A case report of a patient with Complex Regional Pain Syndrome treated with gabapentin followed by a course of stellate ganglion nerve blocks which allowed the gabapentin dosage to be reduced.
A 47 year old lady was referred to the Pain Clinic. She had sustained a fracture to the thumb, wrist and elbow of the right arm following a heavy fall. Approximately 2-3 weeks after the plaster was taken off she started to complain of pain in the right arm which gradually intensified.
On examining her right arm she had pins and needles in the hand and dusky coloured skin with skin peeling off the finger tips. There was pain on light touch (allodynia) and exaggerated pain to a painful stimulus (hyperalgesia), throughout the right hand. This was also evident in her forearm, going all the way up to her shoulder.She also had lateral epicondilitis with tenderness and allodynia over the lateral epicondyle. On examination of neck and shoulders, she had multiple trigger points. The pain was becoming incapacitating for her and she was not able to continue with her activities of daily living. This was making her extremely unhappy and she was increasingly depressed. She was started on a Gabapentin titration pack; this was titrated up to 600 mg three times a day. This started to improve her pain but she was keen to improve it more. She then underwent a total of 6 Stellate ganglion nerve blocks which were performed at two weekly intervals. Following the Stellate ganglion nerve blocks, she was able to reduce the dose of Gabapentin down to 300 mg t.d.s. and the pain was significantly better controlled. The plan is to continue her on this medication for another 3-4 months and then slowly wean this down, hopefully removing it altogether.