Successful reversal of complex regional pain syndrome type 1 of both upper extremities in five patients.

Dear Editor, Bilateral complex regional pain syndrome (CRPS) appears to be unusual [1–5]. We report details of bilateral CRPS diagnosed by International Association for Study of Pain (IASP) criteria in five patients who presented with florid symptoms (more prominent in one extremity) that persisted despite physical therapy (PT) and medications (Figure 1). They were effectively treated with a novel multimodality treatment regimen (MMTR) developed from our experience in over a hundred patients of CRPS-1 in the last 10 years. Figure 1 (First row, left to right—figure of Patient 3 not included so as to maintain clarity of other figures.) Patient 1 : 52-year-old man with bilateral claw hand. He had severe stiffness from fixed deformity that made writing, holding cups, cutlery, etc. impossible for 14 months after complex regional pain syndrome-1 (CRPS-1). Flexor and extensor muscle contractures were palpable as ropy strands and attempts to make a fist passively resulted in pressure allodynia. Note also the scars of sword injury that severed several tendons in both palms and forearms. He presented with 5–8 verbal rating scale (VRS) pain only on movement. Edema and hair growth (R > L). Patient 2 : 72-year-old diabetic man had severe pain, sensory and motor features of CRPS-1 in both hands 4 months after a fall that resulted in soft tissue injuries; left more affected than right; complete disability, unable to get out of bed, and dress or feed himself; complete prostration. The man had severe rest pain (VRS 8–10) with hyperalgesia, allodynia, severe stiffness, weakness, dystonia, and abnormal movements (L > R). Patient 4 : 60-year-old lady had plating done for right elbow fracture and external fixator put for left lower end radius fracture 5 months prior to presentation. The woman had severe rest pain (VRS 8–10), hyperesthesia, hyperalgesia, and allodynia, severe stiffness, and weakness. …