48 year old lady with CRPS treated with Pregabalin
A 48 year old lady attended the Pain Clinic complaining of right foot pain. She had had a traumatic leg injury in which the fibula had been broken following a walking accident. Subsequent to this, she had a fibular nail, screws and a tendon repair to correct the problem. A few days following her operation, she started complaining of burning pain inside the cast with an average pain score of 5/10 and worse pain score of 6-7/10. This was described as feeling the wound was infected and a “hot wax type of pain”.
The pain was aggravated by movement and in her own words felt like ‘barbed wire wrapped around the ankle’. She was given Co-dydramol but this did little to help with the pain.On examination of the left leg, there were 2 scars: one on the medial malleolus (3.5 cm long) and one on the lateral malleolus (9 cm long) from her surgery. Surrounding these scars there was increased sensitivity to light touch (allodynia) and pin prick (hyperalgesia)which were very marked. Also, there was an increase to light touch on the foot which was felt as pain, and a reduction in pin prick sensation. Overall, the limb was red and swollen (oedematous). Along the leg above the ankle, light touch produced tingling and there was a reduction in pin prick sensation. Standing exacerbated the pain. A diagnosis of CRPS (Complex Regional Pain Syndrome) was made. This lady was immediately started on a regime of Amitriptyline 30 mg nocte, Pregabalin 150 mg twice a day, Vitamin C 100 mg twice a day and Celecoxib 100 mg twice a day. She was on the medication for approximately 11 days. At her next consultation, the pain had receded to almost nothing but was then starting to creep back. An extra dose of Pregabalin was then introduced at lunchtime. The pain started to improve and an intensive course of physiotherapy was commenced including flexion and extension exercises, rubbing, bending and lymphatic drainage of the limb. Regarding adverse effects of the medication, it did make her feel a little sleepy and she had some slurring of her words occasionally. However, she was able to function and get on with her work, and was sleeping well. She felt that the balance of adverse effects versus the pain relief was tolerable. She continues to improve on the higher dose of the Pregabalin and continues with physiotherapy.