By Ed Coghlan
For the 200 persons who attended a CRPS Educational Conference in Long Beach, one presentation held everyone’s attention. Dr. Pradeep Chopra of the Brown Medical School gave a comprehensive review of CRPS—a disease that this pain management specialist has a special interest.
In an interview with the National Pain Report over the weekend, he argued that CRPS needs more research.
“The lack of good research is holding us back. It is a very complex condition and medicine doesn’t want to treat complex conditions because they take a lot more time and effort,” he said.
Dr. Chopra believes that his colleagues need to pay more attention to complex pain conditions like CRPS, Neuropathic Pain and Fibromyalgia.
“It’s much easier to treat a simple disease or injury. A CRPS patient can take me over four hours to evaluate,” he said. “If a doctor can see more patients during that time he/she will make more money. They don’t want to deal with complex conditions and there are no magic pills to treat CRPS.
Cancer is easier to treat,” he pointed out. “At least there’s a set pattern of treatment.”
It’s because of that lack of a set pattern of treatment that Dr. Chopra urges patients to be more self-determinant is their care.
And he has some tips:
- Educate Yourself—“Find out what are the good treatments/the snake oil treatments/what are the harmful treatments…and basically be the leader of your own team to manage your own condition. There’s no one treatment that’s going to work for everyone.”
- Don’t Take Opioids – “Opioids not a good answer for CRPS especially in higher doses because they don’t work in CRPS and can actually make CRPS worse. They sensitize patients to CRPS. It makes the pain worse and we’ve seen again and again where patients come off opioids and have felt better. Research has shown that it actually helps their neuropathic pain once they come off opioids.” (By the way, Dr. Chopra thinks the whole opioid controversy is way overblown—saying that only .01% of chronic pain patients who take the prescribed medicine become addicted)
- Ketamine Is the Court of Last Resort-“ Before you get into ketamine infusion because it is logistically and financially challenging, try everything else first and see what needs to be fixed. Get your Vitamin D levels fixed. Ketamine is just another tool in your toolbox. It’s not the silver bullet. Patients spend a lot of money thinking Ketamine is going to work. That’s not a fact. It does help, but it has to be done in conjunction with other therapies.
- The Need for Restorative Sleep: Non-restorative sleep is when you brain is still awake while you’re sleeping which is common in CRPS patients. You wake up tired and exhausted because the nerves that turn on your “flight or fight” mechanism are activated which is part of CRPS. It’s not the pain that keeps you awake–it’s the nerves. Take drugs that address the flight or fight mechanism rather than taking a sleep medicine and importantly practice good sleep hygiene. No TV or computers in the bedroom. The bed is made for sleeping not watching television.
“Each patient needs to have a game plan and put the treatments all together,” he said. “Different things work for different people and you have to know what works for you. It will help your doctor.”
Treating CRPS has a big trial and error component.
“It’s like cooking,” he said. “You need a little bit of salt and little bit of pepper to make the dish tasty. Too much of one can give you bad side effects. You have to pay attention to your body.”
He spoke for over an hour and took questions for another half hour. If there hadn’t been a time limit, he might still be answering questions. People, both patients and physicians, buttonholed Dr. Chopra in the hall outside for most of the day, seeking his wisdom on how to handle this confusing and frustration and very painful disease.
The conference was sponsored by RSDSA.