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EP239 A case of dysautonomia in CRPS: a nine years follow up of a very rare and complex patient
  1. Dimitrios Peios1,
  2. Athanasia Tsaroucha2,
  3. Aikaterini Tsirogianni3 and
  4. Georgios Matis4
  1. 1Functional Neurosurgery, St Luke’s private hospital, Thessaloniki, Greece
  2. 2Pain Department , Aretaieio University Hospital, Athens, Greece
  3. 3Pain Department , General Hospital of Katerini, Katerini, Greece
  4. 4Functional Neurosurgery, Cologne University Hospital, Cologne, Germany


Background and Aims CRPS is a debilitating condition of chronic pain that challenges both patient and physician, with often detrimental results that can go all the way even to decision of mutilating the affected limb. Our objective is to evaluate efficacy, decision making and patient satisfaction, as well as complications of treatments of a very rare and complex case of CRPS that progressed with dysautonomia syndrome.

Methods Analysis of data collected from progression of disease through a nine years follow-up of a specific patient with CRPS of the left arm, with onset of symptoms after a procedure for epicondylitis that injured the left radial nerve at the level of the elbow. A review of literature is included to examine the connection of the two conditions.

Results Through the course of nine years the patient underwent approximately 34 interventions, from conservative medical treatments to intravenous ketamine, neuromodulation techniques, spinal injections and other blocks, radiofrequency ablations, intrathecal pump implantation in various pain centers. The recent years there was a need to incorporate treatments also for more generalized autonomic dysfunction, like neurogenic bladder, respiratory and cardiovascular manipulations, and also gastrointestinal dysfunction.

Conclusions CRPS is a condition that requires continues medical care, adjustment of treatments and monitoring for new symptoms. Although it is not clear that dysautonomia directly connects with CRPS, studying cases for a long period of time may reveal there is a common basis. More important is that all symptoms should be addressed in time and any physician’s bias should not hinder their diagnosis and treatment.

  • dysautonomia
  • CRPS
  • pain management
  • opioids
  • neuromodulation
  • intrathecal pump
  • spinal cord stimulation
  • sacral root stimulation

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