BackgroundComplex regional pain syndrome type I (CRPS I) in children is a serious condition disrupting the family and school life of patients with the condition after it fully develops. It has been emphasized that early diagnosis is closely associated with earlier reduction of pain leading to preferable outcomes.ObjectivesTo report a case of acute CRPS I in a boy who was found to develop this condition by a routine visual analog scale (VAS) pain monitoring and who recovered from CRPS I at an early phase by prompt pharmacological, physical, and educational therapies.Study designCase report.Case reportA 12-year-old boy sprained his left ankle while playing soccer and was referred to our clinic 4 days after the injury. At the first visit, he could walk, reporting motion pain with a VAS scale of 80 mm. On day 5, pain intensity increased to 100 mm, and a diagnosis of acute CRPS I was made. On day 7, he could not move the injured ankle; therefore celecoxib and pregabalin were administered, and physical and educational therapies started. On day 35, pain intensity was 0 mm and he could walk and run normally.ConclusionRoutine monitoring of VAS for every patient in pain is useful to discover an abnormal transition of VAS, enabling the early diagnosis of CRPS I. Inflammation and peripheral or central sensitization are postulated for early development of CRPS I. The present case suggested a combination of physical therapy and pharmacological intervention with celecoxib and pregabalin reduced peripheral and central sensitization.

Three types of therapies for osteoporotic back pain were investigated. [Subjects and Methods] The subjects were 51 females with back pain without vertebral fracture, who presented bone mineral densities of less than 80% of the young adult mean (YAM). The following therapies were conducted: exercise (n=4: mean age, 74.5 ± 12.2 years), osteoporosis drugs (n=21: mean age, 76.8 ± 8.4 years), and combined therapy with exercise and drugs (n=21: mean age, 77.2 ± 7.6 years). Pain intensity measured on the visual analog scale (VAS), YAM, and urinary type I collagen cross-linked N-telopeptide (uNTX) were measured at baseline and six months after the therapeutic interventions. [Results] After six months, VAS and YAM were unchanged in all of the groups, while uNTX of the combined therapy group showed a statistically significant decrease, indicating suppression of bone absorption by combined therapy. [Conclusion] The results suggest that combined therapy with exercise and osteoporosis drugs normalizes bone metabolism, resulting in a decrease in uNTX.