Case report of patient with CRPS (Complex Regional Pain Syndrome) treated with lumbar sympathectomy and medication
This 63 year old lady presented to the clinic complaining of left foot and leg pain, with increasing oedema. She had had surgical incisions and on examination, there was a reduction in pinprick and pain with light touch over the foot. She was taking Gabapentin 300 mg t.d.s.
Diagnosis and Treatment of CRPS (Complex Regional Pain Syndrome)
A diagnosis of neuropathic pain had already been made and the possibility of complex regional pain syndrome. She was started on Pregabalin 75 mg twice per day, Amitriptyline 100 mg at night and reviewed 4 weeks later. Unfortunately, on the Pregabalin and Amitriptyline she had excessive adverse effects including excessive drowsiness, but had no pain relief.
She was put on Amitriptyline 50 mg nocte and started on Oxycodone and Tramadol as required. She was then reviewed 3 weeks later. She had had some benefit with the Tramadol after 3 weeks but this seemed diminished and she did not find the Amitriptyline to be helpful. We decided to go back onto the Gabapentin.
Lumbar Sympathectomy for patient with CRPS (Complex Regional Pain Syndrome)
The pain was getting extremely bad and the decision was made to do a lumbar sympathectomy. This was performed approximately one week later. She was also started on a regime of Oxycontin 20 mg twice per day and Tramadol as required, and the Amitriptyline was stopped.
Follow up after Lumbar Sympathectomy
Four weeks after the lumbar sympathectomy, she had a dramatic improvement in the pain, including a reduction in localised oedema, which she was very pleased with. It was decided to continue with the Oxycontin, as previously outlined, and to repeat the lumbar sympathectomy. She will be reviewed in approximately 6 weeks time.