I reviewed a 47 year old lady in the Pain Clinic. She had an accident falling over a pavement curb in which she fractured her thumb, wrist and elbow on the right side. She was in plaster for approximately 12 weeks. When the plaster was removed, she started to get increasing amounts of pain and hypersensitivity.
On examination of the right arm, she had lateral epicondylitis (which is tenderness over the lateral border of the elbow). She also complained of pins and needles in the right arm and a dusky appearance. She also had the beginnings of peeling of her fingertips. In the mid part of the arm there was pain on light touch (allodynia); there was also pain and tenderness on palpation all over the right arm; also pain on light touch (allodynia) all over the right hand and some pain on pin prick sensation (hyperalgesia) of the right hand. She also had multiple trigger points in the neck and shoulders. She was finding activities of daily living such as washing and cooking, to be increasingly difficult and a diagnosis of Complex Regional Pain Syndrome (CRPS) type 1 was made.
The lady was immediately started on a Gabapentin titration pack and was titrated up to Gabapentin 800 mg three times a day over the next few weeks. She also started on a course of Stellate Ganglion nerve blocks. She had a total of 6 of these performed at weekly intervals. After each injection, she had good benefit resulting in increase in blood flow to the arm and a reduction in her pain symptoms.
After approximately 4 months, her pain and hypersensitivity had significantly improved. She had the odd twinge but otherwise was much better and her sleep had also improved. She was then put on a reducing dose of Gabapentin, slowly reduced down to zero over a 4 week period. When she was reviewed in the clinic at the end of this time, the pain had completely resolved and she was discharged from the Pain Clinic.