Complex regional pain syndrome type I treated with topical capsaicin: A case report

This report describes the case of a multitrauma patient who underwent an am putation of the left arm and had a complicated left crural fracture with a delayed union. He was treated in an inpatient setting for preprosthetic tra ining for a myoelectric prosthesis and to regain walking abilities. After c onsolidation of the crural fracture, complex regional pain syndrome type I (CRPS I) developed in the left foreleg, which hindered mobilization. Topica l capsaicin .075% was prescribed and a stress-loading mobilization schema w as instituted. No other treatment modalities directed at CRPS I were added. After 6 weeks, no signs or symptoms of CRPS I were present and capsaicin w as discontinued. Capsaicin is a well-accepted and documented treatment moda lity in neuropathic pain states such as postherpetic neuralgia. However, it has rarely been described in CRPS I. Capsaicin is discussed within the fra mework of recent insights in the neurobiology of nociception, and it is con cluded that it may provide a theory-driven treatment for CRPS I, especially in the acute stage, that facilitates physical therapy and prevents periphe ral and spinal sensitization.