Reactivation of Complex Regional Pain Syndrome (CRPS)
Type I after Venipuncture: A Case Report
Majid Saleem, MD, Ahmed H. Ghaleb, MD, Carmelita S. Pablo, MD
Dept. of Anesthesiology, Univ. of Arkansas for Medical Sciences, Little Rock, Arkansas

INTRODUCTION:
Complex Regional Pain Syndromes (CRPS) I and II are significant health problems in US with high rate of treatment failure. The pathophysiology and natural course of CPRS remains obscure and management contentious. We report a case of recurrence of CRPS in patient with history of CRPS I, after venipuncture in the affected extremity.
CASE REPORT:
Patient is a 67 year old female with known CRPS type I after left lower extremity fracture about nine years ago, who had multiple (13) lumbar sympathetic block done with complete resolution of symptoms. Patient presented this time with pain in the left lower extremity, alloying, hyperalgesia and swelling. Pt underwent multiple lumbar sympathetic blocks with eventually complete relief of pain. Pt was seen again after 3 months, with symptomatologyy of CRPS. This started after a peripheral venous catheter placed during
work-up of chest pain. Now patient has pain, allodynia, paresthesia and swelling of left lower extremity. Patient underwent multiple lumbar sympathetic blocks with only partial relief of symptmatology.
DISCUSSION:
The features of CRPS type I include an initiating noxious event or immobilization, allodynia or hyperalgesia with pain disproportionate to any inciting event, presence of edema, vasomotor and sudomotor changes. CRPS II shares the same symptomatology of CRPS I but follows an injury to a peripheral nerve. Studies suggest a 4–10% recurrence of CRPS after the first event. The onset of CRPS is usually associated with a history of trauma, surgery, or immobilization. There is no correlation between the severity of the initial injury and the ensuing painful syndrome.4 In the United States, physicians perform approximately 43,000 sympathetic nerve blocks per year for the treatment of pain. Only some patients with nerve injury or CRPS respond to sympathetic nerve blockade. Patients pain can be defined as “sympathetically mediated” or “sympathetically independent” according to their response
to temporary sympathetic nerve block. Staging of the disease presents a critical window of opportunity for optimal therapeutic results. Therefore, it is commonly advocated that a limited trial of interventions that interrupt sympathetic function should be instituted early in the course of CRPS.
CONCLUSION:
CRPS has been reported following various nerve injuries and trivial procedures. However caution must be exercised in those situations. Can CRPS reactivate following a venipuncture or intramuscular injections, every physician should be aware of the possibility. Prompt diagnosis and treatment might go a long a way in alleviating this dreadful and debilitating complication. Patients should be educated about not having any needle sticks on the affected extremity. They could wear arm/neck bracelet or keep a warning card that
specifies that no trauma of any kind to that extremity.
REFFERENCES:

1. SN Raja et al. CRPS I. Anesthesiology 2002; 96.

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