scholarly journals Pulsed Radiofrequency Treatment of Complex Regional Pain Syndrome: A Case Series

2014 ◽  
Vol 19 (4) ◽  
pp. 186-190 ◽  
Author(s):  
Vlad Djuric
Keyword(s):  
Pain Relief ◽  
Lower Extremity ◽  
Effective Treatment ◽  
Complex Regional Pain Syndrome ◽  
Present Report ◽  
Case Series ◽  
Pain Syndrome ◽  
Sympathetic Chain ◽  
Type I ◽  
Pulsed Radiofrequency

BACKGROUND: Various forms of sympathetic chain neurolysis (sympathectomy) have, at one time or another, held promise as effective treatment options for complex regional pain syndrome (CRPS). Complications, such as worsening pain and the development of new pain syndromes, have prevented sympathectomy from emerging as a standard intervention. In an effort to avoid poor outcomes associated with neurolysis, pulsed radiofrequency (PRF) has been proposed as a potential treatment alternative for a number of chronic neuropathic pain states, including some forms of CRPS.METHODS: The present report describes three cases in which patients diagnosed with lower extremity CRPS type I obtained substantial and lasting intervals of pain relief following PRF of the lumbar sympathetic chain. Over a period of four years, 14 fluoroscopically guided procedures using PRF lesioning of the lumbar sympathetic chain at L2, L3 and L4 were performed in three individuals with CRPS type I of the lower limb. Outcome measures included pre- and post-treatment self-reported pain and medication requirements.RESULTS: Substantial pain relief (>50%) was achieved in 91.7% of PRF applications at three months and 83.3% at six months, with some treatments resulting in persistent relief well beyond 12 months. Medication use decreased to a comparable degree, with discontinuation of opiates after all but three treatments.CONCLUSIONS: PRF lesioning of the lumbar sympathetic chain can be an effective treatment for patients with CRPS type I of the lower extremity, with the potential to provide ≥6 months of substantial pain relief.

CRPS of Lower Extremity– A Case Report and Review

2016 ◽  
Vol 27 (1) ◽  
pp. 22-28
Author(s):  
Mahima Agrawal
Keyword(s):  
Case Report ◽  
Lower Extremity ◽  
Lower Limb ◽  
Relaxation Training ◽  
Single Case ◽  
Case Series ◽  
Pain Syndrome ◽  
Type I ◽  
Retrospective Case ◽  
Single Case Report

Abstract Complex regional pain syndrome (CRPS) of the lower limb is a relatively uncommon entity as compared to CRPS of the upper extremity. Literature search has revealed only 2 retrospective case series and a single case report of lower extremity CRPS type I from 1975 to 2014 on Pubmed, isolated cases of CRPS type I of lower extremity have also been reported following knee surgeries and arthroscopies. This report presents a case of lower limb CRPS type I following blunt trauma to right foot, treatment of which was directed towards management of allodynia, vasomotor symptoms and surgical correction of deformity which had developed because of the disease, coping mechanisms were also reinforced through counselling and relaxation training. The individual responded well to treatment with a reported 75% reduction in the disabling symptoms and improvement in ambulatory status.

scholarly journals Intrathecal Bupivacaine Monotherapy with a Retrograde Catheter for the Management of Complex Regional Pain Syndrome of the Lower Extremity

2016 ◽  
Vol 7;19 (7;9) ◽  
pp. E1087-E1092
Author(s):  
W. Porter McRoberts
Keyword(s):  
Side Effects ◽  
Pain Relief ◽  
Lower Extremity ◽  
Complex Regional Pain Syndrome ◽  
Treatment Algorithm ◽  
Pain Syndrome ◽  
Targeted Treatment ◽  
Lower Extremity Weakness ◽  
Advanced Therapy ◽  
Invasive Techniques

Complex regional pain syndrome (CRPS) presents a therapeutic challenge due to its many presentations and multifaceted pathophysiology. There is no approved treatment algorithm and clinical interventions are often applied empirically. In cases of CRPS where symptoms are localized to an extremity, a targeted treatment is indicated. We describe the use of intrathecal bupivacaine monotherapy, delivered through a retrograde catheter, in the treatment of CRPS affecting the lower extremity. The patient, a 57-yearold woman with a history of failed foot surgery, was seen in our office after 2 years of ineffective treatments with local blocks and neurolytic procedures. We advanced therapy to moderately invasive procedures with an emphasis on neuromodulation. A combined central and peripheral stimulation technique that initially provided 75% pain relief, failed to provide lasting analgesia. We proceeded with an intrathecal pump implant. Based on the results of dorsal root ganglion (DRG) mapping, L5-S1 was identified as the optimal target for therapy and a retrograde catheter was placed at this level. Various intrathecal medications were tested individually. An intrathecal morphine trial was ineffective (visual analog scale [VAS] 7), while intrathecal clonidine provided excellent pain relief (VAS 0) that was limited by severe side effects. Bupivacaine provided 100% analgesia with tolerable side effects (lower extremity weakness and minor bladder incontinence) and was selected for intrathecal infusion. After 14 months, bupivacaine treatment continued to control pain exacerbations. We conclude that CRPS patients benefit from early identification of the predominant underlying symptoms and a targeted treatment with moderately invasive techniques when less invasive techniques fail. Key words: Intrathecal bupivacaine, bupivacaine monotherapy, retrograde catheter, complex regional pain syndrome (CRPS), dual stimulation, dosal root ganglion (DRG) testing

Pulsed radiofrequency applied to the dorsal root ganglia for treatment of post-stroke complex regional pain syndrome: A case series

2016 ◽  
Vol 33 ◽  
pp. 192-197 ◽  
Author(s):  
Ilknur Albayrak ◽  
Seza Apiliogullari ◽  
Ozkan Onal ◽  
Cengizhan Gungor ◽  
Ali Saltali; ◽  
...  
Keyword(s):  
Complex Regional Pain Syndrome ◽  
Dorsal Root Ganglia ◽  
Dorsal Root ◽  
Case Series ◽  
Pain Syndrome ◽  
Pulsed Radiofrequency ◽  
Post Stroke

scholarly journals Acute worsening of clinical presentation in CRPS after SARS-CoV-2 (COVID-19) vaccination: a case series

2021 ◽  
Author(s):  
Jessica Zhang ◽  
Semih Gungor
Keyword(s):  
General Population ◽  
Complex Regional Pain Syndrome ◽  
Medical Management ◽  
Clinical Presentation ◽  
Case Series ◽  
Pain Syndrome ◽  
Individualized Therapy ◽  
Type I ◽  
Mortality And Morbidity ◽  
Clinical Worsening

We present the acute worsening of clinical presentation in complex regional pain syndrome (CRPS), following mRNA-based COVID-19 vaccination. We report the case series of three patients diagnosed with CRPS type I who presented with acute worsening of symptoms after mRNA-based COVID-19 vaccination and their medical management. The acute clinical worsening after mRNA-based COVID-19 vaccination was transient and effectively managed with adjustment of individualized therapy in all three patients. The mortality and morbidity of COVID-19 infection are serious, and vaccination is recommended in the general population, including patients with a diagnosis of CRPS. However, clinicians should be aware of the possibility that there may be a clinical worsening CRPS after mRNA-based COVID-19 vaccination.

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