-Case Reports-

Combination of Continuous Epidural Block and Rehabilitation in a Case of Complex Regional Pain Syndrome

Kazuhiro Hayashi¹, Kimitoshi Nishiwaki², Masato Kako¹, Kentaro Suzuki¹, Keiko Hattori¹, Koji Sato¹, Izumi Kadono^1,3 and Yoshihiro Nishida^1,3

¹Department of Rehabilitation, Nagoya University Hospital, Aichi, Japan
²Department of Anesthesiology, Nagoya University Graduate School of Medicine, Aichi, Japan
³Department of Orthopaedic Surgery, Nagoya University Graduate School and School of Medicine, Aichi, Japan

Epidural analgesia is used to promote rehabilitation in patients with refractory complex regional pain syndrome (CRPS) who cannot bear physical programs due to intense pain. However, the actual rehabilitation process has not been focused in previous reports. Here, we outline our experience of treating a young woman with CRPS type 1 who underwent rehabilitation facilitated by a continuous lumbar epidural block.
A 15-year-old girl developed throbbing pain from her left toe to her ankle, with no obvious cause. She was admitted to the hospital 2 months after symptom onset for an assessment of pain intensity, range of motion, weight-bearing, neglect-like symptoms, pain catastrophizing, and a CRPS severe score with impaired activities of daily living. The rehabilitation program was initiated under facilitation of continuous epidural block. Her rehabilitation program included physical therapy, motor imagery, mirror therapy, and cognitive behavioral therapy. The intensity of the exercise was gradually increased without exacerbating her symptoms. Ultimately, she recovered completely after a continuous epidural block for 21 days and rehabilitation for 80 days.
A combination of continuous epidural block and intensive rehabilitation improved the symptoms of this patient. The treatment course would be helpful for planning rehabilitation programs in other patients with CRPS.

J Nippon Med Sch 2016; 83: 262-267

Keywords
catastrophizing, cognitive behavior therapy, complex regional pain syndrome, epidural anesthesia, physical therapy

Correspondence to
Kazuhiro Hayashi, PT, MSc, Department of Rehabilitation, Nagoya University Hospital, 65 Tsuruma-cho, Showa-ku, Nagoya, Aichi 466-8550, Japan
hayashi.k@med.nagoya-u.ac.jp

Received, February 8, 2016
Accepted, September 26, 2016