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Pain and Spine Medicine

Complex Regional Pain Syndrome- Role of Oral Corticosteroid: A Case Report

(Kiosk 5) Complex Regional Pain Syndrome- role of Oral Corticosteroid: A Case Report

Thursday, November 16, 2023
12:45 PM – 2:15 PM CT
Case Diagnosis: Complex Regional Pain Syndrome Secondary to CVA.

Case Description or Program Description: 79-year-old male with history of hypertension and coronary artery disease presented with a transient episode of slurred speech. Several days later, he developed right-sided weakness, aphasia, and facial droop. An initial CT scan of the head showed no acute infarction. However, repeat CT showed acute infarcts in the left middle cerebral artery and the left anterior cerebral artery. In the rehabilitation unit, the patient initially complained of right shoulder pain. Several days later the patient began developing allodynia in his right hand and wrist leading to a diagnosis of complex regional pain syndrome (CRPS).

Setting: Acute Inpatient Rehabilitation Facility

Assessment/Results: Initially the patient could not move his right arm and had a strength of 0/5. Pain was rated 9/10 in the shoulder and 7/10 in the wrist. The patient was started on a tapering prednisone dose for 6 days, starting with 60 mg and finishing with 10 mg. Following the initiation of the prednisone taper, the patient had rapid improvement in pain, having 3/10 pain in shoulder and 0/10 pain in wrist. Trace movement was also noted in his right upper extremity with a strength of 1 out of 5.

Discussion (relevance): The prevalence of CRPS post-stroke ranges from 12.5-50%, making this a challenging condition affecting many patients. Due to a lack of agreement in diagnostic criteria, it has been a difficult condition to diagnose and treat. While a multidisciplinary approach is crucial, pharmacological treatments are also essential. While NSAIDs, gabapentin, bisphosphonates are some drugs considered to treat CRPS, some studies have also suggested using corticosteroids to treat acute CRPS. In our case, patient had significant improvement in pain within days after starting the prednisone therapy.

Conclusions: Our case further highlights the potential role of corticosteroids in treating acute CRPS.