Complex Regional Pain Syndrome in the ambulatory surgical care setting

Correction of severe foot and ankle contracture due to CRPS using external fixation and pain management: report of a pediatric case

Complex regional pain syndrome-induced dystonia is a severe deformity that can affect the lower extremities and hinder ambulation. Although a number of conservative treatments have been described for this condition, we are not aware of any publications describing the use of surgical intervention for the treatment of this condition. In this report, we describe the case of a pediatric patient with a severe lower extremity deformity in conjunction with chronic pain syndrome. A concerted, interdisciplinary treatment approach was undertaken for the management of this patient, and this included contributions from a foot and ankle surgeon, a pain specialist, an internist, a physical therapist, and a psychiatrist. The primary goal of the treatment strategy was to recreate a plantigrade, weight-bearing lower extremity, while controlling pain. To this end, gradual correction of deformity was achieved using an external fixator and, by 6 months after the surgery, the patient was for the first time in years ambulating on the realigned lower extremity. After 3 years of follow-up, she maintained an activity level that was equal to that which she enjoyed before the injury.

LEVEL OF CLINICAL EVIDENCE

4.

Characteristic trends of lower-extremity complex regional pain syndrome

Complex regional pain syndrome (CRPS) is a multifaceted, progressive, and potentially devastating disorder generally affecting the extremities. In addition, scant information is available regarding the types of patients who develop lower-extremity CRPS. This is a retrospective chart review study of 64 patients who presented to a pain clinic with CRPS of the lower extremity. The study examined 23 variables broadly classified under demographic characteristics, CRPS characteristics, and healthcare utilization. The sample was found to consist of predominantly white, middle-aged women with CRPS I. Subjective complaints consisted of burning, sharp, throbbing, or aching pain with shooting symptoms. Initial presenting clinical findings included allodynia, edema, erythema, and hyperesthesia. The most common precipitating injuries were blunt trauma of the foot with or without fracture or ankle sprain. The most common inciting surgical events were bunionectomy, tarsal tunnel release, and heel-spur surgery. Referral to the pain clinic was delayed more commonly in trauma patients than in postsurgical patients, with a corresponding increase in pain clinic visits for treatment. This study may act as a guide for physicians treating the lower extremity to aid in the recognition of lower extremity complex regional pain syndrome and its characteristics.