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Reflex Sympathetic Dystrophy (RSD) (CRPS) Message Board


Reflex Sympathetic Dystrophy (RSD) (CRPS) Board Index


Gina ,

Sorry you are feeling so crappy,

To try and answer your Q's I guess the difference with SIP and SMP are:

The phenomenon of sympathetically maintained pain (SMP), referring to selective diagnostic blockade of pain with alpha-1 blockers such as Phentolamine, and Guanethidine have been mistaken for exclusive prerequisite for diagnosis of CRPS. In early phases of CRPS (a few weeks to a few months), the pain is usually successfully blocked with Phentolamine alpha-1 sympathetic blockade confirming the SMP nature of the pain. As the disease becomes chronic, and especially as the condition becomes complicated by treatment modalities such as surgery or repetitive application of ice, the pain changes its nature from SMP to SIP(sympathetic independent pain).
In early stages, the disease is characterized by up-regulation and supersensitivity of sensory nerves to norepinephrine. In chronic stages, the disease is manifested by a dysfunctional rather than an up-regulated sympathetic system. By then, the clinical picture also changes due to the inflammatory nature of the neuropathic pain leading to edema, secondary entrapment neuropathies, subcutaneous hemorrhages, or neurodermatitis. In addition, with passage of time, neurovascular instability develops pointing to dysfunction and failure of the sympathetic system to protect and to sustain normal vasomotor function. This phenomenon, causing fluctuating changes of circulation and color of the extremity in a matter of a few minutes (chameleon sign), reflects lack of sustained normal tonus of arteriolar vasculature normally achieved by intact sympathetic function. The neurovascular instability cannot be expected to be responsive to sympathetic blocks (SMP) due to instability and random dysfunction of vasomotor tonus. This is one of the factors that explain the SIP nature of CRPS after a few months.


I am not sure about the stim and if it helps SIP pain or not, but i can tell you thats what i am (SIP) and i have a SCS and it stopped working 6 mos after i got it. It only works from my knee up and the severeity of my RSD is in my lower leg and foot and ankle. I am having a peripheral neuro stimulator pu tin with in the next few weeks to see if that helps..

The Epidural infusions are a [B]god sent[/B]!!! I have had 3 of these and they are the only thing that take away the pain. I had mine for a total of 6 days while i was in the hosp and i was in heaven. My doc did the first one hopig that it would break the pain cycle and put it into remission , but it didnt it came all right back once the epidural was out. But he has done 2 more since then to help me deal with the pain and to see if it would break the pain cycle seeing that its the only thing to take my pain away. I would HIGHLY suggest the epidural infusion first before you think of having the stim done. I had a total of 7 spinal blcoks adn like you i didnt respond to them either. But i responded to the epidural..

I know how you feel that you want to prove to everyone that you are not crazy and you do have this awefull disease. Ihad a hard time nad finally had my doc do it when i was in the hosp with my first epidural infusion. He told them that it wasnt in my head and that i was in soo much pain and the pain is 10 times the pain of cancer and that finnally hit them. That this is serious and just because i have a smile on my face and able to walk around a little bit , that i am not really ok, but trying to make it less noticeable bc i didnt want them to know how bad i was bc i knew that they would say you dont look like it..

I havent taken Tegretol before, but I am on Neurontin 2800 mgs and it just makes me snowed.. The Baclofen is great for the muscle spasms!! Glad he gave that to you !! All the pain meds dont touch my pain, so i really dont take them at all., only if i need to get some sleep and they make the snowed feeling worse so that i sleep.

Hope you are doing better! Let me know if i didnt help or if you have any more Q's..





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