Management of Chronic Truncal Wall Type-I Complex Regional Pain Syndrome in a Patient with Uncontrolled Diabetes Mellitus: Case Report

Abstract

Complex regional pain syndrome (CRPS) is a chronic pain syndrome associated with sensory, vasomotor, sudomotor, motor and trophic changes commonly affecting the upper and lower extremities; however, we report a case of truncal wall CRPS in an uncontrolled type 2 diabetes mellitus patient. A male in his late fifties presented with right lower chest and upper abdominal wall burning, sharp and stabbing type of pain for 5 years associated with hyperalgesia and allodynia. The extensive evaluation ruled out any underlying pathology and the symptoms were increasing with time. He failed to respond to conservative pharmacological, non-pharmacological treatment and rehabilitation measures. In our institute, he underwent alcohol neurolysis of subcostal transversus abdominis plane and rectus sheath nerves with rehabilitation measures and reported significant relief in his symptoms. It has now been 6 months since the procedure was done and he has complete relief in pain. Hence, if sympathetic block is difficult to do, peripheral nerve block with alcohol and rehabilitation measures provide desirable effect in abdominal wall CRPS.

Keywords

• alcohol neurolysis
• complex regional pain syndrome
• rectus sheath block
• subcostal transversus abdominis plane block