ABSTRACT
Topical 8 % capsaicin is an established therapeutic option for the treatment of peripheral neuropathic pain. In accordance with the internationally accepted definition, complex regional pain syndrome (CRPS) type II is a form of neuropathic pain so that capsaicin plasters represent a treatment option. However, for the treatment of CRPS it is recommended that painful stimuli should be avoided but capsaicin induces a strong nociceptive stimulation and so its use is at present controversial. We report on the course of such an application in a patient who developed CRPS type II with intractable neuropathic pain after hallux surgery. As a result of a single treatment with capsaicin a pronounced recurrence developed with central nervous symptoms.
Subject(s)
Capsaicin/administration & dosage , Capsaicin/adverse effects , Causalgia/chemically induced , Causalgia/drug therapy , Hallux/surgery , Postoperative Complications/chemically induced , Postoperative Complications/drug therapy , Acute Disease , Administration, Cutaneous , Adult , Anesthesia, Epidural , Causalgia/diagnosis , Causalgia/surgery , Combined Modality Therapy , Dose-Response Relationship, Drug , Female , Follow-Up Studies , Guideline Adherence , Humans , Nerve Block , Pain Measurement/drug effects , Postoperative Complications/diagnosis , Postoperative Complications/surgery , Recurrence , Reoperation , Surveys and Questionnaires , Tissue Adhesions/diagnosis , Tissue Adhesions/surgery , Toes/innervationABSTRACT
Intraspinal drug infusion using implantable pumps and catheter systems is a safe and effective therapy for selected pain patients with severe chronic pain. It improves pain relief, reduces drug-related side effects, decreases the need for oral analgesia and enhances quality of life in a segment of chronic pain patients whose pain has not been controlled with more conservative therapies. Intrathecal drug therapy has therefore established its role in the treatment of malignant pain, benign pain and severe spasticity.Careful patient selection and management as well as a multidisciplinary approach are determinants of successful treatment. Current practices for patient selection and management, screening, drug selection, dosing and implantation for intrathecal drug delivery systems are discussed.
