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Case Studies in Pain Management: Complex Regional Pain
Complex Regional Pain
Patient history
Treatment plan
provided dramatic pain relief. This permit- The last thing this 55-year-old female real- ted the patient to tolerate well the occu- to provide this patient desperately needed pational therapy of her hand; it took only carpal tunnel-release surgery was a seri- respite from the pain but also to end the three weeks of modalities and exercise to ous complication. Yet that is precisely what pain relief roller-coaster upon which she restore the hand to near-normal function found herself because of the short-acting medications being taken. Both objectives Discussion
reddened, almost completely dysfunctional patient’s medications to provide continu- This patient was fortunate in that her RSD The referring physician prescribed short- ous, 24-hour pain relief. Further, in so doing, If intervention is started within the first lets. He also wrapped her hand in a cast in enough to tolerate occupational hand ther- chances of achieving a complete cure are an ill-advised attempt to force extension of apy – something she required in order to the fingers, which had locked into a balled- restore function to the involved appendage.
being able to cure RSD drop to near zero. Accordingly, we switched the patient’s principal medication to a once-a-day, 120- Case description
patient at that stage is to provide pain man- agement. In truth, it is rare for RSD to be signs of improvement, the patient’s ortho- instructed the patient to only use those for pedic surgeon referred her to us for help believed the patient would benefit from tak- given enough time and pain-relief medica- The patient’s history and results of physi- ing duloxetine, a very effective combination tion, the problem will resolve on its own.
cal examination led us to suspect a form mood stabilizer and nerve pain medication, We issued our no-casting order to the hand and so we prescribed that for her as well.
specialist for the reason that molding a shell as reflex sympathetic dystrophy – RSD for Then, three days after beginning the new short. To begin the process of confirming medication regimen, the patient was started of the worst possible actions that can be this suspicion, we ordered a triple-phase on a therapeutic stellate ganglion blockade taken: Immobilization causes sympathetic of 0.25% bupivicaine (dosage 10 cc), after nerve outflow to increase, causing exacer- positive for RSD. However, a positive triple- which we sent her to see a hand-specialized phase bone scan by itself is not conclusive. occupational therapist to help desensitize To validate it, we then diagnostically admin- the involved hand. Strict orders were given istered stellate ganglion blockade injec- to the hand specialist to not use casting.
tions. The patient reported substantial pain relief in her hand immediately afterward. Taken together, these results all pointed with the morphine sulfate and duloxetine Call 225-368-2300 today to schedule your preferred appointment time.
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Sandra R. Weitz, MD Elizabeth Russo-Stringer, MD Alpesh D. Patel, MD 225-368-2300 |
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