Welcome to the April update — click on ‘abstract’ for link to Pubmed
Dermatological Findings in Early Detection of Complex Regional Pain Syndrome.
Kabani R, Brassard A.
IMPORTANCE Complex regional pain syndrome (CRPS) is a chronic pain condition usually affecting the extremities. It mostly occurs in 3 distinct stages with intense pain being the hallmark feature in every stage. Skin abnormalities are common, and often necessary, in the clinical findings required to diagnose CRPS. OBSERVATIONS A man in his 30s presented to the dermatology clinic with complaints of recurrent redness, swelling, and burning pain in his left arm. Based on this clinical presentation with normal findings from a neurological examination and unremarkable findings on diagnostic imaging, the diagnosis of CRPS was made. CONCLUSIONS AND RELEVANCE It is important for dermatologists to understand and recognize CRPS as a neurological disorder with major dermatologic implications. The ability of dermatologists to identify and direct patients with this syndrome is a critical factor in determining the likelihood of favorable outcomes following diagnosis of CRPS. This report outlines and reviews a neurological condition presenting with clinically significant cutaneous changes. We illustrate the bias that dermatologists may have in exclusively associating patient complaints with dermatological implications. This stresses the necessity for dermatologists to perform comprehensive medical histories and physical examinations to minimize diagnostic error and improve patient care.
Complex regional pain syndrome in a 15-year-old girl successfully treated with continuous epidural anesthesia.
Saito Y1, Baba S2, Takahashi A3, Sone D4, Akashi N5, Koichihara R2, Ishiyama A2, Saito T2, Komaki H2, Nakagawa E2, Sugai K2, Sasaki M2, Otsuki T3.
A 15-year-old girl developed severe pain in her right upper limb within a few days after she experienced an astatic epileptic seizure accompanied by falling on her right side. She was treated with fluid infusion through a cannula into her right hand. Swelling, mild flaring, and muscle weakness of the right arm subsequently appeared. Pharmacotherapy and stellate ganglion block were ineffective, and continuous epidural anesthesia was commenced 14days after the falling event. The pain and accompanying symptoms completely disappeared within 5days. Early treatment with continuous epidural anesthesia may be a promising option for the management of complex regional pain syndrome during childhood.
RS: Interesting but remember this is a case study!
Case report: Long-standing complex regional pain syndrome relieved by a cephalosporin antibiotic.
Ware MA1, Bennett GJ2.
We describe a young woman who had had treatment-refractory complex regional pain syndrome (CRPS) for 6years before receiving antibiotic treatment with cefadroxil (a cephalosporin derivative) for a minor infection. Cefadroxil reduced the patient’s pain and motor dysfunction (dystonia and impaired voluntary movement) within days; the pain and motor disorder returned when cefadroxil was discontinued; and both again abated when cefadroxil was re-instituted. The patient has now had symptom relief for more than 3years on continuing cefadroxil therapy. We discuss this case in the context of previous reports of antibiotic treatment relieving neuropathic pain in experimental animals.
RS: Again interesting but a case study.
Complex Regional Pain Syndrome in a Young Athlete with Von Willebrand Disease.
Khadavi MJ1, Alm JC, Emerson JA.
A 17-year-old female with type 1 Von Willebrand Disease (vWD) developed left medial calf pain while running track. Over the next 6 months, orthopedic surgery, sports medicine, vascular surgery, and neurology treated her under various working diagnoses; however, the pain, allodynia, coldness, and pale skin color worsened. She was admitted to a tertiary pediatric hospital for intractable pain where PM&R diagnosed her with complex regional pain syndrome (CRPS) type 1, began gabapentin, and initiated an aggressive inpatient rehabilitation program. During her 3 weeks of inpatient rehabilitation, passive range of motion of knee extension improved from 40° from extension to full extension, and ankle dorsiflexion improved from 15° from neutral to a consistent range of motion beyond neutral. Additional outcome measures were distance of ambulation and assistive device usage; from admission to inpatient rehabilitation to 2 months postdischarge, her weight-bearing tolerance progressed from nonweight-bearing to partial weight-bearing, and ambulation improved from 20 feet with a three-point crutch gait to unlimited distances with a four-point crutch gait. This is the first known case of a bleeding disorder as the likely underlying microvascular pathology associated with CRPS, a theory exposed in 2010.
Visit our clinic site here for details on our specialist CRPS Clinics in London: Specialist Pain Physio Clinics, London or call us on 07932 689081