A Rare Case Of Treatment-resistant Complex Regional Pain Syndrome

A Rare Case Of Treatment-resistant Complex Regional Pain Syndrome

Muhammad Usman Khan, Minahil Zaman, Sadaf Mushtaq, Amen Mansoor, Khalid Bashir
National Hospital & Medical Center, Lahore, Pakistan

Introduction: Complex regional Pain syndrome (CRPS) is characterized by chronic pain with sensory, motor, vasomotor, sudomotor, and trophic changes affecting the extremities following trauma or surgery. The Budapest Criteria is not an extremities-focused diagnostic tool, and cases of truncal presentations remain controversial.

Case Description: A 31-year-old male presented with chronic right lower thoracic and upper lumbar pain persisting for three years after improper posturing during a gym workout session. Treatments including radiofrequency ablation, Botox injections, epidural steroids, and medications like gabapentin, duloxetine, and carbamazepine had proven ineffective. At our clinic, exploration of further treatment modalities such as trigger point injections, lidocaine patches, TENS, right lumbar medial branch blocks (L1-L3), and L2 dorsal root ganglion ablation remained unsuccessful in achieving sustained pain relief.

Discussion and main learning points: We present an atypical truncal CRPS, without prior history of surgery & trauma. An initial musculoskeletal presentation, followed by delayed allodynia, skin discoloration, and temperature changes, resulted in a late diagnosis. The multifactorial pathophysiology of CRPS produces a complex of nociceptive, neuropathic, sympathetically mediated & non-sympathetically mediated pain. Despite a multidisciplinary approach, a pain specialist may still encounter resistant and unusual presentations of CRPS.

Keywords: Post-operative pain, pain management