1328 - A Cream Come True: Case of Complex Regional Pain Syndrome Managed with Topical Lidocaine

A 72-year-old female with poorly-controlled diabetes mellitus, hypertension, and atrial fibrillation on anticoagulation presented three years after history of recurring toenail infections leading to osteomyelitis of the left foot second digit necessitating distal Syme amputation of second phalanx. The patient initially presented to Podiatry, who diagnosed Complex Regional Pain Syndrome (CRPS), started her on physical therapy, and referred her to outpatient Physical Medicine and Rehabilitation (PM&R) clinic, after her pain was still severe (8/10). PM&R added diclofenac 1% gel which did decrease pain minimally. EMG was ordered revealing only left lumbosacral radiculopathy. On follow up a mixture of 2mL of 2% lidocaine was mixed into a 15 mL BioFreeze medium and applied directly to the affected digit and surrounding area, and the patient reported immediate pain relief lowering her pain to 2/10. She was prescribed lidocaine 5% topical cream for continued outpatient pain relief. 

Discussions:

A familiarity with Complex Regional Pain Syndrome (CRPS), its diagnostic criteria, and its subtypes is crucial to PM&R practice due to its impact on function, mobility, and quality of life. Characterized by chronic, disproportionate pain and autonomic changes, CRPS can lead to disability if not managed early and appropriately. Physiatrists play a central role in optimizing recovery through multimodal strategies aimed at pain reduction and functional restoration. Common topical agents, such as lidocaine, capsaicin, and non-steroidal anti-inflammatories can offer localized pain relief with minimal systemic side effects. When combined with graded motor imagery, desensitization, and active exercise topical treatments help facilitate functional improvement highlighting the importance of an interdisciplinary, rehabilitation-centered approach in CRPS management.

Conclusions: Complex Regional Pain Syndrome (CRPS) can present a challenging obstacle to maintaining functionality for some post-operative patients. Using a multimodal approach including topical analgesics can be assistive in adherence to therapeutics.