[Complex regional pain syndrome].

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Abstract

[Indexed for MEDLINE] 19. Scand J Pain. 2016 Jan;10:15-18. doi: 10.1016/j.sjpain.2015.07.005. Epub 2015 Aug 24. Complex regional pain syndrome following viper-bite. Kleggetveit IP(1), Skulberg PK(2), Jørum E(1). Author information: (1)Section of Clinical Neurophysiology, Department of NeurologyOslo University Hospital-Rikshospitalet, Oslo, Norway. (2)Askim Medical Center, Askim, Norway. Comment in Scand J Pain. 2016 Jan;10:108-110. doi: 10.1016/j.sjpain.2015.11.008. BACKGROUND: Complex regional pain syndrome (CRPS) may occur following fractures, surgery or different trauma. Development of CRPS following snake-bite has only been published in three reports (from Turkey, Nepal and Korea), although snake bites occur frequently world-wide. There has been no report from Western Europe. Vipera Berus is a common snake in European countries and the only venomous snake in Norway. We here describe the development of CRPS in a young woman as a consequence of a viper bite (Vipera Berus) in the right arm. METHODS: We performed a clinical investigation (inspection, measurement of skin temperatures, sensory and motor evaluation) of the patient six months following the viper-bite, measurement of thermal thresholds (quantitative sensory testing, QST), measurement of resting sweat output (RSO) and quantitative sudomotor axon reflex (QSART) from both arms. RESULTS: The patient fulfilled the Budapest criteria for a CRPS-condition, with continuous pain and symptoms and findings of autonomic dysfunction. In addition, we found elevated thresholds of warmth and cold, evidence of an affection of afferent A-delta and C-fibres as well as an affection of the efferent sympathetic sudomotor C-fibres by QSART. An increased RSO-volume was in inverse relationship to the decreased QSART result. CONCLUSION AND IMPLICATIONS: It is important to be aware of viper-bite as a possible eliciting event for CRPS for early diagnosis and treatment of a patient. As long-lasting pain and oedema are known complications, it is probable that CRPS after viper-bites previously may have been underdiagnosed. As many patients are unaware of being bit, viper bite should be considered in cases of unexplained sudden pain and swelling of a limb. Copyright © 2015 Scandinavian Association for the Study of Pain. Published by Elsevier B.V. All rights reserved. DOI: 10.1016/j.sjpain.2015.07.005