Monday, January 7, 2013

CRPS Case Study: Recurrence After Use of Capsaicin patch

This is not me... but I've closely resembled this highly inflamed "red stage" in both hands and feet. The skin in CRPS' red phase can radiate heat that can be felt from a foot away.  This is close to how my extremities react to applications of lotions, medicated creams and patches.

Although this article has the limitations inherent to any case report, I am grateful to see it.  Just by coincidence, I've been inundated with suggestions from well-intentioned curious medical types about what lotions or patches I should apply to my legs and hands.  My response, that applying anything beyond the special antibiotic soap (a 2% solution of Hibiclens), any lotion, oil, or capsaicin cream/patches, lidocaine patches, cause an extreme, immediate, and long-lasting inflammatory response.  My entire lower leg or forearm immediately swells, turns boiled-lobster red, with what almost seems a boiled-lobster temp, and -- just for giggles -- breaks out in... welts.  Welts?  (I don't really know what to call them... maybe they're bubonic plague bullae or maybe they're more akin to a mess o'flea bites, whatever is ugliest or über gross.  Fluid-filled and not itchy, oh no, that would be too pleasant -- because they burn.)

Anyway, it's hard to explain why I cannot lather my extremely dry skin with soothing emollients... so as I said -- I'm grateful to see this case study!

Yes, damn it, I did recently praise myself to High Heaven for my circumspect descriptions of CRPS' impact on my body.  Be divine, and forgive the occasional slip-up?

In other news, I am multi-tasking my efforts at distraction for pain relief, and that's meant excessive television viewing these past few days.  Did you know there is an Amish Mafia?  Live and learn.  The episode blasting in the background right now features Big Bad Lebanon Levi and the "fights" -- they have MMA matches.  Good Wikipedia warns me, however, that the whole show may be nothing but lies, legends, and nonsense.  Whew.  Back to the norm for "reality" television.

Ahem, without further ado, here's the abstract of the case study in question:

Der Schmerz. 2012 Dec 9.

Pronounced symptom deterioration in complex regional pain syndrome type II after isolated application of a highly concentrated capsaicin patch : A case report.

[Article in German]

Girtler RKloimstein HGustorff B.

Abteilung für Anästhesie, Intensiv- und Schmerzmedizin, Wilhelminenspital der Stadt Wien, Montleartstr. 37, 1160, Wien, Österreich,

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.

Further Resources:
First two pages of text (the second has several photos)


  1. Anand P, Bley K (2011) Topical capsaicin for pain management: therapeutic potential and mechanisms of action of the new high-concentration capsaicin 8% patch. Br J Anaesth 107:490–502 CrossRef
  2. Cheshire WP, Snyder CR (1990) Treatment of reflex sympathetic dystrophy with topical capsaicin. Case report. Pain 42:307–311 CrossRef
  3. Harden RN (2005) Pharmacotherapy of complex regional pain syndrome. Am J Phys Med Rehabil 84:17–28
  4. Harden RN (2010) Validation of proposed diagnostic criteria (the „Budapest criteria“) for complex regional pain syndrome. Pain 150:268–274CrossRef
  5. Lanz S, Maihöfner C (2009) Symptome und pathophysiologische Mechanismen neuropathischer Schmerzsyndrome. Nervenarzt 80:430–444CrossRef
  6. Mackey S, Feinberg S (2007) Pharmacologic therapies for complex regional pain syndrome. Curr Pain Headache Rep 11:38–43 CrossRef
  7. Perez RS, Zollinger PE, Dijkstra PU et al (2010) Evidence based guidelines for complex regional pain syndrome type 1. BMC Neurol 10:20CrossRef
  8. Ribbers GM, Stam HJ (2001) Complex regional pain syndrome type I treated with topical capsaicin: a case report. Arch Phys Med Rehabil 82:851–852 CrossRef
  9. Ribbers GM, Geurts AC, Stam HJ et al (2003) Pharmacologic treatment of complex regional pain syndrome I: a conceptual framework. Arch Phys Med Rehabil 84:141–146 CrossRef
  10. Robbins WR, Staats PS, Levine J et al (1998) Treatment of intractable pain with topical large-dose capsaicin: preliminary report. Anesth Analg 86:597–583
  11. Eisenhart-Rothe R von, Rittmeister M (2004) Medikamentöse Therapie des komplexen regionalen Schmerzsyndroms Typ I. Orthopade 33:796–803
  12. AWMF-Leitlinien-Register Nr. 030/116 (2008) Diagnostik und Therapie komplexer regionaler Schmerzsyndrome (CRPS). Leitlinien für Diagnostik und Therapie in der Neurologie, 4. überarbeitete Aufl. Georg Thieme, Stuttgart

Description of Journal Der Schmerz

ISSN: 0932-433X (Print) 1432-2129 (Online)
Zielsetzung der Zeitschrift Der Schmerz ist ein international angesehenes Publikationsorgan und wendet sich an Ärzte aller Fachgebiete sowie an Allgemeinmediziner und Psychologen, die mit der Behandlung von Schmerzpatienten oder in der Schmerzforschung beschäftigt sind. Das Ziel der Zeitschrift ist es, die Versorgung von Schmerzpatienten langfristig zu verbessern. Praxisorientierte Übersichtsarbeiten greifen ausgewählte Themen auf und bieten dem Leser eine Zusammenstellung aktueller Erkenntnisse aus allen Bereichen der Schmerzforschung und Symptomkontrolle bei Schmerz. Neben der Vermittlung von relevantem Hintergrundwissen liegt der Schwerpunkt dabei auf der Bewertung wissenschaftlicher Ergebnisse unter Berücksichtigung praktischer Erfahrung. Frei eingereichte Originalien ermöglichen die Präsentation wichtiger klinischer Studien und dienen dem wissenschaftlichen Austausch. Kasuistiken zeigen interessante Fallbeispiele und ungewöhnliche Krankheits- bzw. Behandlungsverläufe. Beiträge der Rubrik „CME: Weiterbildung – Zertifizierte Fortbildung“ bieten gesicherte Ergebnisse wissenschaftlicher Forschung und machen ärztliche Erfahrung für die tägliche Praxis nutzbar. Nach Lektüre der Beiträge kann der Leser sein erworbenes Wissen überprüfen und online CME-Punkte erhalten. Die Rubrik orientiert sich an der Weiterbildungsordnung des Fachgebiets.
Aims & Scope Der Schmerz is an internationally recognized journal and addresses all scientists, practitioners and psychologists, dealing with the treatment of pain patients or working in pain research. The aim of the journal is to enhance the treatment of pain patients in the long run. Review articles provide an overview on selected topics and offer the reader a summary of current findings from all fields of pain research, pain management and pain symptom management. Freely submitted original papers allow the presentation of important clinical studies and serve the scientific exchange. Case reports feature interesting cases and aim at optimizing diagnostic and therapeutic strategies. Review articles under the rubric “Continuing Medical Education” present verified results of scientific research and their integration into daily practice. Review All articles of Der Schmerz are peer reviewed. Declaration of Helsinki All manuscripts submitted for publication presenting results from studies on probands or patients must comply with the Declaration of Helsinki. Indexed in Science Citation Index Expanded, Medline, Neuroscience Citation Index, Research Alert, EMBASE and Scopus.

1 comment:

  1. Haha I'm not the only one who's seen Amish Mafia. Levi isn't that big and bad, he cried over the girl :)
    That's some arm.


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