1329 - Unexplained Pain, Unveiled: Recognizing CRPS in a Complex Case

Friday, February 20, 2026

5:00 PM - 6:30 PM AST

Presenting Author(s)

AP

Aliza M. Perez, DO

Resident Physician
The Mount Sinai Hospital- NYC
new york city, New York, United States

Co-Author(s)

NS

Nuha Syed, BA

Medical Student
The Touro College of Osteopathic Medicine
New York City, New York, United States
SB

Sofia Barchuk, DO

Attending Physician
Mount Sinai Hospital
New York, New York, United States

Submitter(s)

AP

Aliza M. Perez, DO

The Mount Sinai Hospital- NYC
new york city, New York, United States

Case Diagnosis: Complex Regional Pain Syndrome Type I

Case Description: A 77-year-old female with a history of lymphoma in remission, cirrhosis, recurrent deep vein thromboses, chronic lymphedema, and hypertension presented with bilateral lower extremity pain and functional decline. Evaluation for sepsis and systemic inflammatory diseases was unrevealing. Lumbar spine MRI showed foraminal stenosis, yet symptoms were not explained by stenosis alone. Electromyography was inconclusive; abdominal and pelvic CT was unremarkable. Autoimmune and inflammatory processes were ruled out. Elsberg syndrome was considered, though lumbar puncture was declined. Physiatry was consulted for pain described as a “squeezing” sensation, aggravated by light pressure. Exam demonstrated marked allodynia, edema, and diffuse bilateral weakness. Functional evaluation revealed severe impairment in gait and transfers, primarily limited by pain. A trial of a Medrol dose pack led to partial improvement. Triple-phase bone scan showed increased uptake in bilateral toes and ankles with mild sclerosis. Clinical features met Budapest criteria, supporting Complex Regional Pain Syndrome (CRPS) type I.

Discussions: CRPS is a clinical diagnosis characterized by pain disproportionate to inciting injury, with sensory, motor, sudomotor/edema, and trophic changes. In medically complex patients, diagnostic overshadowing may delay recognition. This patient’s multifactorial history, inconclusive studies, and nonspecific imaging initially diverted attention away from CRPS. However, the presence of allodynia, pain-limited mobility, edema, and supportive bone scan ultimately established the diagnosis. Early suspicion is vital, as delayed recognition can worsen prognosis and functional recovery. Physiatrists play an essential role in identifying CRPS through functional assessment, maintaining a broad differential, and initiating timely interdisciplinary management.

Conclusions:
This case underscores the importance of including CRPS in the differential for patients with severe, unexplained pain and sensory changes when alternative evaluations are unrevealing.