Complex Regional Pain Syndrome Presenting Similar to A Myocardial Infarction: A Case Study

Date

2019-03-05

Authors

Lee, Yein
Nguyen, Ryan
Crow, Thomas

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Abstract

Background: Complex Regional Pain Syndrome (CRPS) is a disease of chronic pain often times arising after an initial triggering event (i.e., surgery, trauma, stroke etc.) that is refractory to normal pain management. CRPS is classified into type I and type II. Type I is absent of a nerve injury, while type II has a nerve injury. Both can present with symptoms of abnormalities in skin blood flow, edema, spontaneous pain, and hyperalgesia. The current mechanism of action of this syndrome is poorly understood, however it is believed that the trigger alters the autonomic nervous system, chronically stimulating the affected region. We report a patient who has a history of a myocardial infarction that left him with chronic chest and left arm pain refractory to pain management. Case Presentation: A 50-year-old male with a history of coronary artery disease in native artery, hypertension, hyperlipidemia, obesity, diabetes, and one prior myocardial infarction presented with severe chest pain located in the middle to upper left chest region that radiated to the left arm. He states that the pain is a 10/10, sharp, and burning. The pain that radiates to his arm is debilitating. He reports similar pain in the past with marked swelling and decreased range of motion in his left upper extremity. He says he has been suffering this chronic pain associated with episodes of intense pain since his myocardial infarction. He has been to the emergency room numerous times in the past for similar symptoms, which were all negative for any acute coronary syndrome. Conclusion: CRPS Type I often arises after an inciting event without any underlying nerve damage and usually affects a patient’s extremities. Since a uniform treatment for CRPS does not currently exist, treatment is usually patient specific and varies from neuromodulation, medications, nerve blocks, physical therapy, and regional anesthesia. Treatments are aimed at reducing a patient’s pain back to their baseline. Sympathetic nerve blocks provided the best relief of symptoms for our patient. The distribution of our patient’s chronic pain closely resembles the pain pattern seen in a patient suffering from a myocardial infarction. This unique presentation can help remind physicians that we should have an open mind to all possible differentials, and that we should pay close attention to our patients’ stories and physical exam to help us provide appropriate, cost-effective care for our patients.

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