Simultaneous upper and lower extremity complex regional pain syndrome type I in tetraplegia

Abstract

Study design: Clinical case report. Objectives: To present the first case of incomplete tetraplegic spinal cord injury (SCI) in which complex regional pain syndrome (CRPS) type I was present in all four of the patient's extremities. Setting: Ankara Physical Medicine and Rehabilitation Education and Research Hospital, Ankara, Turkey. Methods: A 49-year-old man with incomplete tetraplegia (American Spinal Injury Association (ASIA) C) was admitted to our clinic for rehabilitation. According to the patient's history, pain and edema began in his right foot 1 1 2 months after his injury. After 10 days later the same symptoms appeared in his left foot as well. In the third week after pain and edema appeared in the right foot, these were also observed in both hands, markedly in the left. Results: Three-phase bone scan images supported a diagnosis of stage 3 CRPS type I in all four extremities. After the diagnosis was made, passive range of motion (PROM) exercises were started. Transcutaneous electrical nerve stimulation and whirlpool sessions were used for pain and edema control. Drug therapy included Calcitonin, Naproxen sodium and Amitriptyline. After 6 weeks of treatment, the patient's visual analog scale pain score had decreased to 38 mm from an initial score of 85 mm at the onset of the treatment, and PROM of wrists/hands, fingers and ankles had become full and painless. Conclusion: We conclude that CRPS type I might be more common in SCI than is usually suspected, and that tetraplegic patients should be carefully evaluated for the presence of CRPS type I in upper and lower extremities.Spinal Cord (2005) 43, 568-572.

Effect and mechanisms of exercise for complex regional pain syndrome

“…In addition, the characteristics of capricious symptom, difficult diagnosis, and refractory of CRPS indicate the need for the matched graded multi-professional care. Some complementary treatments such as medications, transcutaneous electrical nerve stimulation ( Sutbeyaz et al, 2005 ; Anandkumar and Manivasagam, 2014 ; Bilgili et al, 2016 ), acupuncture ( Peng et al, 2018 ), and manual lymphatic drainage ( Duman et al, 2009 ), have also shown great effect to improve pain and oedema in combination with exercise therapy ( Melf-Marzi et al, 2022 ). Given the comprehensive search, we found a lack of sufficient high- quality clinical studies about CRPS to carry out deeper analyses, which is one of the limitations of this study.…”

The effectiveness of whirlpool for patients with neuropathic pain due to knee osteoarthritis

“…In these studies the effect of whirlpool was explained by that whirlpool bath treatment improves regional perfusion, and nutrition; with this the oxygenation to the tissues increases and the skin softens. So as a result, pain and edema reduces and range of motion improves [37,38]. In a study the effects of a warm whirlpool bath on pain and stiffness of 44 patients with chronic stroke induced knee OA were evaluated and whirlpool was found beneficial for patients with chronic stroke induced knee OA [39].…”

The effects of whirlpool bath and neuromuscular electrical stimulation on complex regional pain syndrome

“…Whirlpool, a physiotherapy modality, is one treatment option 20 ) . Clinical studies have shown that whirlpool bath treatment improves regional perfusion, nutrition, and oxygen to the tissues, and softens the skin; as a result, it is used to reduce pain and edema in CRPS 21 , 22 ) . A previous study conducted of whirlpool treatment also revealed an analgesic effect 23 ) .…”