Clinical approach and diagnosis of the syndrome complex regional pain

Abstract

Complex regional pain syndrome (CRPS) is a debilitating pain pathology. However, the gold standard diagnostic method has not yet been defined, currently, it uses the combination of pathological history and correlated clinical signs. To overcome this limitation, it is necessary to identify laboratory or imaging tests capable of diagnosing this pathology. In this scenario, the present study describes a case report on a clinical approach and thermographic evaluation for the diagnosis of complex regional pain syndrome. Female patient, 22 years old, with intense burning pain in the back, radiating to the left upper limb, associated with paresthesia and limitation of basic activities of daily living. On physical examination, he presented pain on palpation, brushing of the left scapular region and left superior limb movement. Radiographic investigations, includ-ing MRI, did not demonstrate relevant findings. Infrared thermography revealed hyporadiation in the dorsal region, with sympathetic vasomotor hyperactivity and a typical maintenance pain pattern. Drug therapy with amitriptyline, pregabalin and lidocaine patch was started. After 30 days, the patient reported improvement in the pain, despite numbness in the subscapular region during the day and burning at night. After drug treatment, the patient in this report partially re-covered the movement and sensitivity of the limb and achieved total improvement of the pain until the present date. It can be concluded that infrared thermography represents a suitable exam for diagnostic aid and, for treatment, the association of amitriptyline, pregabalin and lidocaine patch seems to be effective in patients with CRPS.