge off.  I was put on Nucynta & had terrible side effects (hallucinations, terrible insomnia,vomiting).  But it got rid of the nerve pain in my arm.  I switched pain physicians & was put on nortriptyline & I've found some relief from that.  

Everyone is very different so it really isn't possible to figure out what's the best dose for you. The best thing is to take the least amount because tolerance builds quickly.  I came off everything for some time because I wanted to see where my true pain was.  My blood pressure got very high & despite being put on 2 BP meds I couldn't get it down.  Now I'm back on OxyContin & oxycodone for BT pain.  I am hoping to get off them when the weather gets better.
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Avatar_f_tn
I'm so sorry to hear about the nerve damage in your leg. How did this happen? I'm a nurse but specialize in Cardiology, so I know little about pain meds. I can say that I'm scared to death to be on morphine or any type of pain meds. I've tried skipping doses but my pain became so bad that it took double the dose to just take the edge off. If I take it as scheduled, my pain is managed. I'm on MS Contin 30 mg at 6am, 15mg MS at 1pm for break through pain, 30 mg MSC at 7pm, and another 15 mg MS around 2-3 am. I only sleep for 2 hours at a time. I stay up 1-2 hrs than back to sleep.  I've not been referred to a pain clinic yet but I dread it. Healthcare workers and society roll their eyes at people who are in pain clinics, including me. Now I'm ashamed because I had no idea how bad pain could be. Thank you for listening!
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Avatar_f_tn
Hello marycarmel. I also have rsd in my left hand, wrist, and arm. I had ulnar nerve transportation, carpel tunnel release, and 2 lipomas removed on 2/28/2013. The surgery was to last about 45 mins. However, my nerves (medial & ulnar) were so scared and the lipomas were so deep (intramuscular) it took 3 hrs to complete. I had a soft cast on after surgery. I was discharged that day. The following morning my hand and upper arm were huge. I went to see my ortho and found out I had compartment syndrome. The cast was quickly removed and the pain improved. However, over the next 4 days my pain became intolerable. I could not lay it on anything because of the extreme sensitivity, stabbing pain, and I was unable to move any joint in my left arm. I tried Percocet, Demerol, and hydrocodone with no relief. I went back to my ortho and ultimately diagnosed with rsd. Since then I have been to PT 3 times, had a SND done (relief for about 6 hours), and use a TENS unit. My pain varies from day to day. I never know what to expect. I work my hand, wrist, and arm for 2-3 hrs. a day. I can know move my hand and wrist, but it's not back to normal. The swelling also changes day to day but always worse in the pm. I'm now on MS Contin 15 mg in am, 30 mg pm along with MS 15-30 mg q 4-6 as needed for break through pain. My Neurontin is maxed due to elevated LFT's. Sorry to give you so much info but I'm scared to death about my future with a diagnosis of rsd. Is your pain controlled? Can you give me any advise or info about rsd since you have it? Are you able to work? I so sorry to hear about your extensive surgeries.
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