Hyperbaric oxygen treatment in recurrent development of complex regional pain syndrome: A case report

A broad spectrum of conditions including neuropathic pain, complex regional pain syndrome (CRPS) and fibromyalgia, have been implicated as causes of chronic pain. There is a need for new and effective treatments that patients can tolerate without significant adverse effects. One potential intervention is hyperbaric oxygen treatment (HBOT). The case reported here is unique in describing repeated HBOT in a patient who developed recurrent post-traumatic CRPS of the lower as well as the upper limbs. In the first event, two months after distortion and abruption of the external right ankle, the patient suffered leg pain, oedema formation, mild hyperaemia, limited mobility of the ankle and CRPS Type 1. In the second event, the same patient suffered fracture-dislocation of the distal radius 1.5 years after the first injury. After the plaster cast was removed the patient developed pain, warmth, colour changes, oedema formation and limited wrist mobility with CRPS Type 1. Pharmacological treatment as well as HBOT were used with significant improvement of functional outcome in both cases. Some studies suggest that patients with a history of CRPS are more likely to develop secondary CRPS compared to the rates reported in the literature among the general population. Patients with a history of CRPS should be counselled that they may be at risk for developing secondary CRPS if they undergo surgery or sustain trauma to another extremity.

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Successful Treatment of Lower Limb Complex Regional Pain Syndrome following Three Weeks of Hyperbaric Oxygen Therapy

Pain Research and Management ◽

10.1155/2016/3458371 ◽

2016 ◽

Vol 2016 ◽

pp. 1-4 ◽

Cited By ~ 5

Author(s):

Rita Katznelson ◽

Shira C. Segal ◽

Hance Clarke

Keyword(s):

Complex Regional Pain Syndrome ◽

Hyperbaric Oxygen ◽

Lower Limb ◽

Hyperbaric Oxygen Therapy ◽

Skin Color ◽

Oxygen Therapy ◽

Pain Syndrome ◽

Animal Pain ◽

History Of ◽

One Year

Hyperbaric oxygen therapy (HBOT) is a treatment that delivers 100% oxygen at increased atmospheric pressures. The efficacy of HBOT for treating pain has been described in various animal pain models and may have clinical efficacy in the treatment of human chronic pain syndromes. We present our experience with posttraumatic Complex Regional Pain Syndrome (CRPS) type 2 in a patient who underwent 15 sessions of HBOT. A 41-year-old male with one-year history of CRPS of left foot followed by left ankle fracture demonstrated less pain, decreased swelling, less allodynia, and improvement in skin color and range of motion of the lower limb after 3 weeks of HBOT. Patient was back to work for the first time in over a year. HBOT may be considered as a valuable therapeutic tool in the treatment of long-standing CRPS.

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Neurogenic Edema from Complex Regional Pain Syndrome Resulting in Fulminant Infection Necessitating Below Elbow Amputation

Journal of Hand and Microsurgery ◽

10.1055/s-0037-1608694 ◽

2017 ◽

Vol 09 (03) ◽

pp. 159-162

Author(s):

Daniel Carpenter ◽

Reid Draeger

Keyword(s):

Complex Regional Pain Syndrome ◽

Upper Extremity ◽

Soft Tissues ◽

Carpal Tunnel Release ◽

Extreme Case ◽

Pain Syndrome ◽

Left Hand ◽

Thickness Skin ◽

History Of

AbstractWe report a case of severe upper extremity complex regional pain syndrome type 1 (CRPS-1) and neurogenic edema that ultimately led to a medically necessary below-elbow amputation. The patient presented with a history of remote bilateral carpal tunnel release complicated by debilitating and recalcitrant bilateral CRPS-1. Following years of severe neurogenic edema of the left upper extremity, the patient had full-thickness skin sloughing on the dorsum of her hand due to massive edema. This subsequently led to maggot infestation of the soft tissues of the left hand ultimately necessitating amputation. We present the case as an illustration of an extreme case of neurogenic edema, a potential physical manifestation of CRPS-1. The case presented discusses upper extremity amputation as an end treatment option for CRPS-1, though in this case amputation was primarily indicated secondary to medical necessity.

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Ghrelin system is involved in improvements in glucose metabolism mediated by hyperbaric oxygen treatment in a streptozotocin‑induced type�1 diabetes mouse model

Molecular Medicine Reports ◽

10.3892/mmr.2020.11481 ◽

2020 ◽

Author(s):

Limin Song ◽

Junhua Yuan ◽

Yuan Liu ◽

Di Zhang ◽

Caishun Zhang ◽

...

Keyword(s):

Type 1 Diabetes ◽

Glucose Metabolism ◽

Mouse Model ◽

Hyperbaric Oxygen ◽

Hyperbaric Oxygen Treatment ◽

Oxygen Treatment ◽

Diabetes Mouse

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Complex regional pain syndrome type 1 in the medico-legal setting: High rates of somatoform disorders, opiate use and diagnostic uncertainty

Medicine Science and the Law ◽

10.1177/0025802418779934 ◽

2018 ◽

Vol 58 (3) ◽

pp. 147-155 ◽

Cited By ~ 4

Author(s):

Christopher Bass ◽

Gregory Yates

Keyword(s):

Complex Regional Pain Syndrome ◽

Somatoform Disorders ◽

Illness Perception ◽

Pain Syndrome ◽

Mental States ◽

Panic Attacks ◽

Syndrome Type ◽

Opiate Use ◽

History Of

Objective The aim of this study was to review demographic and clinical characteristics of patients with complex regional pain syndrome type 1 (CRPS) seen in a UK medico-legal setting – particularly the relationship between CRPS and somatoform disorders. Methods Fifty consecutive cases of CRPS (interviewed 2005–2016) undergoing psychiatric assessment were reviewed. A systematic assessment of mental states was conducted via interview and examination of medical/psychiatric records. Thirty patients also completed the Brief Illness Perception Questionnaire (BIPQ). Results Sixty per cent of patients ( n = 30) were female, and the mean age was 43 years. Twenty-two per cent ( n = 11) were employed, and 60% ( n = 30) received disability benefits. Symptoms were reported in the upper limb (62%; n = 31), lower limb (30%; n = 15), both (6%; n = 3) or elsewhere (2%; n = 1). Eighty-four per cent ( n = 42) satisfied DSM-5 criteria for current somatoform disorder. A history of more than two pain-related functional somatic syndromes (e.g. non-cardiac chest pain) was found in 42% ( n = 21) and functional neurological symptoms (e.g. ‘claw-hand’) in 42% ( n = 21). BIPQ scores resembled those associated with somatoform disorders and disorders mediated by psychological factors (e.g. irritable bowel syndrome). In 38% ( n = 19), the CRPS diagnosis was disputed among experts. A history of depression was noted in 60% ( n = 30), panic attacks in 20% ( n = 10) and alcohol/substance misuse in 18% ( n = 9). Opiates were prescribed to 64% ( n = 32). Conclusions Patients diagnosed with CRPS involved in litigation have high rates of prior psychopathology (mainly somatoform disorders) and pain-related disability for which opiate use is common. They risk an adverse reaction to limb pain ‘shaped’ by maladaptive illness beliefs. The CRPS diagnosis lacks reliability in medico-legal settings and may cause iatrogenic harm

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Challenges in the Diagnostic Conceptualization of CRPS-1 (Formerly Conceptualized as RSD)

Guides Newsletter ◽

10.1001/amaguidesnewsletters.2006.marapr01 ◽

2006 ◽

Vol 11 (2) ◽

pp. 1-3, 9-12

Author(s):

Robert J. Barth ◽

Tom W. Bohr

Keyword(s):

Clinical Practice ◽

Complex Regional Pain Syndrome ◽

Somatoform Disorders ◽

International Association ◽

Pain Syndrome ◽

Somatoform Disorder ◽

Syndrome Type ◽

Previous Issue

Abstract From the previous issue, this article continues a discussion of the potentially confusing aspects of the diagnostic formulation for complex regional pain syndrome type 1 (CRPS-1) proposed by the International Association for the Study of Pain (IASP), the relevance of these issues for a proposed future protocol, and recommendations for clinical practice. IASP is working to resolve the contradictions in its approach to CRPS-1 diagnosis, but it continues to include the following criterion: “[c]ontinuing pain, which is disproportionate to any inciting event.” This language only perpetuates existing issues with current definitions, specifically the overlap between the IASP criteria for CRPS-1 and somatoform disorders, overlap with the guidelines for malingering, and self-contradiction with respect to the suggestion of injury-relatedness. The authors propose to overcome the last of these by revising the criterion: “[c]omplaints of pain in the absence of any identifiable injury that could credibly account for the complaints.” Similarly, the overlap with somatoform disorders could be reworded: “The possibility of a somatoform disorder has been thoroughly assessed, with the results of that assessment failing to produce any consistencies with a somatoform scenario.” The overlap with malingering could be addressed in this manner: “The possibility of malingering has been thoroughly assessed, with the results of that assessment failing to produce any consistencies with a malingering scenario.” The article concludes with six recommendations, and a sidebar discusses rating impairment for CRPS-1 (with explicit instructions not to use the pain chapter for this purpose).

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