Background & Aims

Complex regional pain syndrome is a chronic neurological condition resulting from a traumatic insult, which differs from other pain syndromes by presenting autonomic dysfunction, persistent regional inflammatory changes and lack of distribution by dermatomes. This study aims to report a case of complex regional pain syndrome in a young male patient who was diagnosed by thermography and treated with sympathetic block, and to discuss the challenges and outcome of this condition and management.

Methods

The sources of information for this study included medical record review, patient interview, imaging exam record and literature review.

Results

Male patient, 18 years old, who presented a sprain of the right ankle. He underwent ankle immobilization and use of NSAIDs for 3 weeks. He evolved with an infected wound on his foot, resolved after debridement and antibiotic therapy, but remained with persistent pain (VAS 7) and radiated to both lower limbs. After 3 years of intermittent pain, he presented a new low-energy trauma, which triggered a crisis of intense pain (VAS 10) in lower limbs, with inability to walk and need for wheelchair use. Patient lost about 25kg in 4 months. He was diagnosed with complex regional pain syndrome (CRPS) with the aid of thermography. During evaluation, hormonal changes were identified and patient was referred for treatment and hormonal replacement with a nutritionist, using nandrolone, NADH, HMB, creatine, amino acids and vitamins. He underwent optimized pharmacological treatment of pain, using lamotrigine, pregabalin, duloxetine, dipyrone, viminol and buprenorphine. Patient

Conclusions

Complex regional pain syndrome is a condition classically recognized for being difficult to diagnose and treat, often having its diagnosis made late, prolonging the patient’s suffering. Thermography is a complementary exam of great value that has been used recently in an effective way to assist in the diagnosis of neuropathic pain, including in cases of complex regional pain syndrome, which is also very dependent on a good clinical history and a good physical examination. Thermography is a non-invasive exam, with good sensitivity for the diagnosis of the syndrome, despite its specificity being lower. Venous sympathetic blocks are part of the first-line of interventional treatment of complex regional pain syndrome, but its treatment should be multimodal and multidisciplinary, involving also, besides the identification and treatment of other comorbidities or associated imbalances.

References

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Presenting Author

Lucio Gusmao Rocha

Poster Authors

Victor Giacomini

MD

Centro Avançado de Dor e Especialidades Médicas - Distrito Federal

Lead Author

E-mail

Lucio Gusmão Rocha

MD

Centro Avançado de Dor e Especialidades Médicas - Distrito Federal

Lead Author

E-mail

Luisa Mesquita de Morais

MD

Centro Avançado de Dor e Especialidades Médicas - Distrito Federal

Lead Author

E-mail

Victor Queiroz Giacomini

MD

Centro Avançado de Dor e Especialidades Médicas - Distrito Federal

Lead Author

E-mail

Rafael Vieira Rocha

MD

Centro Avançado de Dor e Especialidades Médicas - Distrito Federal

Lead Author

E-mail

Gulliver Rezende Teodoro Ribeiro

MD

Centro Avançado de Dor e Especialidades Médicas - Distrito Federal

Lead Author

E-mail

Robson Nunes da Silva

MD

Centro Avançado de Dor e Especialidades Médicas - Distrito Federal

Lead Author

E-mail

Pedro Vinicius Araújo de Abreu

Student/trainee

Escola Superior de Ciências da Saúde (ESCS) - Distrito Federal

Lead Author

E-mail

Frederico Barra de Moraes

MD

Universidade Federal de Goiás (UFG)

Lead Author

E-mail

Topics

  • Pain Imaging