Calcineurin-inhibitor induced pain syndrome (CIPS): a severe disabling complication after organ transplantation

Bone pain after transplantation is a frequent complication that can be caus ed by several diseases. Treatment strategies depend on the correct diagnosi s of the pain. Nine patients with severe pain in their feet, which was regi stered after transplantation, were investigated. Bone scans showed an incre ased tracer uptake of the foot bones. Magnetic resonance imaging demonstrat ed bone marrow oedema in the painful bones. Pain was not explained by other diseases causing foot pain, like reflex sympathetic dystrophy, polyneuropa thy, Morton's neuralgia, gout, osteoporosis, avascular necrosis, intermitte nt claudication, orthopaedic foot deformities, stress fractures, and hyperp arathyroidism. The reduction of cyclosporine- or tacrolimus trough levels a nd the administration of calcium channel blockers led to relief of pain. Th e Calcineurin-inhibitor Induced Pain Syndrome (CIPS) is a rare but severe s ide effect of cyclosporine or tacrolimus and is accurately diagnosed by its typical presentation, magnetic resonance imaging and bone scans. Incorrect diagnosis of the syndrome will lead to a significant reduction of life qua lity in patients suffering from CIPS.