Efficacy of peripheral nerve block and rehabilitation combined with psychological and social support for intractable pain management in a pediatric patient with complex regional pain syndrome

Abstract

We report the successful management of intractable pain in a pediatric patient with complex regional pain syndrome (CRPS) using peripheral nerve block and rehabilitation combined with psychological and social support. A 13-year-old girl underwent cast immobilization for ligament rupture of the right ankle. She did not visit the hospital for 3 months until removal of the cast. Three months after cast removal, she visited the previous hospital because of intractable pain with swelling and motility disorder. She was diagnosed with CRPS and referred to our hospital given the inability to undergo rehabilitation from the intractable pain. Continuous lumbar epidural block failed as a result of displacement during rehabilitation. We performed ultrasound-guided continuous sciatic nerve block and great saphenous nerve block, which controlled the pain and enabled her to undergo rehabilitation. We also performed psychological and social support with her family and teachers. Our findings suggest that peripheral nerve block may be effective for intractable pediatric CRPS.