Is sympathetic blockade useful in complex regional pain syndrome (CRPS)?

Abstract

A 22-year-old soccer player presents to the pain clinic with right ankle pain. He was kicked in the right ankle during a soccer match 6 weeks prior. Since the injury, he has had increasing pain, swelling, abnormal perspiration, color changes and has been unable to bear weight due to pain. He went to see an orthopedic sports medicine physician for evaluation. Magnetic resonance imaging (MRI) and X-ray of the foot were negative for fracture or any other soft tissue injury. Infection was ruled out, and no surgical intervention was indicated. He tried physical therapy but was unable to tolerate it due to pain. Gabapentin and nortriptyline only provided minimal improvement. The sports medicine physician diagnosed him with complex regional pain syndrome (CRPS) Type I and referred him to the pain clinic for consideration of lumbar sympathetic nerve block. Today’s pain is 8/10 in the right ankle. He describes the pain as burning, sharp, and gnawing. Aggravating factors include movement, socks. Relieving factors include gabapentin.