UPDATE: April 2004:
For an interesting article, please read"ENDING PAIN WITH LIGHT" by T. Klaber, Alternative Medicine 1999 which includes a photon case study. Here is an excerpt regarding the use of photon for CRPS:
"....Individuals suffering from CRPS can be even more sensitive. Usually caused by physical trauma to the nerves, nothing more than a light breeze on their skin can provoke excruciating pain."(page 1)
"On this page you see the image [thermographic images of patient's feet] of a patient suffering with CRPS possibly brought on by an arthroscopic surgery performed in 1994. All conventional treatments failed. As pain increased and atrophy set in, he became totally disabled. ....He was confined to a wheelchair and had to be lifted on and off the plane in a cherry picker. After three successive treatments with the photonic stimulator, he was able to walk with a cane. He walked through three airports on his way home. A one year follow up demonstrated continued improvement with no pain medication or additional treatment". (page 3 Klaber) To read a page from "Ending Pain with Light", click on Klaber.
UPDATE: July 2003
Since 1998, Dr Pollett has been treating CRPS patients with photon therapy. Based on treatment statistics in his clinic, the success rate is 60%.
UPDATE: Sept. 2002
"Infrared Light Therapy in the Treatment of Chronic Pain" in Today's Therapeutic Trends has been published in the fourth quarter issue. We congratulate Dr Pollett on his hard work! Review in upcoming PARC PEARL.
Editor's Note: While we realize that not everyone with CRPS will have this dramatic improvement, there is a proven 60% success rate for photon(laser) treatment. Photon is non-invasive treatment and has a higher success rate compared with another invasive treatment e.g. spinal cord stimulator success rate is about 42% for upper extremity and 47% for lower extremity (Kemler 2000).
UPDATE JUNE 2004:
PARC PEARL Vol. 3 ISSUE 10 SUMMER 2004:
INTERVIEW WITH DR POLLETT:
Our Maritime doctor in Cape Breton, talks about chronic pain and his approach to treating RSD/CRPS. Since 1996 he has been operating a full time pain clinic at Northside General Hospital, North Sydney, NS. He treats RSD patients on a daily basis and maintains that there is a 1 in 60 lifetime risk of developing RSD/CRPS.
He discusses promising new treatments.
ON CHRONIC PAIN:
Q. Should all doctors have training in treating chronic pain? Why?
A. All doctors have some training in treating chronic pain. Problem 1 is that there is not very much of it. Problem 2 is that every hour of teaching medical students is fought over vigorously by various departments each of which has their own agendas and priorities. Increased time for teaching chronic pain means less time for teaching something else. Problem 3 is that there are a wide variety of ideas as to how pain should be managed. It would be easy for the curriculum to be hijacked by pharmaceutical companies since they control most of the money which is used for
Q. What is your approach to treating a chronic pain patient?
A. The most important initial principle in treating a chronic pain patient is to make a correct diagnosis. The second principle is to accept what you see if it appears that the initial diagnosis is wrong or the treatment isn’t working.
It is not the patient’s fault.
Q. What part should the doctor and patient play in the treatment process?
A. Ideally the treatment process requires close collaboration between the doctor and patient. A physician should recognize that although he/she has been trained to recognize and treat many diseases he/she might have only a superficial knowledge of a particular disease.
The patient, whose life has been turned upside down by one particular disease, may have spent a great deal of time, effort and money to acquire a deep knowledge of that particular disease. Unfortunately, much of that knowledge may be anecdotal, or from questionable sources. The patient may also have a poor understanding of the anatomy and physiology or their disease, giving them an unrealistic understanding of what they do know.
It is important that realistic goals and expectations be discussed at the beginning of therapy.
RSD/CRPS is a poorly understood disease even by “experts”. There is a saying that if a disease has many treatments, none of them are any good.
Many RSD/CRPS will find one treatment to be their “miracle cure”, sometimes after years of failures. The same treatment given to the next patient, whose disease appears to be identical, may result in total failure.
Q. How did you become interested in treating CRPS?
A. I became interested in treating chronic pain when I was doing family practice and realized how little I knew about it. Later, as an anesthesiology resident in London, Ontario, I saw my first RSD patient.
:I couldn’t believe that I had never heard of a disease which could cause so much damage."
Q. What is your approach to treating patients with RSD/CRPS?
A. My approach to treating patients with RSD/CRPS is the same as any other chronic pain patient.
First, one must confirm or make the diagnosis. I have the advantage of having an infrared camera, which is helpful in confirming the diagnosis. If the patient meets the correct criteria, I explain to them what is going and what they can expect.
Many of them are relieved that finally someone believes them.
My own thoughts are” If you only knew what you could be in for.”
I then explain the possible treatment modalities. Because some are covered by Medicare and some are not, the patient participates in deciding how to proceed. I make them aware that there is a strong possibility that none
of the possible treatments may succeed and that even if a treatment appears to be successful, the disease can return at any time and require further treatment.
Many patients require ongoing treatment to keep the pain level low. If the treatment is stopped, the pain level immediately rises. I stress the importance of maintaining mobility in the affected limb(s).
Q. What percentage of your clinic patients are RSD/CRPS patients?
A. On a given day there are probably between 5 and 10 RSD/CRPS patients in the clinic out of a total patient count between 35 and 50. This does not mean that between 10% and 30% of my patients have RSD. It just reflects the fact that RSD/CRPS patients need to be treated more frequently.
Q. What treatments does the clinic offer for RSD/CRPS patients?
The treatments in my clinic can be divided into two groups:
Specific and non-specific.
Specific treatments consist of nerve blocks such as stellate ganglion blocks and lumbar sympathetic blocks and Bier blocks using an occlusive tourniquet to keep a ganglionic blocking drug such as guanethidine or Bretylium
in the affected limb for a period of time. These treatments are exclusively used for RSD/CRPS and are of no value in other chronic pain diseases.
I have seen some studies which claim that Bier blocks are of no value. In most of those studies only two or three blocks were done and since the patients weren’t “cured” the treatment was said to be of no value. I have a number of patients who get several days pain relief with each block, but the duration of pain relief does not increase. However, by doing repeated blocks, the patient can be kept at a low pain level most of the time. This way they can undertake most of the activities they want to do.
Non-specific treatments are those which can be used for other chronic pain conditions as well.
The most useful ones for RSD/ CRPS are infrared photonic(laser) therapy, intravenous lidocaine therapy and oral medications.
Infrared photonic therapy has been used in my clinic since 1998.
I have reviewed my results on a number of occasions and found that about 60% of RSD/CRPS patients get significant improvement.
About 7% improve to the point that no additional treatment of any kind is necessary. Most of the patients who have been treated successfully require ongoing treatments from time to time, but the intervals between treatments can be months or even years.
In about 40% of patients the photonic treatment fails completely. I have had some patients where I have wondered if the photonic treatment has accelerated the RSD/CRPS process, but I think (hope) that in those cases the treatment was unable to stop a rapidly advancing process.
I consider photonic therapy to be non-specific because it is also useful in treating diabetic neuropathy, myofascial pain, rheumatoid arthritis and other painful conditions.
Intravenous lidocaine is widely used in my clinic. It reduces pain levels in over 80% of pain patients for several days at a time. I consider it a control rather than a cure, but it allows me to use lower doses of opiates and other pain medications.
Opiates do play a role in treating RSD/CRPS. They are effective but they carry a lot of socio-political baggage. Also, many patients dislike the feeling of being” doped up”. Other pain medications such as anti-inflammatory drugs, anti-depressants and anti-convulsants are part of the pharmaceutical package which can be used to treat RSD/CRPS. Most patients prefer the minimum amount of drugs possible because of the sedation, side effects and expense involved. Other medications which can be helpful are vasodilators such as verapamil(Isoptin) or drugs which increase red blood cell flexibility such as pentoxyfylline(Trental) . I have one patient whose RSD is controlled by Trental alone, but for most patients these drugs are just an adjunct to other therapy.
Q. What do you see on the horizon as promising drugs or new treatments for RSD/CRPS?
A. I have been looking into drugs such as ketamine, which has been used successfully in other clinics. Its main problem is difficulty in administration. Ideally, the patients should be admitted to an ICU for the first week of treatment. They can be treated as an outpatient but should be kept in a darkened room and closely monitored for a four-hour intravenous treatment. I don’t presently have the facilities to do this and if I do acquire the facilities, I’m not sure if I would be funded well enough by Medicare to afford it.
Dorsal column stimulators are a new/old treatment for RSD/CRPS. I don’t do them myself but have sent three patients elsewhere for this treatment. So far no success.
Q. Do you have any comments?
A. RSD/CRPS is a fascinating condition because even though it has been described for 150 years, there are still clinicians who deny it exists.
The bias is most notable in older orthopedic surgeons, possibly because they were taught that if you treated an injured limb improperly, the patient could develop “Volkmann’s Ischemic Contracture”, another name for RSD/CRPS.
Rather than admit fault, they preferred to deny the disease.
Ironically, it probably was not their fault. It just seems that some limbs will develop RSD/CRPS no matter how trivial or serious the injury.
RSD AND GOLF
RSD/CRPS can be compared to golf. Just as a beginning golfer can sometimes get a hole-in-one, a neophyte pain physician can sometimes “cure” an RSD/CRPS patient with a simple nerve block. From then on he’s hooked, but it may be quite a while before he duplicates his success.
Cheers! Harry Pollett
Warm thanks to Dr Harry Pollett for taking time out of his busy schedule to do this important interview on Canada Day 2004.
UPDATE: MAY 2005
Helen Small, President of PARC, visits Northside General Pain Clinic run by Dr Pollett and his staff in North Sydney, Cape Breton. She takes part in the photon(laser) treatment program starting May 17, 2005.
UPDATE: OCTOBER 2006
Helen returns for more photon treatment. So far so good!
Helen wishes to thank the wonderful staff at Northside General Hospital for all their humour, concern and medical care.Leaving after treatments were over, was like LEAVING HOME. Lori, Velda, Lynette, Tanya and Jennifer, you are the best! Oh, yes, the doctor too. (Big grin!)