EXTERNAL NEUROMODULATION FOR A 'LITTTLE BIG STING'-COMPLEX REGIONAL PAIN SYNDROME FOLLOWING POST-PHLEBOTOMY NERVE INJURY

摘要

Background and Aims: Phlebotomy is a routine essential procedure performed regularly in medical practice. Although different venipuncture injuries have been reported with routine phlebotomies, there have been limited reports on peripheral nerve complications (1).We report a case of CRPS following phlebotomy and the application of external neuromodulation (EN) as a treatment modality for CRPS (2).Methods: A 34-year-old right hand dominant lady presented with a 4-year history of pain in her right arm following a difficult phlebotomy during an admission to the emergency department. At the time she felt a very sharp, electric lancinating pain in her arm. The pain persisted and was refractory to conventional medical management including antineuropathic medications. She described pain as sharp, shooting and burning associated with numbness, dusky skin discoloration, reduced hair growth, and dys-esthetic sensations in a non-dermatomal distribution. She was significantly disabled and experienced difficulties with activities of daily living. She responded transiently to TENS and subsequently underwent three trials of external neuromodulation. EN with 1-15 mA, 2 Hz using nerve-mapping pen for 10 min gave her up to 40% pain reduction for 5-6 hours. The concurrent use of TENS following the EN helped to extend the pain relief and improved mobility.Results: The external neuromodulation gave her reasonable pain relief and helped her to concurrently use TENS more effectively and improve her functionality.Conclusions: Nerve injury and development of CRPS type 2 following phlebotomy is a rare but well recognized complication. Neuromodulation is a recommended option for refractory CRPS. This case demonstrates the effective application of external neuromodulation, a novel minimally invasive technique which can be widely used.