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Su Y, Li Z, Wang Q, Tang H. Local subcutaneous lidocaine injection for the treatment of complex regional pain syndrome: a case report and literature review. Front Neurol 2023; 14:1232199. [PMID: 37645606 PMCID: PMC10461082 DOI: 10.3389/fneur.2023.1232199] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2023] [Accepted: 07/24/2023] [Indexed: 08/31/2023] Open
Abstract
A 14-year-old child was diagnosed with complex regional pain syndrome (CRPS) after bromhidrosis surgery. She experienced a stinging, knife-like, and intermittent attack pain, accompanied by numbness of both upper limbs and limited movements. Ultrasound-guided radiofrequency surgery on the peripheral nerve did not reduce pain. Then, gabapentin 300 mg three times a day and 2% lidocaine by local subcutaneous injection once a day for 3 days were administrated. After the local subcutaneous injection of lidocaine, the pain was significantly relieved, and the pain induced by skin touch at the scar disappeared. No pain recurred after the 1-month follow-up. An evidence-based literature review showed that local or systemic intravenous lidocaine was used to reduce adult CRPS symptoms but less has been reported in children. In our case, a local subcutaneous injection of 2% lidocaine in a child for CRPS treatment was reported to be effective in relieving complex local pain with favorable outcomes. Though further high-quality randomized controlled trials are needed to investigate the effects and safety of local subcutaneous lidocaine injection on pain relief in children with CRPS, it could still provide a relatively safe and effective adjuvant therapy for minor patients.
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Affiliation(s)
- Yaping Su
- Department of Pharmacy, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, China
- Department of Pharmacy, The People's Hospital of Xin Tai City, Taian, China
| | - Zhenyu Li
- Department of Pharmacy, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, China
| | - Qian Wang
- Department of Pharmacy, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, China
| | - Hui Tang
- Department of Pharmacy, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, China
- Stem Cell Clinical Institute, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, China
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Abstract
Abstract
This review aimed to synthesize the current evidence on the effectiveness of invasive treatments for complex regional pain syndrome in children and adolescents. Studies on children and adolescents with complex regional pain syndrome that evaluated the effects of invasive treatment were identified in PubMed (search March 2013). Thirty-six studies met the inclusion criteria. Articles reported on a total of 173 children and adolescents with complex regional pain syndrome. Generally, many studies lack methodological quality. The invasive treatments applied most often were singular sympathetic blocks, followed by epidural catheters and continuous sympathetic blocks. Rarely, spinal cord stimulation and pain-directed surgeries were reported. An individual patient frequently received more than one invasive procedure. Concerning outcome, for approximately all patients, an improvement in pain and functional disability was reported. However, these outcomes were seldom assessed with validated tools. In conclusion, the evidence level for invasive therapies in the treatment of complex regional pain syndrome in children and adolescents is weak.
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Voet C, le Polain de Waroux B, Forget P, Deumens R, Masquelier E. Spinal cord stimulation for complex regional pain syndrome type 1 with dystonia: a case report and discussion of the literature. F1000Res 2014; 3:97. [PMID: 25254100 PMCID: PMC4168752 DOI: 10.12688/f1000research.3771.1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 04/28/2014] [Indexed: 11/20/2022] Open
Abstract
Background: Complex Regional Pain Syndrome type 1 (CRPS-1) is a debilitating chronic pain disorder, the physiopathology of which can lead to dystonia associated with changes in the autonomic, central and peripheral nervous system. An interdisciplinary approach (pharmacological, interventional and psychological therapies in conjunction with a rehabilitation pathway) is central to progress towards pain reduction and restoration of function.Aim: This case report aims to stimulate reflection and development of mechanism-based therapeutic strategies concerning CRPS associated with dystonia.Case description: A 31 year old female CRPS-1 patient presented with dystonia of the right foot following ligamentoplasty for chronic ankle instability. She did not have a satisfactory response to the usual therapies. Multiple anesthetic blocks (popliteal, epidural and intrathecal) were not associated with significant anesthesia and analgesia. Mobilization of the foot by a physiotherapist was not possible. A multidisciplinary approach with psychological support, physiotherapy and spinal cord stimulation (SCS) brought pain relief, rehabilitation and improvement in the quality of life.Conclusion: The present case report demonstrates the occurrence of multilevel (peripheral and central) pathological modifications in the nervous system of a CRPS-1 patient with dystonia. This conclusion is based on the patient’s pain being resistant to anesthetic blocks at different levels and the favourable, at least initially, response to SCS. The importance of the bio-psycho-social model is also suggested, permitting behavioural change.
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Affiliation(s)
- Caroline Voet
- Rehabilitation Medicine, Université Catholique de Louvain, Brussels, Belgium
- Multidisciplinary Reference Unit for Chronic Pain, Université Catholique de Louvain, Brussels, Belgium
| | - Bernard le Polain de Waroux
- Multidisciplinary Reference Unit for Chronic Pain, Université Catholique de Louvain, Brussels, Belgium
- Anaesthesiology, Cliniques Universitaires Saint-Luc, Université Catholique de Louvain, Brussels, Belgium
- Institute of Neuroscience, Université Catholique de Louvain, Brussels, Belgium
- Neuropharmacology Unit, pole CEMO, Université Catholique de Louvain, Brussels, Belgium
| | - Patrice Forget
- Multidisciplinary Reference Unit for Chronic Pain, Université Catholique de Louvain, Brussels, Belgium
- Anaesthesiology, Cliniques Universitaires Saint-Luc, Université Catholique de Louvain, Brussels, Belgium
- Institute of Neuroscience, Université Catholique de Louvain, Brussels, Belgium
- Neuropharmacology Unit, pole CEMO, Université Catholique de Louvain, Brussels, Belgium
| | - Ronald Deumens
- Institute of Neuroscience, Université Catholique de Louvain, Brussels, Belgium
- Neuropharmacology Unit, pole CEMO, Université Catholique de Louvain, Brussels, Belgium
| | - Etienne Masquelier
- Rehabilitation Medicine, Université Catholique de Louvain, Brussels, Belgium
- Multidisciplinary Reference Unit for Chronic Pain, Université Catholique de Louvain, Brussels, Belgium
- Institute of Neuroscience, Université Catholique de Louvain, Brussels, Belgium
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Verdolin MH, Stedje-Larsen ET, Hickey AH. Ten consecutive cases of complex regional pain syndrome of less than 12 months duration in active duty United States military personnel treated with spinal cord stimulation. Anesth Analg 2007; 104:1557-60, table of contents. [PMID: 17513657 DOI: 10.1213/01.ane.0000264087.93163.bf] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Complex regional pain syndrome describes a constellation of symptoms that may involve the sympathetic nervous system. Emerging consensus recommends early intervention with spinal cord stimulation to facilitate physical therapy. Isolated case reports suggest this may be an effective treatment. Ten consecutive active duty United States military personnel with newly diagnosed complex regional pain syndrome underwent early intervention with spinal cord stimulation with favorable results, including decreased pain scores and decreased opioid intake. Six received injuries directly as a result of service in Iraq or Afghanistan. These patients also had posttraumatic stress disorder, but it did not interfere with successful pain control. Additionally, 6 of 10 patients continued on active duty.
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Affiliation(s)
- Michael H Verdolin
- Department of Anesthesiology, Naval Medical Center San Diego, San Diego, California 92134-1005, USA.
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Tan AK, Duman I, Taşkaynatan MA, Hazneci B, Kalyon TA. The effect of gabapentin in earlier stage of reflex sympathetic dystrophy. Clin Rheumatol 2006; 26:561-5. [PMID: 16897121 DOI: 10.1007/s10067-006-0350-y] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2006] [Revised: 05/23/2006] [Accepted: 05/23/2006] [Indexed: 10/24/2022]
Abstract
The objective of this paper is to investigate the effect of gabapentin in the earlier stage of reflex sympathetic dystrophy syndrome (RSD). Twenty-two patients diagnosed with RSD were enrolled. Initial gabapentin dosage was 600 mg/day. This dosage is increased gradually until a satisfactory pain level was reached. After this level, this dosage was maintained throughout the study. An exercise program was also applied to the patients. Provoked and static pain scores of the patients were obtained initially, at 3-day intervals for maintenance dosage determining, and at 6 weeks after the discharge. Functional improvement parameters were volumetric measurement; dynamometric measurement and third finger pulp-distal palmar crease distance measurement for hands; and metric circumferential measurement and range of motion for elbow, knee, and foot initially, at baseline, on the tenth day, upon discharge, and 6 weeks after the discharge. The mean maintenance dose of gabapentin was 1,145.46+/-377.6 mg/day (range, 900-1,800 mg/day). Improvements in spontaneous and provoked pain intensities were statistically significant. No statistically significant difference was obtained in functional improvement parameters. Dizziness in three patients, headache in two patients, and mild burning feeling in the tongue in one patient were the reported side effects. These symptoms resolved spontaneously in few days. Gabapentin cannot be recommended as the drug of choice, but it may be considered as one of the therapeutic alternatives in the management of pain due to RSD. We suggest that it is effective only for the pain and not for other symptoms of RSD. Serious side effects that will cause the patient to stop using the drug are rare.
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Affiliation(s)
- Arif Kenan Tan
- Department of Physical Medicine and Rehabilitation, Gulhane Military Medical Academy, 06018 Etlik, Ankara, Turkey
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