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Effectiveness of perampanel in managing chronic pain caused by the complex regional pain syndrome: A case report
This report describes a patient with complex regional pain syndrome (CRPS) type I in the right lower leg and foot who responded well to perampanel, an AMPA receptor antagonist, for managing the chronic pain. Patient concern: A 61-year-old woman complained of pain in her right lower leg and foot over a period of 7 year (numeric rating scale: 8) due to CRPS type I. Diagnosis: CRPS type 1. Interventions: Despite the combination of 300 mg pregabalin, 225 mg/1950 mg tramadol/acetaminophen, and 10 mg nortriptyline per day, her right lower leg and foot were nearly disabled due to the severity of the p...
Source: Medicine - December 3, 2021 Category: Internal Medicine Tags: Research Article: Clinical Case Report Source Type: research

Dramatic effect in passive ROM exercise under sedation in a patient with intractable complex regional pain syndrome (type I): A case report
Rationale: Complex regional pain syndrome (CRPS) usually occurs after trauma and surgery but can also occur spontaneously. There are various known pathophysiology and treatment protocols for CRPS. However, there is no established treatment guideline. Although physical therapy is known as the first line treatment for CRPS, performing physical therapy is difficult due to severe pain. This case reports the first case with positive effect of physical therapy under sedation that allowed early physical therapy. Patient concerns: A 19-year old female had her right elbow area slightly hit by someone else, after which it began...
Source: Medicine - March 1, 2019 Category: Internal Medicine Tags: Research Article: Clinical Case Report Source Type: research

Spinal epidural abscess associated with an epidural catheter in a woman with complex regional pain syndrome and selective IgG3 deficiency: A case report
Rationale: Continuous epidural infusion of local anesthetic may be an alternative to sympathetic blocks in refractory cases of complex regional pain syndrome (CRPS). Spinal epidural abscess (SEA) is a well-known complication associated with this technique, especially in patients with immune deficiencies. We herewith report a cervical SEA associated with an epidural catheter in a woman with CRPS and selective IgG3 subclass deficiency. Patient concerns: Severe pain interfering with activities of daily living. Diagnosis: Complex regional pain syndrome type-1 with involvement of upper extremity. Interventions: The p...
Source: Medicine - December 1, 2018 Category: Internal Medicine Tags: Research Article: Clinical Case Report Source Type: research

Management of chronic pain in Ehlers–Danlos syndrome: Two case reports and a review of literature
Rationale: Ehlers–Danlos syndromes (EDSs) are a heterogeneous group of heritable connective tissue disorders involving defective collagen synthesis. Patients with EDS are prone for chronic myofascial pain, apart from other comorbidities. Although the initial pathology is commonly nociceptive, progression of EDS leads to neuropathies and central sensitization of pain signals. Overall, approximately 90% or more EDS patients suffer from chronic pain. There are no existing guidelines to manage chronic pain in EDS patients. In this article, we illustrate 2 case reports of EDS patients with chronic pain and review the releva...
Source: Medicine - November 1, 2018 Category: Internal Medicine Tags: Research Article: Clinical Case Report Source Type: research

Extrapyramidal signs occurring after sympathetic block for complex regional pain syndrome responding to diphenhydramine: Two case reports
We report a video case reports of two patients with a diagnosis of CRPS type-I. Both patients exhibited similar presentation of unusual extrapyramidal motor response of the affected limb following lumbar sympathetic block. Both patients were treated with intravenous diphenhydramine to abort the extrapyramidal motor response. Outcomes: Both patients similarly responded to treatment with intravenous diphenhydramine with abrupt resolution of the motor response. Lessons: Sympathetic blockade may interfere with the adaptive autonomic reflex circuits of the motor balance homeostasis in patients with complex regional pain s...
Source: Medicine - June 1, 2018 Category: Internal Medicine Tags: Research Article: Clinical Case Report Source Type: research

Complex regional pain syndrome type II after cervical transforaminal epidural injection: A case report
We report a case of a 61-year-old patient who developed complex regional pain syndrome (CRPS) type II after a cervical transforaminal epidural steroid injection (CTESI). Patient concerns: The patient developed sudden-onset severe pain and swelling of his upper right limb after a cervical transforaminal epidural injection. Diagnoses: On physical examination, the patient's symptoms and signs corresponded to the Budapest criteria for CRPS. Cervical magnetic resonance imaging and laboratory tests were performed to rule out other causes. An electrodiagnostic study revealed right C6/7 radiculopathies. A three-phase bone sc...
Source: Medicine - May 1, 2018 Category: Internal Medicine Tags: Research Article: Clinical Case Report Source Type: research

Sacral epiduroscopic laser decompression for complex regional pain syndrome after lumbar spinal surgery: A case report
We present a case report of a 31-year-old female with CRPS symptoms after lumbar spinal surgery treated by performing SELD. Patient concerns: This patient was referred to our pain clinic for left ankle pain. She received a lumbar discectomy for a herniated lumbar disc (L5/S1) but the pain was aggravated after surgery. Diagnoses: The characteristics of the pain were burning, tingling, and cold, and were accompanied by other symptoms such as swelling, color change and mail dystrophy. The patient was diagnosed with CRPS. Interventions: Medications and interventional therapies were not effective in reducing pain. SELD...
Source: Medicine - May 1, 2018 Category: Internal Medicine Tags: Research Article: Clinical Case Report Source Type: research

Restoration of the corticoreticular pathway following shunt operation for hydrocephalus in a stroke patient
We report on a stroke patient who showed restoration of discontinued corticoreticular pathways (CRPs) on serial diffusion tensor tractography (DTT) concurrent with recovery of gait disturbance following shunt operation for hydrocephalus.Patient concerns:A 67-year-old female patient underwent stereotactic drainage for management of intraventricular hemorrhage due to a rupture of the left posterior communicating artery.Diagnoses:After 4 weeks from onset, the patient exhibited quadriparesis with more severe weakness in the proximal muscles and could not even stand or walk. She underwent comprehensive rehabilitation for 3 week...
Source: Medicine - January 1, 2018 Category: Internal Medicine Tags: Research Article: Clinical Case Report Source Type: research

Pramipexole-induced limb dystonia and its associated complex regional pain syndrome in idiopathic Parkinson's disease: A case report
Rationale: This case may be due to basal ganglia dysfunction, which was probably caused by abnormal activation of dopamine 1-like receptor (D1R) boosted by pramipexole binding on dopamine 3-like receptor (D3R) in a situation where D3R was overexpressed by the chronic treatment of L-dopa. Patient concerns: Striatal hand and foot deformities. Diagnoses: Striatal hand and foot deformities with CRPS. Interventions: Steroid treatemnt and withdrawal of the pramipexole. Outcomes: Recovered significantly. Lessons: Since the degree of overexpression of D3R is increased in a high dose of pramipexole, for patients with PD who ar...
Source: Medicine - July 1, 2017 Category: Internal Medicine Tags: Research Article: Clinical Case Report Source Type: research

Using concept mapping as a planning tool: Child welfare citizen review panels
This study reports on the use of Concept Mapping (CM) to outline a framework for planning and subsequently evaluating the CRP in one southeastern state. CM is a mixed-method research approach that uses multi-dimensional scaling and hierarchical cluster analyses to explore an area of study. Through these analyses, the method creates visual depictions of conceptual relationships between ideas. Data yielded a seven cluster concept map that CRP members (N=36) utilized for planning processes, and subsequently for developing an internal evaluation tool. Results from this study offer a unifying framework by which CRPs, and simila...
Source: Evaluation and Program Planning - August 11, 2015 Category: Global & Universal Source Type: research

Nerve resection for the treatment of chronic neuropathic pain
When empirical observations fly in the face of prior knowledge, it is likely that there are lessons to be learned. Peter Watson and coauthors report in this issue of PAIN® a case of a young woman with chronic debilitating complex regional pain syndrome (CRPS) 2 resulting from traumatic nerve injury in the ankle, exacerbated by a subsequent orthopedic procedure. Typical of CRPS, the pain spread beyond the ankle, resulting in severe burning pain and tactile allodynia on most of the lower leg. A variety of pharmacologic, physical, and psychological therapies failed to relieve the pain. After 13years of suffering by the patie...
Source: Pain - February 24, 2014 Category: Anesthesiology Authors: Marshall Devor, Michael Tal Tags: Commentaries Source Type: research

How Policy Makers Can Smooth The Way For Communication-And- Resolution Programs Communicating About Errors
Communication-and-resolution programs (CRPs) in health care organizations seek to identify medical injuries promptly; ensure that they are disclosed to patients compassionately; pursue timely resolution through patient engagement, explanation, and, where appropriate, apology and compensation; and use lessons learned to improve patient safety. CRPs have existed for years, but they are being tested in new settings and primed for broad implementation through grants from the Agency for Healthcare Research and Quality. These projects do not require changing laws. However, grantees’ experiences suggest that the path to suc...
Source: Health Affairs - January 6, 2014 Category: Global & Universal Authors: Sage, W. M., Gallagher, T. H., Armstrong, S., Cohn, J. S., McDonald, T., Gale, J., Woodward, A. C., Mello, M. M. Tags: Access To Care, Ethical Issues, Health Reform, Hospitals, Insurance Coverage, Legal/Regulatory Issues, Physicians, Quality Of Care, Health Spending Communicating About Errors Source Type: research

Communication-And-Resolution Programs: The Challenges And Lessons Learned From Six Early Adopters Communicating About Errors
In communication-and-resolution programs (CRPs), health systems and liability insurers encourage the disclosure of unanticipated care outcomes to affected patients and proactively seek resolutions, including offering an apology, an explanation, and, where appropriate, reimbursement or compensation. Anecdotal reports from the University of Michigan Health System and other early adopters of CRPs suggest that these programs can substantially reduce liability costs and improve patient safety. But little is known about how these early programs achieved success. We studied six CRPs to identify the major challenges in and lessons...
Source: Health Affairs - January 6, 2014 Category: Global & Universal Authors: Mello, M. M., Boothman, R. C., McDonald, T., Driver, J., Lembitz, A., Bouwmeester, D., Dunlap, B., Gallagher, T. Tags: Access To Care, Health Reform, Hospitals, Legal/Regulatory Issues, Physicians, Quality Of Care, Health Spending Communicating About Errors Source Type: research

Implementing Hospital-Based Communication-And-Resolution Programs: Lessons Learned In New York City Communicating About Errors
We report the hospitals’ experiences with implementing the CRP over a twenty-two-month period. We found that all five hospitals improved disclosure and surveillance of adverse events but were not able to fully implement the program’s compensation component. These experiences suggest that strong support from top leadership at the hospital and insurer levels, and adequate staff resources, are critical for the success of CRPs. Hospitals considering adopting a CRP should ensure that their organizations can tolerate risk, their leaders are willing to reinforce CRP implementation, and resources are in place to educat...
Source: Health Affairs - January 6, 2014 Category: Global & Universal Authors: Mello, M. M., Senecal, S. K., Kuznetsov, Y., Cohn, J. S. Tags: Access To Care, Health Professions Education, Health Reform, Hospitals, Legal/Regulatory Issues, Physicians, Quality Of Care Communicating About Errors Source Type: research