Repeated depot steroid injections at the site of nerve injury in CRPS II

<p>Asif G Kayani and Zeeshan A Kayani</p>

Repeated depot steroid injections at the site of nerve injury in CRPS II

Asif G Kayani and Zeeshan A Kayani

Combined Military Hospital Rawalpindi, Pakistan

: Analg Resusc: Curr Res

Abstract

Complex Regional Pain Syndrome (CRPS) is one of the most painful, disabling and difficult to treat neuropathic conditions. The triggering factor is trauma and the clinical response is indistinguishable whether it is the type I or II. Type I (previous RSD) does not apparently involve a major nerve injury whereas in the type II CRPS (previous Causalgia) there is a well defined major nerve injury. The diagnostic criteria have been defined by the International Association for Study of Pain (IASP). Treatment approach is multidisciplinary and options include medications as anticonvulsants, antidepressants, bisphosphonates, COX-inhibitors, soral steroids, N-methyl-D-aspartate receptor antagonists like Ketamine, intravenous lidocaine. Interventional techniques such as sympathetic nerve and plexus blocks, local anesthetic blocks, central neuraxial blocks and spinal cord stimulation have been employed. Physical medicine and psychotherapeutic approaches help the patient in modifying response to pain and performing limited routine activities. This galaxy of treatment options highlights the inadequacy of relief achieved in most of the cases, at times amputations have been done to get rid of the painful limb. In our centre we regularly use repeated depot steroid injections, triamcinolone, in combination with local anaestheticsat the site of nerve injury in CRPS II in addition to medication and physical therapy with good results. Experience in initial cases of prospective study comparing triamcinolone/LA combination with LA injection alone will be discussed during this presentation. On review of literature no study is yet available discussing steroid injections at injury site for nerve blocks in CRPS.