We are at a cross-roads on a decision that involves our adult children and their child (our granddaughter). Missy has a terrible condition called complex regional pain syndrome. Her foot and ankle throb all day and all night. There’s swelling so she can’t get a shoe on. She doesn’t want to go to school because of it. The doctor has recommended a nerve block. Her parents don’t want to subject her to any more pain. We see it as a treatment that hasn’t been tried yet — what’s to lose? What do you think?

It’s very difficult to know how to approach problems like this one that involves a child suffering pain and disability. There isn’t a great deal known or understood about this condition. We know that women are affected more often than men. Likewise, girls seem more susceptible to this problem than boys.

There is usually a precipitating event that brings it on — it could occur as a result of an injury as minor as having blood drawn, or a sprained ankle. Other times, it may be the result of a more significant injury such as surgery, a fracture, immobilization with casting or splinting, or in adults, as a result of a stroke.

Experts who treat this problem in children agree that as part of a total program, a nerve block can be very helpful. In fact, when nerve blocks are done early (first few months of symptoms), it only takes one injection to completely cure the problem.

But there’s a recommended algorithm (steps to take) in the treatment of complex regional pain syndrome (CRPS). Medications are the first line of care. Antiinflammatories, analgesics (pain relievers), muscle relaxants, and anticonvulsants have all been shown to help. The physician starts with the least invasive drug and works to find the right drug, dosage, or combination of drugs that work best.

Medications go hand-in-hand with an aggressive physical therapy program. Only if these two treatment methods fail to resolve the problem do they take the next step of a nerve block. But because a single nerve block injection can put a complete stop to the painful symptoms, this treatment approach is recommended under these circumstances by those who treat this problem.