Amputation of the upper extremity due to chronic, refractory CRPS: a case report

Andrzej Żyluk

Abstract


Chronic refractory complex regional pain syndrome (CRPS) is the severest form of this condition characterised by acute pain, other painful phenomena (hyperpathia, allodynia), severe functional impairment of the affected extremity and non-responsiveness to standard treatments. This paper presents a case of a 40-year-old man suffering from this form of CRPS, in whom all treatment options, including non-standard appeared ineffective. The patient suffered from intractable pain and a completely disabled extremity was considered by him a burden, additionally affecting his daily living. After a review of the literature and informing the patient about the potential benefits and the potential risk of failure of surgery, at the request of the patient an amputation of the upper extremity was performed at the level of 1/3 distal arm. The postoperative course was uneventful, but amputation did not result in cessation of the pain which persisted in the residual limb. The presented case shows that limb amputation for chronic refractory CRPS may not give expected beneficial effect.


Keywords


chronic CRPS, resistance to therapy, limb amputation

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References


Goebel A, Barker C, Birklein F, Brunner F, Casale R, Eccleston C, et al. Standards for the diagnosis and management of complex regional pain syndrome: results of a European Pain Federation task force. Eur J Pain 2019;23(4):641-51.

Perez RS, Zollinger PE, Dijkstra PU, Thomassen-Hilgersom IL, Zuurmond WW, Rosenbrand KC, et al. Evidence based guidelines for complex regional pain syndrome type 1. BMC Neurol 2010;10:20.

Żyluk A, Mosiejczuk H. A comparison of the accuracy of two sets of diagnostic criteria in the early detection of complex regional pain syndrome following surgical treatment of distal radial fractures. J Hand Surg Eur 2013;38(6):609-15.

Żyluk A, Puchalski P. Complex regional pain syndrome: observations on diagnosis, treatment and definition of a new subgroup. J Hand Surg Eur 2013;38(6):599-606.

Żyluk A. Chronic, refractory CRPS involving 3 limbs: a case report. Handchir Mikrochir Plast Chir 2013;45(3):186-9.

Puchalski P, Żyluk A. Results of the treatment of chronic, refractory CRPS with ketamine infusions: a preliminary report. Handchir Mikrochir Plast Chir 2016;48(3):143-7.

Żyluk A, Puchalskich P. Pain control in chronic, refractory CRPS by continuous brachial plexus analgesia. Handchir Mikrochir Plast Chir 2018;50(3):190-5.

Krans-Schreuder HK, Bodde MI, Schrier E, Dijkstra PU, van den Dungen JA, den Dunnen WF, et al. Amputation for longstanding, therapy-resistant type I complex regional pain syndrome. J Bone Joint Surg Am 2012;94(24):2263-8.

Bodde MI, Dijkstra PU, Schrier E, van den Dungen JJ, den Dunnen WF, Geertzen JH. Informed decision-making regarding amputation for complex regional pain syndrome type I. J Bone Joint Surg Am 2014;96(11):930-4.

Schrier E, Dijkstra PU, Zeebregts CJ, Wolff AP, Geertzen JH. Decision making process for amputation in case of therapy resistant complex regional pain syndrome type-I in a Dutch specialist centre. Med Hypotheses 2018;121:15-20.

Midbari A, Suzan E, Adler T, Melamed E, Norman D, Vulfsons S, et al. Amputation in patients with complex regional pain syndrome: a comparative study between amputees and non-amputees with intractable disease. Bone Joint J 2016;98-B(4):548-54.

Geertzen JH, Scheper J, Schrier E, Dijkstra PU. Outcomes of amputation due to long-standing therapy-resistant complex regional pain syndrome type I. J Rehabil Med 2020;52(8):jrm00087. doi: 10.2340/16501977-2718.

Schrier E, Geertzen JH , Scheper J, Dijkstra PU. Psychosocial factors associated with poor outcomes after amputation for complex regional pain syndrome type 1. PloS One 2019;14(3):e0213589. doi: 10.1371/journal.pone.0213589.




DOI: https://doi.org/10.21164/pomjlifesci.897

Copyright (c) 2024 Andrzej Żyluk

License URL: https://creativecommons.org/licenses/by-nc-nd/3.0/pl/