Complex Regional Pain Syndrome following ankle fracture
Introduction
I reviewed a 43 year old lady in the Pain Clinic. She had had an open reduction and internal fixation of a right ankle fracture in Portugal in 1986 and later had the metalwork removed. She then had an abscess on the medial side of the right ankle, which was drained.
Examination findings
She was seen in the Pain Clinic complaining of right medial ankle pain. On examination there was an increase in light touch and pinprick sensation and overall, the area was markedly sensitive. She also mentioned swelling in the right ankle and skin discolouration.
Diagnosis of Complex Regional Pain Syndrome (CRPS)
My impression was that this lady had a local area of neuropathic pain, most likely complex regional pain syndrome. She was given a long and frank discussion about the nature of neuropathic pain and was started on Pregabalin 75 mg twice per day for 2 weeks followed by an increased dose. She was also put on the list for a chemical lumbar sympathectomy.
Medication for Complex Regional Pain Syndrome (CRPS)
She was reviewed 4 weeks later. She found the initial dose of the Pregabalin to be extremely helpful but unfortunately, when she went to the higher dose, she got increasing adverse effects including feeling tired, drowsy and dizzy. She also found that on the lower dose, although extremely helpful, at around 4 pm she started to get more pain. She was therefore put on a regime of Pregabalin 75 mg am, 25 mg lunchtime and 75 mg pm. She will be reviewed in the clinic in approximately 2 months time. Otherwise, she is extremely pleased with the benefit that she has received from this medication and is able to get on with her normal daily activities.
