Complex regional pain syndrome type I following pacemaker implantation

Abstract

A 70-year-old woman presented with burning pain and swelling over dorsum of right hand and small joints of the fingers, associated with redness, feeling of warmth, and stiffness of the fingers, with inability to bend the fingers since 2 months. The symptoms were progressively increasing in intensity for the past 1 month. There was no history of fever or trauma to the hand. Two months before her symptoms started, she had permanent pacemaker implanted for complete heart block with syncope. She was hypertensive and was on regular medication. Her X-ray of right hand showed decreased bone density (demineralisation), suggestive of osteopenia. A diagnosis of reflex sympathetic dystrophy syndrome or complex regional pain syndrome type I induced by pacemaker insertion was made. She was treated with amitriptyline and steroids, after which her symptoms improved dramatically.

Complex regional pain syndrome induced by pacemaker implantation for sick sinus syndrome

“…Although written informed consent was obtained, her mental preparedness may not have been at an adequate level prior to pacemaker implantation. Furthermore, unlike the other patients reported [2–4], the pulse generator was exchanged in our patient. The difference between the first implantation and the second procedure was the higher degree of attention paid in order to control the local pain so as to avoid the exacerbation of CRPS.…”

“…CRPS is a rare clinical entity characterized by burning pain and swelling followed by muscle atrophy, skin tightness, and joint stiffness [1]. Its induction by permanent pacemaker implantation is rare, and all known patients that have experienced CRPS following pacemaker implantation were elderly [2–4]. None of them had infection, pacemaker malfunction, or lead troubles.…”

“…A diagnosis of type 1 CRPS was made according to the current guidelines [1], after ruling out amyotrophic lateral sclerosis, myasthenia gravis, and sarcoidosis. Treatment with steroids or neurotropin was recommended [2,4]. However, she was reluctant to start drug therapy.…”

“…This syndrome can be induced by minor trauma, including via medical procedures such as venipuncture. Iatrogenic CRPS after permanent pacemaker implantation is extremely rare [2–4]. We experienced a case of type 1 CRPS induced by permanent pacemaker implantation for sick sinus syndrome (SSS).…”

Ultrasound-Guided Ropivacaine-Driven Pectoralis-Blockage 1 to avoid Significant and Severe Pain during Pacemaker-Implantation

“…The clinical meaning of this value is comparable with "moderate pain". Pain is additional stress for the patient with implanted cardiac device: The complex regional pain syndrome occurred in a few patients after pacemaker implantation [2,3] treated through steroids and neurotropin [4]. This stress may cause cardiomyopathy shortly after pacemaker implantation [5].…”