Changes in regional cerebral blood flow and three-phase bone scan after repeated somatic nerve blocks for sympathetically independent pain.
OBJECTIVE
The pathophysiology of complex regional pain syndrome type 1 (CRPS 1) correlates with variances in both the peripheral and central nerve system. We attempted to explore the topographic correlation between changes in regional cerebral blood flow (rCBF) and 3-phase bone scans during treatments of a series of somatic nerve blocks.


METHODS
The case we present here is a 24-year-old man, who suffered CRPS 1 in his right upper extremity for 4 months, and conservative therapy proved to be ineffectual to him. As he did not respond to stellate ganglion block, the syndrome was regarded as sympathetically independent pain (SIP). However, after administering a series of brachial plexus block and local anesthetics, complete resolution of pain, and restoration of function were manifested. In addition, an increase in rCBF, evidenced by single-photon emission computed tomography (SPECT), and changes in the 3 phase bone scan before and after the nerve block appear to correlate well with the clinical improvement.


CONCLUSIONS
The changes in rCBF seem to support the theory that the pathogenesis of CRPS is also related to the central nervous system. Multiple somatic nerve blocks (SNB) not only improved physical function but also reversed the CRPS symptoms, for which we presume that reduced nociceptive input signals led to cortical reorganization.
Lin
Bo-Feng
BF
Department of Anesthesiology, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan.
Cherng
Chen-Hwan
CH
Fan
Yu-Ming
YM
Wong
Chih-Shung
CS
Huh
Billy K
BK
Yeh
Chun-Chang
CC
D001842:Bone and Bones / Q000000981:diagnostic imaging*; D002560:Cerebrovascular Circulation; D020918:Complex Regional Pain Syndromes / Q000000981:diagnostic imaging / Q000503:physiopathology* / Q000601:surgery*; D006801:Humans; D008297:Male; D009407:Nerve Block; D013564:Sympathetic Nervous System; D019690:Technetium Tc 99m Exametazime; D015899:Tomography, Emission-Computed, Single-Photon; D055815:Young Adult
D019690:Technetium Tc 99m Exametazime