Physical Therapy-

• Physical therapy and medications are commonly used as harmonizing therapies in the beginning of treatment.
• If there is no relief from the physical therapy in one to two months then Sympathetic Nerve Blocks may be considered. The SNB’s are done in conjunction with drug therapy.
• Physical therapy for Neuropathy conditions patients who are still in severe pain should include traction, stretching and massage, no weights.
• Therapy should be done to alleviate or lower pain levels, restore function to the limb, reduce swelling, reduce stiff joints, and strengthen your muscles. If you do not use your limb, you could lose it.
• Make sure to find a PT that specializes in chronic pain and Neuropathy conditions specifically, if possible.
• If it does not feel right, speak up and do not do it. Have open communication with your physical therapist so you get the greatest benefits.
• On your good days, try a few new things in your environment and physical activity. This can increase function, range of motion, increase your muscle strength and improve balance and posture.
• Do what you can do at your level. It will be different for all of us. Moving will increase your health, function of your affected limbs and also helps with constipation and gastrointestinal issues, caused by the Neuropathy conditions and the medications. Movement increases your blood circulation that helps with atrophy and can decrease hypersensitivity.
• Using a combined therapy approach can give lead you to faster relief. The other therapy methods include biofeedback, hot compresses, elevation, massage, range of motion exercises, and hydrotherapy.
• There is some thought that physical therapy is painful and does not help. Patients can combine counseling, physical therapy and a drug regimen for better relief. Doing this can help us stay on track with our treatment plan and increase the benefits of physical therapy.

Non-invasive/Less-invasive procedures-

• Radiofrequency procedure- risks such as new nerve injuries, bleeding, allergic reactions to the medications being used, seizures and the stress and fear about the procedure. It is important that you have a competent pain management specialist because of the variety of complications involved in performing the procedure. Only get this procedure from a trained professional who has performed this procedure on a regular basis. It is important to notify your doctor of any side effects you may have or complications noted after the procedure. Further complications may develop or become life threatening if not taken care of when they first begin.
• Sympathetic nerve block- the SNB does not block motor activity so you can remain mobile and active which offers you better range of motion. Your range of motion and exercises can increase during the time the nerve block has reduced the degree of pain. 
• Tens unit also known as a nerve stimulator- The tens unit provides electrical nerve stimulation that in small amounts to the nerves to overcome the sensation of pain. It is a trick to your nerves. Think about when you have hurt yourself on something in the past. Your reaction is to rub the area. This causes a good sensation to be sent the brain, which can sometimes help forget the pain. The tens unit because it is noninvasive, some are portable and available for self-treatment with a small unit. Negative effects can include skin rashes from the sticky side of the electrode, people with pacemakers and pregnant women should not use the tens unit.
• Topical pain patches; Lidoderm patches as well as Lidocaine lotion, fontanel and Clonidine. Be sure to check with your doctor about potential side effects.
• Acupuncture- other adverse issues include; bleeding, inflammation, intensification of pain, nerve irritation and or injury, infections, poor wound healing, and skin irritations.
• Hyperbaric Medicine- How it works: Advances wound healing, increases the delivery of oxygen to injured tissues, encourages greater blood vessel formation, preserves damaged tissues. What to expect: you may feel pressure in the ears similar to the sensation felt when landing in an airplane, chamber may become slightly warmer during the first few minutes of treatment and will be cooler during the last few minutes. In some multi-person chambers, patients can watch television, a movie, listen to the radio or just rest. Patients are asked to take 400 units of Vitamin E daily.

Orthopedic surgery/ Invasive surgery-

• Sympathectomy- the Sympathectomy is a procedure that has high risks and the outcome varies from patient to patient this should be used as a last resort. Carefully weight the risks of the procedure and communicate with your doctor in great detail. Once the nerve bundle is removed, there is nothing for the doctor to treat if the pain returns. The Sympathectomy involves cutting out the sympathetic ganglion nerve bundle, which is located in a specific area along the spinal cord. If it is determined that the source of the Neuropathy conditions pain is sympathetically maintained, in which pain is reduced with a sympathetic nerve block than this may be an option. However if the pain is determined to be sympathetically independent pain a Sympathectomy is not a procedure that will benefit you. Once removed it is permanent. Even if you have SMP, it may turn into sip down the road with an additional insult to the body, so the risks are high for failure of this procedure. If you have chosen to receive a full Sympathectomy, you will be limited or out of treatment options. With the possible risks, make sure that you are an appropriate candidate for this procedure and that you are willing to undergo the procedure in spite of the risks. Since this procedure does not always work even when SMP is involved.
• Spinal cord stimulator-complications such as infections and the spread of Neuropathy symptoms to other parts of your body are at a higher risk. The idea with this choice is the spinal cord interrupting the pain signal to the brain. Spinal cord stimulators have an effect on the entire central nervous system. Before a SCS is implanted permanently, you should have a period with a temporary stimulator. The surgical implantation is described as feeling like an electrical current, but is reported by patients to be far less bothersome compared to the pain of Neuropathy conditions. The spinal stimulator is not a cure but in many cases, it can reduce the pain to a more manageable level. However, only a small number of Neuropathy patients who have the stimulator have benefits that last more than 2 years, and most have complications such as moved leads, infections, quick draining of batteries and feeling of internal shocks in your spine. Any patients that are undergoing radiation, pacemakers or are exposed to alarm detection devices should not consider this option. Complications associated with surgical implantation of the SCS include: significant bleeding in the epidural space, infection in the epidural space could potentially lead to meningitis or an epidural abscess. Surgical complications associated with spinal cord stimulation include injury to the spinal cord, paralysis, accumulation of fluid in the power source site (Seroma), and spinal headaches, tenderness at the power source (generator/receiver) is common until healing occurs, but persistent pain at the stimulator site is possible, as is tissue damage at the site of the stimulator lead and connecting cable(s), mechanical complications with the system include dislodgment of the lead/electrode, movement of the lead/electrode, breaks in the wiring or problems with the power source, occasionally, loss of pain relief in a painful area can occur, even if stimulation is still felt in that area

Goal creation and treatment plans should also include:

• Drug management,
• Family/ social adjustment,
• Improve the patient's quality of life and psycho-social functioning,
• Increasing mobilization/range of motion through physical therapy to help prevent progression and worsening of Neuropathy conditions symptoms.
• Medical team coordination 

Medications-

• Aspirin and acetaminophen also known as Tylenol
• Anti-convulsants: Carbamazepine (Tegretol), Gabapentin (Neurontin), Phenytoin (Dilantin)
• Antidepressants: Amitriptyline, Nortriptyiline
• Corticosteroids: to reduce inflammation and swelling example; Calcitonin spray
• Muscle relaxants: Baclofen (Lioresal), Klonopin
• Non-steroidal anti-inflammatory drugs (N-SAIDS) or Ibuprofen
• Narcotic analgesics - usually reserved for severe, chronic pain
• Opioids: used with widespread pain
• Intrathecal drug delivery- drugs delivered into the spinal fluid through the spinal cord or delivered through a pain pump- pain pump drugs include morphine and Baclofen.
• Medications may offer enough pain relief to begin physical therapy exercises you could not do prior.
• If no lasting relief after six weeks is achieved a stronger longer lasting narcotic like morphine for breakthrough pain as well as antidepressants are usually prescribed.
• The antidepressants are used for pain control as well as to treat the psychological effects related to prolonged pain and loss of enjoyment of life.
• Ketamine or Lidocaine infusions that are effective for approximately 80% of patients.
• Intrathecal pump with Bupivacaine, Clonidine supplementation may be effective for some, and Intrathecal pump of Baclofen is often successful for severe Dystonia. 

Top U.S. Neurological doctors have said that this is the closest treatment to a cure for RSD and other Neurological conditions.

• There are 3 forms/levels of Ketamine protocols. Outpatient, Inpatient and Coma. All three protocols have opponents and proponents in the medical field, but for many RSD patients this option has become a glimmer of hope and possibility of returning us to a life of normalcy. Dr. Schwartzman a leading specialist in RSD and the Ketamine Protocols says this is the closest treatment to a cure and he sees a day where the Ketamine protocols become the leading treatment for RSD patients. Per NIDA Research Report Series: Hallucinogens and Dissociative Drugs, 2001 - Ketamine is an odorless, tasteless drug that is found in liquid, pill, and powder form. Ketamine is classified as a type of dissociative drug. It alters the actions of the neurotransmitter glutamate throughout the brain. Glutamate is involved in perception of pain, responses to the environment, and memory.
• Outpatient: Out patient version is usually done over a 5-10 day protocol. Some doctors do a few days, weeks or spread it out over a few months. Each infusion last approximately 4 hours. After a patient receives inpatient or coma Ketamine treatments they are typically given outpatient infusions as "boosters" over the next few months to a year or so to enhance the lasting effects of the pain lowering benefits. Of course each doctor will have their own protocol and we are just listing a typical version. This version was approved by the FDA in 2002 and is used by doctors across the country currently.
• A recent outpatient IV Ketamine study for the treatment of CRPS/RSD study was done by Drexel University College of Medicine doctors and healthcare professionals demonstrated a statistically significant reduction in many pain parameters, (p<0.05). The report will be featured in an a upcoming journal publication call PAIN. This is a land mark as it is the first study utilizing an active placebo as a control. Professionals involved are: Robert J. Schwartzman, MD, Guillermo M. Alexander, Ph.D., John R. Grothusen, Ph.D., Terry Paylor RN, Erin Reichenberger MS and Marielle Perreault BS.
• In Patient: This treatment is typically done over 5-7 continuous days of IV infusion with a combination of Ketamine and Clonidine while the patient is in the hospital. The patient will typically undergo booster treatments after the inpatient protocol is complete. This protocol is being done by doctors and hospitals since 2002. Thousands of patients have done this procedure with a high success rate. Although all patients are different outcomes are continually being improved and the success rate is always increasing as well. Although it is not a cure it is the closest thing RSD patients have to one. A successful case is considered remission.
• Coma: Patients are placed into an induced coma with a high dose of Ketamine, for 5 to 7 days. Patients travel to Monterey, Mexico with a team of American doctors as this procedure is not yet approved by the FDA. It will be difficult to get approval because the FDA  is requiring a double blind study. Due to obvious reasons this is going to be very difficult. There are a number of patients who have gone into remission with this treatment as well

IVIG is given as a plasma protein replacement therapy (IgG) for immune deficient patients who have decreased or abolished antibody production capabilities. In these immune deficient patients, IVIG is administered to maintain adequate antibodies levels to prevent infections and confers a passive immunity. Treatment is given every 3–4 weeks. In the case of patients with autoimmune disease, IVIG is administered at a high dose (generally 1-2 grams IVIG per kg body weight) to attempt to decrease the severity of the autoimmune diseases such as Dermatomyositis.

Uses of IVIG - For neurological conditions/diseases 2 grams per kilogram of body weight is implemented for three to six months over a five day course once a month. Then maintenance therapy of 100 to 400 mg/kg of body weight every 3 to 4 weeks follows. (Typical for treatments of Neurological conditions.)

Although routine use of IVIG is common practice, sometimes for long term treatments, and is considered safe, complications of IVIG therapy are known and include:

• Headache
• Dermatitis - usually peeling of the skin of the palms and soles.
• Infection (such as hiv or viral hepatitis) by contaminated blood product; there is also an as yet unknown risk of contracting variant cjd (vcjd).
• Pulmonary edema from fluid overload, due to the high colloid oncotic pressure of ivig
• Allergic/anaphylactic reactions; for example, anaphylactic shock, especially in iga deficient patients, who by definition can still produce igg antibodies (iga deficient patients are more likely to produce igg against the ivig administration than normal patients).
• Damage such as hepatitis caused directly by antibodies contained in the pooled ivig.
• Acute renal failure
• Venous thrombosis
• Aseptic meningitis

Many Neuropathy patients consider milestones successful treatment:

• Ability to perform physical therapy with marked improvement in muscle strength
• Able to achieve a full night’s sleep repeatedly
• Decreased need for narcotics
• Diminished depression
• Improved thinking
• Increase in stamina
• Lower pain levels, or pain controlled with low to moderate consideration
• Swelling of the effected arm or leg diminishes