Patient with Complex Regional Pain Syndrome (CRPS) treated with medication and lumbar sympathectomy
History of patient with Complex Regional Pain Syndrome (CRPS)
A 47 year old lady was reviewed in the Pain Clinic. She had an open reduction internal fixation of a right ankle fracture in Portugal in 1986, and later had metalwork removed. She then had an abscess on the medial side of t right ankle, which was drained. She came to the Pain Clinic complaining of right medial ankle pain.
Examination of patient with Complex Regional Pain Syndrome (CRPS)
On examination there was an increase in light touch and pin prick sensation, and overall the area was markedly sensitive. She also mentioned swelling in the right ankle and skin discolouration.
Treatment of patient with Complex Regional Pain Syndrome (CRPS)
My impression was that this lady had a local area of neuropathic pain, most likely complex regional pain syndrome. I gave her a long and frank account of the nature of neuropathic pain and started her on Pregabalin 75 mg twice per day for 2 weeks, followed by Pregabalin 150 mg twice per day. She was also put on the list for a lumbar sympathectomy.
She was reviewed 4 weeks later and had had great benefit with the Pregabalin. She found the 75 mg twice per day dose to be much better, but unfortunately was getting end of dose effect at around 4 pm. She was therefore put on Pregabalin 75 mg am, 25 mg lunch time and 75 mg in the evening. After one month on this regime, she was finding around the clock benefit with the medication.
Lumbar sympathectomy for patient with Complex Regional Pain Syndrome (CRPS)
We still plan to continue with the lumbar sympathectomy to see if we could improve her pain some more and otherwise, she will continue on this medication regime for at least the next 3-4 months.