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

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.

Changes in management of patients with diseases of musculoskeletal system and joints

2021 ◽  
pp. 36-40
Author(s):  
A. L. Vertkin ◽  
A. N. Barinov ◽  
G. Yu. Knorring
Keyword(s):  
Side Effects ◽  
Pain Relief ◽  
Severe Pain ◽  
Pain Syndrome ◽  
Cooperative Action ◽  
Pain Syndromes ◽  
Adequate Pain Relief ◽  
Inflammatory Drugs ◽  
Group B ◽  
Group B Vitamins

Pain syndrome accompanies the vast majority of diseases; therefore, the issues of adequate pain relief remain topical not only for urgent conditions, but also for everyday medical practice. Modern and changed in recent years approaches to the appointment of anesthetic therapy should take into account not only the pathogenetic mechanisms of the development of pain syndrome in a particular patient, but also the need to use drug combinations. This allows for the potentiation of the analgesic effect, reduction of effective dosages of individual drugs and minimization of side effects. In case of severe pain syndrome in the presence of signs of impaired nociception, neuropathic and muscle-fascial pain syndromes, the use of non-steroidal anti-inflammatory drugs in conjunction with group B vitamins is justified. The article considers the pathogenetic details of such a combination therapy, reveals the mechanisms of the cooperative action of the proposed combination of drugs.

Complex Regional Pain Syndrome in Children: a Multidisciplinary Approach and Invasive Techniques for the Management of Nonresponders

Pain Practice ◽  
2015 ◽  
Vol 15 (8) ◽  
pp. E81-E89 ◽  
Author(s):  
Manuel J. Rodriguez- Lopez ◽  
Mariano Fernandez-Baena ◽  
Alex Barroso ◽  
Jose A. Yáñez-Santos
Keyword(s):  
Complex Regional Pain Syndrome ◽  
Multidisciplinary Approach ◽  
Pain Syndrome ◽  
Invasive Techniques

Pain Relief and Functional Recovery in Patients with Complex Regional Pain Syndrome after Motor Cortex Stimulation

2011 ◽  
Vol 89 (3) ◽  
pp. 167-172 ◽  
Author(s):  
Erich Talamoni Fonoff ◽  
Clement Hamani ◽  
Daniel Ciampi de Andrade ◽  
Lin Tchia Yeng ◽  
Marco Antonio Marcolin ◽  
...  
Keyword(s):  
Pain Relief ◽  
Motor Cortex ◽  
Complex Regional Pain Syndrome ◽  
Functional Recovery ◽  
Pain Syndrome ◽  
Motor Cortex Stimulation
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