Saturday 2/21/2026 SKOOL LIVE TRASNSCRIPT: CRPS and complex conditions
1:11pm
I tried LDN several times and stopped because it felt like too much. Then I read about people who are very medication-sensitive — low endorphin, nervous-system dysregulated types — and that sounds like me.
It’s developed into chronic pain. I’m very deconditioned. There’s swelling and discoloration. Both feet are swollen now with ankle edema.
CRPS was more or less ruled out, then suggested again. It’s not a clear case — maybe atypical.
CRPS usually starts after a limb injury with significant nervous system dysregulation. It begins on one side, then sometimes the other side “learns” it and symptoms spread.
You started LDN in August at 0.1 mg. You’re now at 0.7 mg. You’re not sure if it’s helping, but it doesn’t seem harmful.
1:12pm
CRPS can spread — contralateral, upper to lower — and eventually the whole system feels inflamed. Of course, I can’t diagnose you, but that pattern is consistent.
You’re in Switzerland. LDN does exist there. It may not be widely known, but some patients in Switzerland and Germany are using it.
1:13pm
You’re wondering whether to increase the dose or add something else because the pain and swelling aren’t improving.
Most physicians are not very familiar with LDN.
Diseases don’t read textbooks. Classical presentations are actually less common than atypical ones. CRPS does not have a definitive test.
AI can be helpful, but it struggles with nuance. Clinical judgment comes from years of experience.
1:14pm
Historically, if an MRI didn’t show MS, patients were told nothing was wrong. Now we recognize MRI-negative MS. Rheumatoid arthritis can be seronegative. CRPS has no definitive diagnostic test.
For LDN dosing, I usually ask three questions:
- Are you medication-sensitive?
- Have you had the condition a long time?
- Are you full of vitality or depleted?
Depending on those answers, I may start at:
- 0.1 mg (100 micrograms)
- 0.01 mg (10 micrograms)
- 0.001 mg (1 microgram)
Some patients need extremely small starting doses.
Recently, I had someone who couldn’t tolerate very small amounts initially. Now she’s at 9 mg and doing well.
Patients live in their bodies 24/7. I guide them, but they adjust within reason based on response.
1:15pm
For chronic pain and Hashimoto’s, the goal is safe and effective treatment.
Split dosing can be helpful.
When I had neuropathy, I used split dosing — morning and evening, sometimes three times daily temporarily.
Dose matters less than effect.
If there is no effect and no side effects, gradual increase may be reasonable.
When I triggered sciatica, I used higher doses quickly. I experienced nausea and side effects, so I alternated dosing days until my system adapted. Eventually the pain resolved, and I returned to once-daily dosing.
1:16pm
CRPS often spreads as one limb “teaches” another.
LDN is one tool.
Another tool is nervous system regulation — methods to calm or activate the system appropriately. The nervous system is capable of change.
1:17pm
Typical starting ranges in my approach:
- 0.1 mg
- 0.01 mg
- 0.001 mg
Some patients require extremely low doses initially.
Once stable, patients can adjust slowly under guidance.
1:18pm
CRPS is best addressed early.
There are very few clinicians deeply experienced with it.
LDN is one important tool, particularly in nervous-system driven pain conditions.
1:20pm
For very low dosing, dilution math allows microgram and nanogram ranges:
- 50 mg tablet
- 1:100 dilution = 0.5 mg
- 1:100 again = 5 micrograms
- 1:100 again = 50 nanograms
Very small doses are achievable with proper dilution methods.
1:25pm
Again, for chronic pain and autoimmune conditions like Hashimoto’s — the focus is safe and effective dosing.
Split dosing can make sense in certain patients.
1:39pm
LDN typically takes about a week to begin showing effects. Supplements may also take about a week.
Follow-up evaluation is often 3–6 weeks after dose adjustment.
Patients should monitor response and adjust gradually.
1:41pm
Thank you all for being here.
If there are no further LDN-related questions, we’ll sign off.
