Department of Anesthesiology and Perioperative Medicine, Mayo Clinic, Rochester, MN, USA.
Department of Anesthesiology and Perioperative Medicine, Division of Pain Medicine, Mayo Clinic, Rochester, MN, USA.
J Med Case Rep. 2022 Jun 27;16(1):251. doi: 10.1186/s13256-022-03466-9.
Complex regional pain syndrome is a chronic pain condition characterized by autonomic dysfunction, changes in sympathetic and vasomotor activity, and sensory and motor changes. Complex regional pain syndrome is a clinical diagnosis and may occur after trauma or surgery. Complex regional pain syndrome-related pain may occur spontaneously and is out of proportion with the inciting event. We report herein the rare case of a man who developed concomitant painful generalized ulcerations after diagnosis of complex regional pain syndrome.
A 43-year-old Caucasian male with history of four-extremity complex regional pain syndrome type 2 secondary to right rotator cuff surgery performed at an outside hospital presented to a tertiary care center for treatment of generalized ulcerations on all extremities of unknown etiology. Dermatology performed an extensive work-up including laboratory evaluations and biopsies, which were relatively unremarkable. His ulcers were treated with vinegar-based dressings, hydrotherapy, and irrigation and debridements. He was started on methadone (replacing a home fentanyl patch), ketamine infusion, and amitriptyline in addition to his home adjuncts. He obtained good symptom control, improved sleep, and diminished cognitive slowing, compared with his fentanyl patches.
This case report emphasizes an atypical case of generalized ulceration formation in the setting of complex regional pain syndrome. This case highlights the challenging nature of treating complex regional pain syndrome and using multimodal analgesia to target various nociceptive receptors to successfully reduce symptoms.
复杂性区域疼痛综合征是一种慢性疼痛疾病，其特征为自主神经功能障碍、交感神经和血管运动活动改变以及感觉和运动变化。复杂性区域疼痛综合征是一种临床诊断，可能在创伤或手术后发生。复杂性区域疼痛综合征相关的疼痛可能自发发生，且与激发事件不成比例。我们在此报告一例罕见病例，一名男性在诊断为复杂性区域疼痛综合征后同时出现疼痛性全身性溃疡。
一名 43 岁的白人男性，既往有四肢复杂性区域疼痛综合征 2 型病史，继发于在一家外院进行的右肩袖手术。他因四肢原因不明的全身性溃疡就诊于一家三级护理中心。皮肤科进行了广泛的检查，包括实验室评估和活检，但结果相对无明显异常。他的溃疡采用基于醋的敷料、水疗、冲洗和清创进行治疗。除了使用家用芬太尼贴片外，他还开始使用美沙酮（替代家用芬太尼贴片）、氯胺酮输注和阿米替林。与芬太尼贴片相比，他的症状得到了很好的控制，睡眠得到了改善，认知迟钝也有所减轻。
本病例报告强调了复杂性区域疼痛综合征背景下全身性溃疡形成的非典型病例。本病例突出了治疗复杂性区域疼痛综合征和使用多模式镇痛以靶向各种伤害感受器以成功减轻症状的挑战性。
