Сlinical Case of Successful Lumbar Sympathectomy in the Treatment of Complex Regional Pain Syndrome

ABSTRACT. A 53-year-old male patient had extensive traumatic damage to the right lower limb in a car accident that happened 17 years ago, which subsequently led to a large amputation at the hip level. Later, adduction contracture in the right hip joint with a complex regional pain syndrome developed. Due to the ineffectiveness of various methods of conservative treatment, it was decided to perform right-sided lumbar sympathectomy. Ten days later, the patient was discharged for outpatient treatment. The result of the operation was a complete relief of pain syndrome both in the early postoperative and in the long-term periods of time. Despite the large number of types of conservative therapy in modern clinical practice, none of them is perfect. Doctors decide to operate less often, trying to minimize the intervention. However, therapeutic effects are not always possible as monotherapy, often requiring additional treatments. Due to the wide development and distribution of medical products, doctors often neglect or forget about such a method as lumbar sympathectomy. Therefore, the problem of complex regional pain syndrome remains relevant today.

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Faculty Opinions recommendation of Ketamine produces effective and long-term pain relief in patients with Complex Regional Pain Syndrome Type 1.

Faculty Opinions – Post-Publication Peer Review of the Biomedical Literature ◽

10.3410/f.1165148.627366 ◽

2009 ◽

Author(s):

Philippe Richebe

Keyword(s):

Pain Relief ◽

Complex Regional Pain Syndrome ◽

Pain Syndrome ◽

Syndrome Type

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Clinical overlap of functional neurologic symptom disorder and complex regional pain syndrome in pediatrics: A case report

Journal of Pediatric Rehabilitation Medicine ◽

10.3233/prm-200700 ◽

2021 ◽

pp. 1-8

Author(s):

Heidi Kempert

Keyword(s):

Complex Regional Pain Syndrome ◽

Pain Syndrome ◽

Gait Pattern ◽

Rehabilitation Program ◽

Neurologic Symptom ◽

Physical Mobility ◽

Unsteady Gait ◽

Full Day

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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Venipuncture Induced Complex Regional Pain Syndrome Presenting as Inflammatory Arthritis

Case Reports in Medicine ◽

10.1155/2016/8081401 ◽

2016 ◽

Vol 2016 ◽

pp. 1-4

Author(s):

Punit Pruthi ◽

Pramod Arora ◽

Manoj Mittal ◽

Anugrah Nair ◽

Waqia Sultana

Keyword(s):

Complex Regional Pain Syndrome ◽

Inflammatory Arthritis ◽

Young Male ◽

Pain Syndrome ◽

Poor Response ◽

History Of ◽

Diagnostic Modalities ◽

Musculoskeletal Ultrasonography ◽

The Right

Venipuncture is one of the most commonly done medical procedures. We report a unique case of a 23-year-old young male who presented with features suggestive of inflammatory arthritis. The symptoms, which initially started on the right side, also involved the other side after a few weeks. Although the patient’s symptoms and signs were simulating inflammatory arthritis, he had atypical features like poor response to anti-inflammatory medicines and normal laboratory parameters. His musculoskeletal ultrasonography was also not suggestive of arthritis. His history was reviewed and on direct questioning he revealed a history of venipuncture for blood sample withdrawal, done from right antecubital region for routine health check on the day prior to the onset of symptoms. Complex regional pain syndrome was suspected and triple-phase radioisotope bone scan was done which was highly suggestive of this diagnosis. The patient was managed with multidimensional approach and responded very well to the treatment. Complex regional pain syndrome is usually not thought of in the initial differential diagnosis of inflammatory arthritis. In this report we highlight the need to elicit the often overlooked history of trivial trauma like venipuncture, especially in atypical cases of arthritis. Also the role of newer diagnostic modalities in such cases is emphasized.

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Treatment of Type 1 Complex Regional Pain Syndrome in 14 Years Old Child

N.N. Priorov Journal of Traumatology and Orthopedics ◽

10.17816/vto20140479-82 ◽

2014 ◽

Vol 21 (4) ◽

pp. 79-82

Author(s):

V. N Merkulov ◽

A. I Dorokhin ◽

A. I Krupatkin ◽

M. V Merkulov ◽

M. A Avakova

Keyword(s):

Complex Regional Pain Syndrome ◽

Pain Syndrome ◽

Hand Injury ◽

Psychological Status ◽

Interventional Treatment ◽

Bolus Administration ◽

Right Hand ◽

Foot Injury ◽

The Right

Case report on 14 years old girl with type 1 complex regional pain syndrome (CRPS) is presented. At first admission in 5.5 months after right hand injury and development of type 1 CRPS, paravasal sympathectomy on the right upper extremity was performed. Complete elimination of pain syndrome and restoration of the extremity function was achieved. Five and a half months after discharge the left foot and in 3 weeks later the right hand were injured. In both cases injuries were accompanied by pronounced CRPS clinical picture. At second admission in 6 weeks after foot injury interventional treatment with placement of catheters next to nerve trunks and bolus administration of antibiotics was performed for 1 week and enabled to achieve remission of the disease. It was noted that not only hypersymphaticotony but also psychological status of a patient were important for the disease development.

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Successful removal of permanent spinal cord stimulators in patients with complex regional pain syndrome after complete relief of pain

The Korean Journal of Pain ◽

10.3344/kjp.2018.32.1.47 ◽

2019 ◽

Vol 32 (1) ◽

pp. 47-50 ◽

Cited By ~ 1

Author(s):

Su Jung Lee ◽

Yeong Min Yoo ◽

Jun A You ◽

Sang Wook Shin ◽

Tae Kyun Kim ◽

...

Keyword(s):

Spinal Cord ◽

Complex Regional Pain Syndrome ◽

Pain Syndrome ◽

Complete Relief ◽

Successful Removal

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Spinal Cord Stimulation Is Effective in Management of Complex Regional Pain Syndrome I: Fact or Fiction

Neurosurgery ◽

10.1227/neu.0b013e3182181e60 ◽

2011 ◽

Vol 69 (3) ◽

pp. 566-580 ◽

Cited By ~ 71

Author(s):

Krishna Kumar ◽

Syed Rizvi ◽

Sharon Bishop Bnurs

Keyword(s):

Quality Of Life ◽

Spinal Cord ◽

Functional Status ◽

Complex Regional Pain Syndrome ◽

Spinal Cord Stimulation ◽

Pain Syndrome ◽

Sf 36

Abstract BACKGROUND: Complex regional pain syndrome (CRPS) I is a debilitating neuropathic pain disorder characterized by burning pain and allodynia. Spinal cord stimulation (SCS) is effective in the treatment of CRPS I in the medium term but its long-term efficacy and ability to improve functional status remains controversial. OBJECTIVE: To evaluate the ability of SCS to improve pain, functional status, and quality of life in the long term. METHODS: We retrospectively analyzed 25 patients over a mean follow-up period of 88 months. The parameters for evaluation were visual analog scale (VAS), Oswestry Disability Index (ODI), Beck Depression Inventory (BDI), EuroQoL-5D (EQ-5D) and Short Form 36 (SF-36), and drug consumption. Evaluations were conducted at point of entry, 3 months, 12 months, and last follow-up at 88 months (mean). RESULTS: At baseline, the mean scores were VAS 8.4, ODI 70%, BDI 28, EQ-5D 0.30, and SF-36 24. In general, maximum improvement was recorded at follow-up at 3 months (VAS 4.8, ODI 45%, BDI 15, EQ-5D 0.57, and SF-36 45). At last follow-up, scores were 5.6, 50%, 19, 0.57, and 40, respectively. Despite some regression, at last follow-up benefits were maintained and found to be statistically significant (P < .001) compared with baseline. Medication usage declined. SCS did not prevent disease spread to other limbs. Best results were achieved in stage I CRPS I, patients under 40 years of age, and those receiving SCS within 1 year of disease onset. CONCLUSION: SCS improves pain, quality of life, and functional status over the long term and consequently merits early consideration in the treatment continuum.

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Diagnosis of Complex Regional Pain Syndrome I Following Traumatic Axonal Injury of the Corticospinal Tract in a Patient with Mild Traumatic Brain Injury

Diagnostics ◽

10.3390/diagnostics10020095 ◽

2020 ◽

Vol 10 (2) ◽

pp. 95 ◽

Cited By ~ 1

Author(s):

Sung Ho Jang ◽

You Sung Seo

Keyword(s):

Traumatic Brain Injury ◽

Brain Injury ◽

Complex Regional Pain Syndrome ◽

Mild Traumatic Brain Injury ◽

Corticospinal Tract ◽

Axonal Injury ◽

Pain Syndrome ◽

Traumatic Axonal Injury ◽

Right Hand ◽

The Right

A 54-year-old male suffered from direct head trauma resulting from a fall while working. At approximately two months after the accident, he began to feel pain (burning sensation) and swelling of the dorsum of the right hand and wrist. He showed the following clinical features among the clinical signs and symptoms of revised diagnostic criteria for complex regional pain syndrome (CRPS): spontaneous pain, mechanical hyperalgesia, vasodilation, skin temperature asymmetries, skin color changes, swelling, motor weakness. No specific lesion was observed on brain MRI taken at ten weeks after onset. Plain X-ray, electromyography, and nerve conduction studies for the right upper extremity detected no abnormality. A three-phase bone scan showed hot uptake in the right wrist in the delayed image. On two-month diffusion tensor tractography, partial tearing of the corticospinal tract (CST) was observed at the subcortical white matter in both hemispheres (much more severe in the left CST). In addition, the fiber number of the right CST was significantly decreased than that of seven normal control subjects. CRPS I of the right hand in this patient appeared to be related to traumatic axonal injury of the left CST following mild traumatic brain injury.

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Central Pain Due to Injury of the Spinothalamic Tract Misdiagnosed as Complex Regional Pain Syndrome: A Case Report

Diagnostics ◽

10.3390/diagnostics9040145 ◽

2019 ◽

Vol 9 (4) ◽

pp. 145 ◽

Cited By ~ 1

Author(s):

Jang ◽

Kwon ◽

Lee

Keyword(s):

Complex Regional Pain Syndrome ◽

Memory Impairment ◽

Whiplash Injury ◽

Diffusion Tensor ◽

Pain Syndrome ◽

University Hospital ◽

Central Pain ◽

Spinothalamic Tract ◽

Motor Weakness ◽

The Right

Objectives: We report on a patient with whiplash injury who had central pain, due to injury of the spinothalamic tract (STT), but who was misdiagnosed as complex regional pain syndrome (CRPS). Case description: While a minivan in which a 43-year-old female was seated in the passenger seat was stopped for a signal, a truck collided with the minivan from behind, and the minivan then repeatedly collided with trucks in front and behind the minivan. Her head repeatedly struck the minivan seat resulting in whiplash injuries. After onset, she felt pain in both legs with mild motor weakness in all four extremities and memory impairment. Eight years after onset, she was diagnosed at a university hospital as CRPS type 1 with the clinical features of hyperalgesia and mild edema and motor weakness of both legs. She visited another university hospital nine years after onset and complained of pain in the right arm and both legs, constant tingling and burning pain along with allodynia and hyperalgesia. She also showed mild weakness in the four extremities, mild edema of both legs, and memory impairment. On diffusion tensor tractography (DTT), the left spinothalamic tract (STT) showed marked narrowing, and the right STT revealed mild narrowing and partial tearing. In addition, partial tears were observed in both corticospinal tracts and the right corticoreticulospinal tract. Discontinuations were observed in the left corticoreticulospinal tract and the left fornical crus. Conclusion: Injury of the STT was demonstrated on DTT in a patient with central pain following whiplash injury. Previously, the patient was misdiagnosed as CRPS.

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