Anesth Pain Med.  2023 Jan;18(1):70-74. 10.17085/apm.22239.

Treatment experience in a patient of complex regional pain syndrome combined with secondary lymphedema of lower extremity

• Hong JH
• Kim SJ

• KMID: 2540337
• DOI: http://doi.org/10.17085/apm.22239

Abstract

Background
Lymphedema is characterized by localized tissue swelling due to excessive interstitial space retention of lymphatic fluid. Lymphedema is easy to be misdiagnosed since itresembles other conditions of extremity swelling. We present a case of complex regionalpain syndrome (CRPS) type I with secondary lymphedema that was successfully managedwith spinal cord stimulation (SCS).Case: A 39-year-old female patient came to our pain clinic with complaints of lower extremity pain and edema. To find out reason of leg edema, computed tomography of extremity angiography and blood test were performed. However, all of evaluations were normal. Lastlyperformed lymphoscintigraphy showed secondary lymphedema. SCS was performed and itshowed dramatic reduction subsequent to implantation of SCS.Conclusions: We could successfully manage the intractable pain and edema in CRPS combined with lymphedema. If a patient presents different nature of edema, coexistence of other disease needs to be considered.

Keyword

Complex regional pain syndrome; Leg edema; Lymphatic fluid; Lymphedema; Lymphoscintigraphy; Spinal cord stimulation

Figure

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  Fig. 1. Lymphoscintigraphy showing the lymphatic system of both extremities using Tc-99m phytate. It shows delayed lymphatic drainage of both lower extremities with the dermal back flow (right > left). RT: right, LT: left, Avg: average, Max: maximum, Min: minimum, Tot: total, R/L: right/left.

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  Fig. 2. Fluoroscopic image showing the position of the electrode.

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  Fig. 3. The changes of right (green) and left (yellow) side leg girth at the upper thigh (A) before and after spinal cord stimulation (SCS). The changes of right (green) and left (yellow) side leg girth at the lower calf (B) before and after SCS.

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