Poster 413 A Case Study Investigating Opioid Medication Utilization in Patients with Complex Regional Pain Syndrome Before and After Ketamine Infusion Therapy

This case study documents a 13-year-old female who presented to our intensive inpatient chronic pain rehabilitation program with complex regional pain syndrome (CRPS) of her left leg, which was significantly interfering with her normal daily functioning. She participated in a full day of traditional interdisciplinary therapies, including physical and occupational therapy for 3 hours daily. As assistive equipment was altered or weaned her physical mobility, balance, and tremors worsened and/or increased. As she began advancing her legs more independently (versus requiring physical assist), she demonstrated more variable functional strength and stability, inconsistent balance reactions, and a more unsteady gait pattern. The team was treating her according to her incoming CRPS diagnosis; however, as treatment progressed, her physical and psychological presentation seemed more aligned with diagnostic criteria of functional neurologic symptom disorder (FND). Staff then treated according to the FND diagnosis resulting in successful long-term outcomes. The clinical impact from this case study includes highlighting the commonalities between CPRS and FND clinically, discussing differentiating treatment suggestions depending on the diagnosis, and emphasizing key components of family/patient education.

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Motor imagery and its effect on complex regional pain syndrome: an integrative review

Neurology International ◽

10.4081/ni.2015.5962 ◽

2015 ◽

Vol 7 (3) ◽

Cited By ~ 7

Author(s):

Nélio Silva De Souza ◽

Ana Carolina Gomes Martins ◽

Victor Hugo Do Vale Bastos ◽

Marco Orsini ◽

Marco Antônio A. Leite ◽

...

Keyword(s):

Complex Regional Pain Syndrome ◽

Motor Imagery ◽

Pain Perception ◽

Pain Syndrome ◽

Practice Research ◽

Level 3 ◽

The Difference ◽

Brain Reorganization ◽

Stress Influences

The motor imagery (MI) has been proposed as a treatment in the complex regional pain syndrome type 1 (CRPS-1), since it seems to promote a brain reorganization effect on sensory- motor areas of pain perception. The aim of this paper is to investigate, through an integrative critical review, the influence of MI on the CRPS-1, correlating their evidence to clinical practice. Research in PEDro, Medline, Bireme and Google Scholar databases was conducted. Nine randomized controlled trials (level 2), 1 non-controlled clinical study (level 3), 1 case study (level 4), 1 systematic review (level 1), 2 review articles and 1 comment (level 5) were found. We can conclude that MI has shown effect in reducing pain and functionality that remains after 6 months of treatment. However, the difference between the MI strategies for CRPS-1 is unknown as well as the intensity of mental stress influences the painful response or effect of MI or other peripheral neuropathies.

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Ketamine Treatment for Intractable Pain in a Patient with Severe Refractory Complex Regional Pain Syndrome: A Case Report

January 2018 - Pain Physician ◽

10.36076/ppj.2008/11/339 ◽

2008 ◽

Vol 3;11 (5;3) ◽

pp. 339-342

Author(s):

Paul E. Schulz

Keyword(s):

Case Report ◽

Complex Regional Pain Syndrome ◽

Upper Extremity ◽

Pain Syndrome ◽

Future Research ◽

Intractable Pain ◽

Ganglion Block ◽

Ketamine Infusion ◽

Patient Reported ◽

Intravenous Ketamine

In this case report, we describe the effect of ketamine infusion in a case of severe refractory complex regional pain syndrome I (CRPS I). The patient was initially diagnosed with CRPS I in her right upper extremity. Over the next 6 years, CRPS was consecutively diagnosed in her thoracic region, left upper extremity, and both lower extremities. The severity of her pain, combined with the extensive areas afflicted by CRPS, caused traumatic emotional problems for this patient. Conventional treatments, including anticonvulsants, bisphosphonates, oral steroids and opioids, topical creams, dorsal column spinal cord stimulation, spinal morphine infusion, sympathetic ganglion block, and sympathectomy, failed to provide long-term relief from pain. An N-methyl-d-aspartate (NMDA) antagonist inhibitor, ketamine, was recently suggested to be effective at resolving intractable pain. The patient was then given several infusions of intravenous ketamine. After the third infusion, the edema, discoloration, and temperature of the affected areas normalized. The patient became completely pain-free. At one-year of follow-up, the patient reported that she has not experienced any pain since the last ketamine infusion. Treatment with intravenous ketamine appeared to be effective in completely resolving intractable pain caused by severe refractory CRPS I. Future research on this treatment is needed. Key words: Ketamine, Complex Regional Pain Syndrome (CRPS), treatment

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Spinal Cord Stimulation for Complex Regional Pain Syndrome: A Case Study of a Pregnant Female

January 2018 - Pain Physician ◽

10.36076/ppj/2019.19.e487 ◽

2016 ◽

Vol 3;19 (3;3) ◽

pp. E487-E493

Author(s):

Shaik Ahmed

Keyword(s):

Spinal Cord ◽

Complex Regional Pain Syndrome ◽

Spinal Cord Stimulation ◽

Treatment Options ◽

Pain Syndrome ◽

Conclusive Evidence ◽

Treatment Modalities ◽

Child Bearing ◽

The Impact

Background: Spinal cord stimulation (SCS) is a form of neuromodulation, used to treat chronic neuropathic pain refractory to conventional medical management. Spinal cord stimulators are treatment options when intractable chronic pain has not responded to more conventional treatment modalities. Currently, the use of SCS is contraindicated in pregnancy. Nevertheless, many SCS/ neuromodulation recipients are women of child bearing age who may become pregnant. There are no published reports that focus on the possible side effects of SCS or neuromodulation therapy on human fertility, fetal development, pregnancy, delivery, or lactation. Objectives: The purpose of this current report is to present a case study on the use of SCS/ neuromodulation during pregnancy. Study Design: Presentation of the case of a 24 year old female who became pregnant after receiving an SCS implantation for pain control secondary to complex regional pain syndrome (CRPS). The SCS was in use at the time of conception but deactivated when patient became aware of her pregnancy and intermittently reactivated for five minute intervals throughout the entire pregnancy. Results: Currently very little documented evidence is available regarding the safety of using a SCS/ neuromodulator during pregnancy; therefore its use during pregnancy is contraindicated. Available literature suggests that, women who have chosen to keep the SCS/neuromodulator activated during pregnancy have delivered healthy babies without any life threatening complications. Limitations: Case presentations do not provide conclusive evidence of treatment effectiveness. This data is only preliminary and future studies should be used to assess outcomes and measures to provide quantification of the SCS implantation during pregnancy. Conclusions: Women of child bearing age who are recipients of SCS/neuromodulation implantation should be informed of the limited knowledge available regarding the impact of SCS/ neuromodulation use during pregnancy. For current recipients, decisions about ongoing use during pregnancy should be an individual decision based on the potential risks and benefits. Key words: Pregnancy and complex regional pain syndrome, pregnancy and reflex sympathetic dystrophy, pregnancy and spinal cord stimulators, pregnancy and electromagnetic fields, and pregnancy and neuromodulator.

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