We report a case of intractable complex regional pain syndrome (CRPS). The pain improved with regional anesthesia and physical therapy.
A 24-year-old man with hemophilia A, developed throbbing pain from his left foot to the ankle, with no identifiable cause. No organic abnormalities were observed. He diagnosed with CRPS at the pain clinic and admitted to the hospital 10 months after symptom onset for physical therapy with regional anesthesia under clotting factor replacement therapy. Spinal anesthesia was administered on the first and second day of hospitalization, and plantar load stimulation and ankle stretching were performed in the operating room. Subsequently, sciatic nerve blocks and continuous epidural blocks were given, and plantar contact training, ankle joint ROM training, and parallel bar walking training were conducted with cognitive behavioral therapy. Sciatic nerve blocks were continued after discharge. Ninety-five days after onset, the patient was re-admitted for physical therapy, and ROM exercises, partial weight bearing, and gait training together with sciatic nerve blocks and cognitive-behavioral therapy. On discharge following re-admission, the pain improved. The patient walked using one crutch. One year later, the pain further improved, and the patient walked independently.
The combination of regional anesthesia, physical therapy, and cognitive behavioral therapy created a virtuous cycle of pain relief, improved physical functions, and prevented withdrawal from catastrophizing, ultimately leading to overall improvement.
