Treatment of tremors in complex regional pain syndrome. J Pain Symptom Manage 2003 Apr;25(4):386-90
Date
04/15/2003Pubmed ID
12691691DOI
10.1016/s0885-3924(02)00675-9Scopus ID
2-s2.0-0037386023 (requires institutional sign-in at Scopus site) 8 CitationsAbstract
A 14-year-old girl presented with Complex Regional Pain Syndrome, Type I (CRPS-1) of the left ankle after a remote history of sprain. Allodynia, pain, temperature and color changes, and swelling were successfully treated with physical therapy, transcutaneous electrical nerve stimulation (TENS), gabapentin, amitriptyline, and tramadol. Five weeks later, she presented with a continuous, involuntary, intermittent coarse tremor of the left foot causing increased pain. The electromyogram showed rhythmic discharges of 3 Hz frequency lasting 20-80 milliseconds in the left tibialis, peroneus and gastrocnemius, suggestive of either basal ganglia or spinal origin. Tremor and pain were controlled with epidural bupivacaine, but the tremor reappeared after discontinuing epidural blockade. Carbidopa/levodopa 25/100 (Sinemet) was started and the tremor disappeared after two days. With continued physical therapy, pain and swelling resolved within two months and carbidopa/levodopa was discontinued after five weeks with no recurrence of the tremor. Our success in the treatment of CRPS-associated tremor in this young girl with carbidopa/levodopa suggests that this patient may have had underlying movement disorder which was unmasked by the peripheral injury.
Author List
Navani A, Rusy LM, Jacobson RD, Weisman SJAuthors
Lynn M. Rusy MD Professor in the Anesthesiology department at Medical College of WisconsinSteven J. Weisman MD Professor in the Anesthesiology department at Medical College of Wisconsin
MESH terms used to index this publication - Major topics in bold
AdolescentComplex Regional Pain Syndromes
Female
Humans
Tremor
