Abstract

Complex regional pain syndrome (CRPS), formerly known as Sudeck’s syndrome, is a disabling and distressing pain syndrome. First described almost 150 years ago, CRPS sti ll remains a medical chal lenge today, being characterized by chronicity and relapses that can result in significant disability over time. The overall incidence in Estonia is unknown, but women tend to be affected more frequently than men. The CRPS may develop following fractures, traumas or lesions of the peripheral or central nervous system. The clinical picture presents a characteristic clinical triad of symptoms including autonomic (disturbances of skin temperature and colour, presence of sweating abnormalities), sensory (pain and hyperalgesia), and motor (paresis, tremor, dystonia) disturbances. Diagnosis is mainly based on clinical signs. Several pathophysiological concepts have been proposed to explain the complex symptoms of CRPS: (a) facilitated neurogenic inf lammation; (b) pathological sympatho-afferent coupling; (c) neuroplastic changes within the central nervous system. There is accumulating evidence that genetic factors may predispose for CRPS. Complex regional pain syndrome is a rule-out diagnosis. Although many different therapies have been used over time, there is still no „best treatment“.

The goal of this paper was to give an overview of the essence of CRPS and its clinical expression on the basis of a case report. The case involves a 51-year-old female patient who had had pain in the ankle joints, oedema and burning pain on her feet, also a moderate inflammatory activity in blood samples for over 4 years after injuring her left ankle joint during aerobics training. In April 2011 an MRI was performed from the left foot, which revealed petechial bone oedema and oedema of periarticular tissues with presence of f luid in peritendinous spaces. The radiologist suggested that the image could match Sudeck’s syndrome. The patient was hospitalized to Tartu University Hospital in July 2011. Analyses showed a moderate increase in the CRP (C-reactive protein), WBC (white blood cel l count) and ESR (erythrocyte sedimentation rate) indices. The clinical diagnosis was complex regional pain syndrome; treatment with intravenous biphosphonate (90mg Pamidronate) was started. Two days after the infusion the pain disappeared, oedema became smaller and the blood samples normalized. In April 2012 the patient continued with an oral biphosphonate and now she is doing well.

The current case report presents a patient with CRPS, which was the cause of her complaints.