Trauma-induced Complex Regional Pain Syndrome Type II on Upper and Lower Limbs: Case Report and Literature Review

The 46-year-old female patient, a drug addict, was referred to pain clinic with a complex regional pain syndrome (CRPS) of the upper and lower limbs. She developed a CRPS due to an episode of falling down in the bathroom after hypnotic drug overdose, and resulted in long time compression of right brachial plexus and right femoral nerve. She had progressive pain in spite of medical treatment (NSAID, Gabapentin). In addition to pain, she also showed the typical autonomic symptoms like edema, disturbances of skin color and temperature and a severely limited motility of right upper and lower limbs. The clinical symptoms of CRPS type Ⅱ is identical and not restricted to the peripheral nerve distribution. The sympathetic nerve system is not only involved in the pain mechanism with reflectory processes in the segment and with the sympathetic afferent coupling, it also takes part in the neuroplasticity and in the neurogenic inflammation. The logical therapeutic intervention is therefore to normalize the hyperactivity of the sympathetic nerve systems with local anesthetics and steroid. This regulation is done with injections to the stellate ganglion and the lumbar sympathetic trunk. Repeated injections to the stellate ganglion and the lumbar sympathetic trunk caused immediate improvement of pain and allowed the patient to receive early physical therapy and range-of-motion exercises.