Complex Regional Pain Syndrome

Abstract

Complex regional pain syndrome (CRPS) is a neurologic disorder that often results in debilitating chronic pain, but the diagnosis may elude providers as it is one of exclusion. A history of trauma may be elucidated. We report a case of CRPS and review the clinical findings, appropriate workup, and treatment options for the patient. The patient we describe went through an extensive workup before receiving the correct diagnosis. Delay in diagnosis leads to prolonged suffering for the patient and, at times, unnecessary invasive debridement procedures. Raising awareness of this entity may help physicians make the correct diagnosis early, as well as initiate a collaborative effort between neurology, anesthesiology, and dermatology to provide the patient the most favorable outcome. W e present a case of complex regional pain syndrome (CRPS) in a 41-year-old man to highlight the importance of early recognition and diagnosis to reduce the signifi cant morbidity associated with this disease. CASE DESCRIPTIONA 41-year-old white man presented to the emergency department with a severely painful, nonhealing ulceration on his left index fi nger after cutting his fi nger on bailing wire. He was evaluated in an emergency department and discharged. He returned several days later with increasing redness and pain, received a dose of intravenous vancomycin, and was discharged with oral trimethoprim/sulfamethoxazole. Several days later, the worsening pain was so severe that he requested amputation of his fi nger. Upon admission, his wound was debrided in the operating room. After several days of intravenous vancomycin, he was discharged with oral minocycline. All wound cultures performed over the course of his hospitalizations were negative for pathogens. Upon his fourth presentation, still in excruciating pain, the dermatology service was consulted for body tissue culture. Examination of his left index fi nger revealed a dry, heme-crusted ulceration with surrounding erythema and violaceous edema ( Figure ) . He was otherwise healthy, but did suff er from depression and multiple suicide attempts in the past. He reported no drug allergies.Th e biopsy for tissue culture was negative for fungus, bacteria, and acid-fast bacilli. A plain radiograph displayed soft tissue swelling. Th e diagnosis of CRPS following trauma was made. Th e patient did not follow up in the dermatology department, and attempts to contact him were unsuccessful. Chart review showed that he attempted suicide several weeks later. DISCUSSIONCRPS is a condition that is aptly named, as it is often a complex entity to diagnose and manage. Th e disorder results from a neurologic dysfunction that produces severe and often debilitating pain. It most often aff ects extremities and may result from trauma or a vascular event. Th e condition has many pseudonyms, including refl ex sympathetic dystrophy, algodystrophy, causalgia, Sudeck's atrophy, transient osteoporosis, and acute atrophy of bone, which adds to the confusion. In 1993, a consensus group settled on CRPS as an umbr...

The Demographic and Clinical Characteristics of the Patients with Complex Regional Pain Syndrome: A Tertiary Clinic Experience

“…CRPS is a clinical diagnosis of exclusion and treatment should be instituted immediately upon diagnosis to alleviate the debilitating pain patients suf-fer with this disorder. 27 The aim of the CRPS treatment is to restorate the function of the involved limbs by reducing pain and increasing the ROM. In the treatment of CRPS; steroids and nonsteroidal anti-inflammatory drugs, a variety of medical therapies ranging from antiepileptics to opiates, many different methods such as sympathetic ganglion blocks and hyperbaric oxygen treatments are used.…”

Bilateral Tibia Fibula Kırığı Sonrası Kompleks Bölgesel Ağrı Sendromu

“…Ayrıca plazma değişiminin KBAS tedavisinde yararlı olduğu raporlanmıştır (20). Sigarayı bırakmanın KBAS iyileşmesinde olumlu katkı sağlayabileceği bildirilmiştir (21). Katznelson ve ark.…”

Analysis of the Experiences of Adults with Complex Regional Pain Syndrome

“…Thus, CRPS is diagnosed based on clinical signs and symptoms, making it challenging for both medical personnel and patients [ 3 , 4 ]. Late diagnosis of CRPS can lead to long-term distress and, in some cases, unnecessary, invasive debridement procedures [ 5 ]. Thus, medical providers must recognize the various states of CRPS and use a multidimensional treatment approach without preconceptions; otherwise, failure to accurately recognize CRPS jeopardizes the validity of patients’ symptomatology [ 6 ].…”