COVID-19 Mediated Exacerbation of Complex Regional Pain Syndrome Treated With Spinal Cord Stimulator

ABSTRACT

Introduction: Complex regional pain syndrome (CRPS) is a debilitating condition characterized by disproportionate pain to the inciting event, changes in sensation, autonomic abnormalities, and motor dysfunction, as defined by the Budapest criteria. It is difficult to treat, often requiring trials of multiple medications or more invasive measures such as a spinal cord stimulator (SCS) to manage symptoms. The onset of symptoms typically follows tissue damage and may be exacerbated by further injury or systemic stressors. One such stressor appears to be COVID-19 infection, which has already been implicated in cases of neuropathic pain. We present a case of a 60-year-old woman with CRPS type I status post SCS placement with a flare-up attributable to COVID-19 infection. Methods: We describe the following patient's case in pertinent detail. The patient's written consent was obtained prior to the undertaking of this report. Results: A 60-year-old woman presented with a right-sided rotator cuff tear with subsequent repair in 2018 which incited pain and related symptoms. CRPS was diagnosed when her symptoms progressed to right thumb numbness as well as right hand color changes, numbness, and weakness. An SCS was placed in August 2019 which provided pain relief, but the patient presented with exacerbation of symptoms in December 2020, coinciding with COVID-19 infection. She experienced migration of symptoms into the right shoulder which has been significantly interfering with work and sleep. She continued to report pain, swelling, stiffness, dry skin, and temperature changes in her right hand. Conclusion: COVID-19 has been found to present with a widely variable clinical presentation with equally varied sequelae, termed Post-Acute Sequelae of SARS-CoV-2 infection (PASC). Human coronaviruses are known to possess neuroinvasive capabilities, typically manifesting as anosmia in the case of COVID-19 but may also present as neuropathic pain. If not attributable to direct viral invasion, the pathophysiologic underpinnings may be related to proinflammatory cytokines and pain-generating neuropeptides. Our case suggests that COVID-19 infection may play a role in exacerbating symptoms of CRPS. Disclosure Gabrielle Fernandez, BA None, Ganiru Anunike, BA None, Nitin Goyal, MD None