Complex regional pain syndrome type 1. An elusive diagnosis

Complex regional pain syndrome type 1 is a painful disorder that may complicate a traumatic lesion especially in extremities. It is infradiagnosed and potentially very disabling. Its diagnosis consists of a few clinical criteria. It does not exist a complementary diagnostic study which can be considered as gold standard. Its treatment must be multidisciplinary (e.g. medicines, physical therapy, psychological therapy and, in selected cases, invasive procedures). There have been communicated some favorable results using multiple pharmacological treatments in which corticosteroid therapy was among the ones that have reached highest levels of evidence in favor of its utility. Here we present the case of a forty-seven male patient who presented severe pain in his right lower extremity with neuropathic characteristics and a long time of evolution. He had had multiple previous consultations and he had carried out many other treatments. It has been performed a 99Tc three-phase bone scintigraphy that was compatible with the proposed diagnosis. He was treated with methyl prednisone 60 mg q24h with progressive lowering doses during fifteen days with a significant improvement of signs and symptoms. Finally he received hospital discharge for ambulatory rehabilitation treatment.