Diffuse complex regional pain syndrome in an adolescent: A novel treatment approach

Giovanni Cucchiaro, Kevin Craig, Kerri Marks, Meghan Middleton

Research output: Contribution to journalArticle

Abstract

OBJECTIVES:: Late diagnosis and management of complex regional pain syndrome (CRPS) can have severe consequences. We report the case of a young adolescent who failed several months of medical and physical therapy for CRPS, which was initially limited to one extremity but then spread to the remaining extremities. METHODS:: At the time of admission to our hospital, she had been unable to independently perform activities of daily living for several months. We placed an epidural catheter and 2 infraclavicular catheters under general anesthesia and ran continuous infusions of local anesthetic and morphine in the epidural catheter (ropivacaine 0.1% and preservative-free morphine [20 μg/mL] at 8 mL/h) and ropivacaine 0.1% 6 mL/h in each infraclavicular catheter. RESULTS:: Patients were started intense physical, occupational, and psychotherapeutic treatments the following day. Color and temperature of extremities normalized within 10 minutes from the time of the bolus of local anesthetic through the catheters. The patient was able to walk and use her hands 48 hours after the placement of the catheters. She was weaned off opioids during her hospital stay and was discharged home 9 days after her initial admission, and was able to walk and attend to her daily living activities. DISCUSSION:: The extensive use of regional anesthesia techniques can greatly benefit patients with CRPS during the acute phase of the rehabilitation process, which includes appropriate physical, and occupational therapy and psychological interventions. It is critical to continue physical therapy and psychological support after discharge from the hospital.

Original languageEnglish (US)
JournalClinical Journal of Pain
Volume29
Issue number12
DOIs
StatePublished - Dec 1 2013
Externally publishedYes

Fingerprint

Complex Regional Pain Syndromes
Catheters
Extremities
Activities of Daily Living
Local Anesthetics
Morphine
Therapeutics
Psychology
Conduction Anesthesia
Occupational Therapy
Delayed Diagnosis
General Anesthesia
Opioid Analgesics
Length of Stay
Rehabilitation
Hand
Color
Temperature

Keywords

  • pain
  • pediatric
  • regional anesthesia

ASJC Scopus subject areas

  • Clinical Neurology
  • Anesthesiology and Pain Medicine

Cite this

Diffuse complex regional pain syndrome in an adolescent : A novel treatment approach. / Cucchiaro, Giovanni; Craig, Kevin; Marks, Kerri; Middleton, Meghan.

In: Clinical Journal of Pain, Vol. 29, No. 12, 01.12.2013.

Research output: Contribution to journalArticle

Cucchiaro, Giovanni ; Craig, Kevin ; Marks, Kerri ; Middleton, Meghan. / Diffuse complex regional pain syndrome in an adolescent : A novel treatment approach. In: Clinical Journal of Pain. 2013 ; Vol. 29, No. 12.
@article{57fdd45b966b4dbabade80cd2ce183ea,
title = "Diffuse complex regional pain syndrome in an adolescent: A novel treatment approach",
abstract = "OBJECTIVES:: Late diagnosis and management of complex regional pain syndrome (CRPS) can have severe consequences. We report the case of a young adolescent who failed several months of medical and physical therapy for CRPS, which was initially limited to one extremity but then spread to the remaining extremities. METHODS:: At the time of admission to our hospital, she had been unable to independently perform activities of daily living for several months. We placed an epidural catheter and 2 infraclavicular catheters under general anesthesia and ran continuous infusions of local anesthetic and morphine in the epidural catheter (ropivacaine 0.1{\%} and preservative-free morphine [20 μg/mL] at 8 mL/h) and ropivacaine 0.1{\%} 6 mL/h in each infraclavicular catheter. RESULTS:: Patients were started intense physical, occupational, and psychotherapeutic treatments the following day. Color and temperature of extremities normalized within 10 minutes from the time of the bolus of local anesthetic through the catheters. The patient was able to walk and use her hands 48 hours after the placement of the catheters. She was weaned off opioids during her hospital stay and was discharged home 9 days after her initial admission, and was able to walk and attend to her daily living activities. DISCUSSION:: The extensive use of regional anesthesia techniques can greatly benefit patients with CRPS during the acute phase of the rehabilitation process, which includes appropriate physical, and occupational therapy and psychological interventions. It is critical to continue physical therapy and psychological support after discharge from the hospital.",
keywords = "pain, pediatric, regional anesthesia",
author = "Giovanni Cucchiaro and Kevin Craig and Kerri Marks and Meghan Middleton",
year = "2013",
month = "12",
day = "1",
doi = "10.1097/AJP.0b013e31829d676a",
language = "English (US)",
volume = "29",
journal = "Clinical Journal of Pain",
issn = "0749-8047",
publisher = "Lippincott Williams and Wilkins",
number = "12",

}

TY - JOUR

T1 - Diffuse complex regional pain syndrome in an adolescent

T2 - A novel treatment approach

AU - Cucchiaro, Giovanni

AU - Craig, Kevin

AU - Marks, Kerri

AU - Middleton, Meghan

PY - 2013/12/1

Y1 - 2013/12/1

N2 - OBJECTIVES:: Late diagnosis and management of complex regional pain syndrome (CRPS) can have severe consequences. We report the case of a young adolescent who failed several months of medical and physical therapy for CRPS, which was initially limited to one extremity but then spread to the remaining extremities. METHODS:: At the time of admission to our hospital, she had been unable to independently perform activities of daily living for several months. We placed an epidural catheter and 2 infraclavicular catheters under general anesthesia and ran continuous infusions of local anesthetic and morphine in the epidural catheter (ropivacaine 0.1% and preservative-free morphine [20 μg/mL] at 8 mL/h) and ropivacaine 0.1% 6 mL/h in each infraclavicular catheter. RESULTS:: Patients were started intense physical, occupational, and psychotherapeutic treatments the following day. Color and temperature of extremities normalized within 10 minutes from the time of the bolus of local anesthetic through the catheters. The patient was able to walk and use her hands 48 hours after the placement of the catheters. She was weaned off opioids during her hospital stay and was discharged home 9 days after her initial admission, and was able to walk and attend to her daily living activities. DISCUSSION:: The extensive use of regional anesthesia techniques can greatly benefit patients with CRPS during the acute phase of the rehabilitation process, which includes appropriate physical, and occupational therapy and psychological interventions. It is critical to continue physical therapy and psychological support after discharge from the hospital.

AB - OBJECTIVES:: Late diagnosis and management of complex regional pain syndrome (CRPS) can have severe consequences. We report the case of a young adolescent who failed several months of medical and physical therapy for CRPS, which was initially limited to one extremity but then spread to the remaining extremities. METHODS:: At the time of admission to our hospital, she had been unable to independently perform activities of daily living for several months. We placed an epidural catheter and 2 infraclavicular catheters under general anesthesia and ran continuous infusions of local anesthetic and morphine in the epidural catheter (ropivacaine 0.1% and preservative-free morphine [20 μg/mL] at 8 mL/h) and ropivacaine 0.1% 6 mL/h in each infraclavicular catheter. RESULTS:: Patients were started intense physical, occupational, and psychotherapeutic treatments the following day. Color and temperature of extremities normalized within 10 minutes from the time of the bolus of local anesthetic through the catheters. The patient was able to walk and use her hands 48 hours after the placement of the catheters. She was weaned off opioids during her hospital stay and was discharged home 9 days after her initial admission, and was able to walk and attend to her daily living activities. DISCUSSION:: The extensive use of regional anesthesia techniques can greatly benefit patients with CRPS during the acute phase of the rehabilitation process, which includes appropriate physical, and occupational therapy and psychological interventions. It is critical to continue physical therapy and psychological support after discharge from the hospital.

KW - pain

KW - pediatric

KW - regional anesthesia

UR - http://www.scopus.com/inward/record.url?scp=84887817378&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=84887817378&partnerID=8YFLogxK

U2 - 10.1097/AJP.0b013e31829d676a

DO - 10.1097/AJP.0b013e31829d676a

M3 - Article

C2 - 23823251

AN - SCOPUS:84887817378

VL - 29

JO - Clinical Journal of Pain

JF - Clinical Journal of Pain

SN - 0749-8047

IS - 12

ER -