Intramuscular Injection and Complex Regional Pain Syndrome Development After “Harmless” Procedures

Abstract

Complex regional pain syndrome (CRPS) is a puzzling pain condition, typically occurring after trauma. Incidents as innocent as IV injection and vaccine administration may serve as the impetus for an as yet poorly understood cascade of neuro-inflammation and somatosensory changes. A condition with variable degrees of psychological involvement, disability, and purely clinical diagnostic criteria, the diagnosis is often significantly delayed before effective treatment is begun, decreasing the likelihood of success. A 58-year-old female initially presented with painless peripheral edema of the left arm without erythema or loss of function, with later bilateral development of multiple domains of symptoms consistent with CRPS. Plausible initiation events in this instance were an IV insertion in the left cubital fossa and vaccination into the right deltoid. Delay in diagnosis is common but utilization of the Budapest Criteria for diagnosis and prompt treatment improves outcomes.

Post‐COVID‐19 vaccination arm pain diagnosed as complex regional pain syndrome: A case report

“… 3 , 4 Post‐vaccination CRPS rarely occurs, and its overall incidence is unknown. 5 , 9 According to a cohort analysis, it affected 563 among 1,232,572 women, who received the human papillomavirus vaccine. 10 The COVID‐19 vaccine elicits an immune response by inducing antibody formation against the SARS‐CoV‐2 virus.…”

“…Injuries to the extremities, such as fractures, sprains, and surgical injuries, have been commonly proposed as precipitating factors for CRPS 3,4 . Post‐vaccination CRPS rarely occurs, and its overall incidence is unknown 5,9 . According to a cohort analysis, it affected 563 among 1,232,572 women, who received the human papillomavirus vaccine 10 .…”

“…4 Injections, specifically vaccinations, have rarely been reported to cause CRPS. 3,5 Herein, we describe the clinical presentation of CRPS in a patient who received the COVID-19 vaccine.…”

“…The risk factors for CRPS include a history of injury, sprain, fracture, immobilization, and surgery 4 . Injections, specifically vaccinations, have rarely been reported to cause CRPS 3,5 …”