Clinical experience and therapeutic options in a patient with complex regional pain syndrome type I and multiple drug intolerance

Abstract presented at the 45° AISD Congress 2022

Lucia Muraca¹, Roberta Roberti², Gianmarco Marciano'², Alessandro Casarella², Vincenzo Rania¹, Caterina Palleria³, Rita Citraro⁴, Pietro Romeo⁵, Giovambattista De Sarro², Luca Gallelli²

(1) Department of Health Science, School of Medicine, University of Catanzaro, 88100 Catanzaro, Italy, (2) 1Department of Health Science, School of Medicine, University of Catanzaro, 88100 Catanzaro, Italy, (3) 2Operative Unit of Clinical Pharmacology and Pharmacovigilance, Mater Domini Hospital, 88100 Catanzaro, Italy, (4) 4Research Center FAS@UMG, Department of Health Science, School of Medicine, University of Catanzaro, 88100 Catanzaro, Italy, (5) 5Department of Orthopedics, Istituto di Ricovero E Cura A Carattere Scientifico, Istituto Ortopedico Galeazzi, 20123 Milan, Italy

Background: Complex regional pain syndrome (CRPS) is a painful chronic neurologic condition that impacts on quality of life [1]. CRPS typically develops in a distal extremity after acute injury (mainly trauma and surgery), although a small percentage of patients may have no inciting events [2]. CRPS is confined to a body region and characterized by continuing pain that has no dermatomal distribution and is disproportionate to any inciting event, together with sensory (hyperalgesia and/or allodynia) vasomotor, sudomotor, motor/trophic signs and symptoms [3,4]. Based on the absence or presence of a specific nerve lesion, it can be classified into two different subtypes: CRPS I and CRPS II, respectively [1]. We report the treatment of CRPS in an elderly woman with multiple drug intolerance

Methods: A 69-years old Caucasian female patient (weight 65kg, height 170cm, BMI 22.49) comes to our attention for a 3-years history of severe burning pain in her right ankle along with oedema and alternating periods of colour changes (reddish or bluish) and/or temperature. Since the onset of these symptoms, which occurred after an ankle sprain, she reported being limited in work and activities of daily living. The severity of her pain was 10/10 on a numeric rating scale (NRS), with an impossibility to tolerate any mechanical stimulation, including sensory stimulation from clothing or blankets. She also reported impaired sleep, mainly difficulties in falling asleep. A diagnosis of CRPS type I was performed two years later, and anti-inflammatory drugs (both steroidal and non-steroidal) were prescribed with the development of adverse drug reactions (ADRs). Neridronate 100 mg every 3 days, was prescribed with the development of ADRs. Different efforts with physiotherapy (mainly with TECAR therapy), also failed to relieve pain.

After these treatments, she came to our attention where a new clinical examination confirmed the CRPS type I diagnosis, and a weekly diamagnetic therapy protocol was started since the patient refused further medications and interventional procedures. During each weekly session lasting 25 minutes, the treatment was carried out with the diamagnetic pump (CTU MEGA 20®-Periso SA. Pazzallo-Switzerland). Magnetic flux density was 86 mT at the site of treatment. Before each treatment, we evaluated the pain intensity and the presence of tissues’ oedema through the NRS score and the measurement of the ankles’ circumference, respectively.

Results: After 10 weeks of treatment, we documented a significant (P<0.01) reduction in pain severity (NRS: 2/10) and the absence of oedema, with an improvement in both qualities of life and sleep. No adverse events were reported during the treatment.

Conclusion: we described the effect of diamagnetic therapy on CRPS, in an elderly woman with multiple drug intolerance. Although high-quality clinical evidence is still lacking, our case report suggests that diamagnetic therapy could be a potential non-invasive and safe adjunctive treatment for CRPS, also offering a useful alternative for patients who did not benefit from drugs and/or refuse invasive procedures.

References

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