Complex regional pain syndrome: diagnosis and treatment at the very onset as the key to success? A case report with implications for first contact doctors

The case report describes a 67-year-old man who suffered from a minor left ankle injury. Physical examination on day 12 revealed swelling of the foot, erythema on its dorsal surface as well as elevated temperature, hyperesthesia, hyperalgesia and allodynia of that area. The treatment included local application of dexamethasone and oral administration of meloxicam. Within a week the symptoms disappeared and one-year follow-up did not show their recurrence. The presented symptoms allowed diagnosis of the earliest stage of complex regional pain syndrome (CRPS), which may be a disabling and difficult to treat adverse event. This report suggests that immediately introduced simple anti-inflammatory therapy may bring a quick and permanent recovery. Hence, first contact physicians should advise the patient to report such symptoms as burning pain of the injured area lasting for a few days and, if CRPS suspicion is justified by the results of physical examination, they should apply an anti-inflammatory treatment immediately.