AKL Hanlan, D Mah-Jones, PB Mills – Pain Physician, 2014

Pain Physician 2014; 17:E629-E635 • ISSN 2150-1149

Case Report

Complex regional pain syndrome (CRPS) is a pain disorder characterized by sensory,

motor, trophic and autonomic dysfunction. The hallmark of the disorder is pain out of

proportion of the inciting event. CRPS is difficult for clinicians to manage as there is no

gold standard for diagnosis or treatment. Patients with CRPS are at risk of developing

contractures, tissue atrophy, joint dislocation and severe chronic pain. While CRPS

is thought to be due to peripheral and central nervous system dysfunction, there is

limited understanding of the pathophysiology of CRPS. The proposed mechanisms are

multifactorial and consequently, so are the proposed treatments. These treatments

can be invasive, such as intrathecal drug delivery or sympathectomy, which have

poor evidence for efficacy. Thus, highlighting the need for a safe, effective, and early

intervention. We present a case of topical 5% lidocaine ointment as a non-invasive,

inexpensive and effective adjunct treatment in the management of pain in a spinal cord

injured patient presenting with early CRPS. The clinically important effect of topical

lidocaine for reducing severe allodynia allowed the patient to participate in rehabilitation

strategies to further manage the debilitating consequences of her CRPS, including

decreased range of motion (ROM) and function. The immediate pain relief from topical

lidocaine allowed the patient to tolerate physical therapy sessions directed at her

CRPS. A successful outcome was measured subjectively and objectively by our patient’s

reduction in symptoms and improvement in ROM and function, respectively. This case

study provides preliminary support for improved pain and functional outcome with early

adjunct treatment of CRPS with topical lidocaine..

Follow Link to PDF file of case report on PainPhyscian.com website where it can be downloaded for free AKL Hanlan, D Mah-Jones, PB Mills – Pain Physician, 2014