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Complex regional pain syndrome CRPS


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Olomi and Munthali BMC Musculoskeletal Disorders (2024) 25:278 https://doi.org/10.1186/s12891-024-07333-0
CASE REPORT
BMC Musculoskeletal Disorders
Open Access
Complex regional pain syndrome: diagnostic challenges and favorable response
to prednisolone
Jimmy Olomi1,3* and Victoria Munthali2
Abstract
Complex regional pain syndrome (CRPS), characterized by severe and disproportionate pain, is a rare and debilitating condition. Due to its rarity, evidence-based treatment guidelines remain limited, creating a challenge for clinicians. We present the case of a 20-year-old female with CRPS type 1 of the right hand. Her pain, initially triggered by a minor trauma, had persisted for three months. The patient demonstrated severe pain, swelling, hyperesthesia, and restricted range of motion. Despite multiple hospital visits, her symptoms did not improve until she was diagnosed with CRPS and treated with oral prednisolone. A dosage of 40 mg daily led to a dramatic response within 10 days. Our report emphasizes the importance of recognizing CRPS and highlights the potential of prednisolone as a treatment option, particularly in resource-limited settings, where more specialized interventions may be unavailable. Further research is essential to establish a stronger evidence base for the use of steroids in CRPS management.
Keywords CRPS, Complex regional pain syndrome, Chronic pain, Hand swelling, Unilateral hand swelling, Limb swelling
Introduction
Complex regional pain syndrome (CRPS) was a name adopted by the International Association for the Study of Pain (IASP) in 1994 to describe a chronic and disabling condition that mainly affects extremities.
Over the years, its definition and diagnosis criteria have been changing; however, the widely accepted definition is that “CRPS describes an array of painful conditions that are characterized by a continuing (spontaneous and/or evoked) regional pain that is seemingly disproportionate
*Correspondence:
Jimmy Olomi
olomijimmy@gmail.com
1University of Dar es salaam (UDSM), P.O. Box 608, Mbeya, Tanzania 2Muhimbili Orthopedic Institute (MOI), P.O. Box 65474, Dar es salaam, Tanzania
3Mbeya zonal referral hospital (MZRH), P.O. Box 419, Mbeya, Tanzania
in time or degree to the usual course of any known trauma or other lesion”. The pain is regional (not in a specific nerve territory or dermatome) and usually has a distal predominance of abnormal sensory, motor, sudomotor, vasomotor, and/or trophic findings. The syndrome shows variable progression over time [1].
CRPS is a rare entity with an incidence of 5.4–26.2 per 100 000 person years [2], affecting more females (4:1) and upper limbs [3].
In this paper, we report a patient who responded well to steroid therapy and hope to remind clinicians of the disease and support the use of steroids in the case of lim- ited resources for the use of interventional therapies.
Case report
We describe a case of a 20-year-old female who sought medical attention due to severe and persistent right-hand
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