By Ed Coghlan.
Jim Broatch is the long-time Executive Director of the RSDA—a non-profit that works to raise awareness and improve treatment of CRPS. It’s been an eventful year—and we wanted to get his perspective of where we’ve been and where we are going in the treatment of CRPS.
National Pain Report: “Jim, how would you characterize the progress that has been made in the diagnosis and treatment of CRPS?”
Jim Broatch: “First, Ed, I want to thank you for publishing the National Pain Report. You are providing a vital service for people suffering in pain.”
“It appears that more physicians are familiar with pediatric and adult CRPS. However, we still hear the horror stories of individuals who have spent years searching for a diagnosis and have finally learned of RSDSA’s existence. Sadly, treatment of chronic pain conditions such as CRPS is still fragmented. Too often, individuals may receive medication or a nerve block but are not referred for the necessary physical and occupational therapy designed to help restore functioning or to learn valuable techniques for managing their pain. Too many treatments which may help are deemed “experimental” and not paid by insurers. Although opioid therapy is not a first-line intervention for people with CRPS, too many individuals stabilized on long-time opioid therapy have been abandoned by their physicians because of the CDC Guidelines and state laws. We must continue to fight that battle. I’m optimistic that within a few years, there will be new bisphosphonate therapies. Currently, there are two ongoing clinical trials. More physicians and pain specialists are utilizing low-dose naltrexone and ketamine to treat CRPS. Hopefully, the National Pain Strategy will eventually be implemented.” https://iprcc.nih.gov/
National Pain Report: “Has your work with the Emergency Room community resulted in more awareness of CRPS?”
Jim Broatch: “The results have been mixed. Some Emergency Departments have been receptive to managing neuropathic pain/CRPS flares with ketamine as suggested by Dr. Ducharme, https://rsds.org/wp-content/uploads/2014/12/Tips-for-Managing-Complex-Regional-Pain-Syndrome.pdf.
“One of RSDSA’s board members, Dr. Billy Alexander, a former ED doc is helping us intervene directly on behalf of individuals with CRPS who have received abusive treatment in the emergency department. We are also developing a protocol for first responders on how to care for people with CRPS.”
National Pain Report: “Where are we w/ the use of Ketamine to treat CRPS?”
Jim Broatch: “Ketamine is increasingly being used to treat CRPS and some individuals have been successful in getting it paid for by insurers. Most are unsuccessful. In 2015, RSDSA conducted a survey of more than 350 medical professionals on their usage of ketamine for the treatment of the pain associated with CRPS. Respondents answered questions about in-patient treatment, out-patient treatment, children versus adults, safety, and basic demographic information.”
“Subsequently, an expert group met to reach a consensus for the development of inpatient and outpatient reference protocols.”
“The reference protocols do not represent guidelines for ketamine infusion for CRPS; rather they are a reference/orientation by which practitioners can access the consensus of highly experienced practitioners. Importantly, this consensus can provide a starting point for statistical validation to formal guidelines and a more uniform approach to research protocols that will validate the safety and efficacy of ketamine through controlled clinical trials. The survey and reference protocols are due to published in Pain Medicine.”
National Pain Report: “If we do this interview again a year from now (which I hope we will) –what do you hope the highlights of the year will be for people who have CRPS?”
Jim Broatch: “RSDSA is developing an accredited course with Dr. Elliot Krane at Stanford for school nurses and pediatricians on how to diagnose and treat pediatric CRPS. We are currently working on a marketing plan to maximize its availability.”
“We are exploring the development of an externship program with selected expert CRPS clinicians and an interdisciplinary treatment facility in California. We must ensure that more clinicians are trained to treat CRPS.”
“We are committed to fund more clinical research in CRPS. The treatments available today cannot be those of tomorrow.”