1. 2014;17;E629-E635Early Adjunct Treatment with Topical Lidocaine Results in Improved Pain and Function in a Patient with Complex Regional Pain Syndrome
   Case Report
   Patricia B Mills, MHSc, MD, Dianna Mah-Jones, Msc, and Amy KL Hanlan, MD.

Complex regional pain syndrome (CRPS) is a pain disorder characterized by sensory, motor, trophic and autonomic dysfunction.  The hallmark of the disorder is pain out of proportion of the inciting event. CRPS is difficult for clinicians to manage as there is no gold standard for diagnosis or treatment.  Patients with CRPS are at risk of developing contractures, tissue atrophy, joint dislocation and severe chronic pain.  While CRPS is thought to be due to peripheral and central nervous system dysfunction, there is limited understanding of the pathophysiology of CRPS.  The proposed mechanisms are multifactorial and consequently, so are the proposed treatments.  These treatments can be invasive, such as intrathecal drug delivery or sympathectomy, which have poor evidence for efficacy.  Thus, highlighting the need for a safe, effective, and early intervention.  We present a case of topical 5% lidocaine ointment as a non-invasive, inexpensive and effective adjunct treatment in the management of pain in a spinal cord injured patient presenting with early CRPS.  The clinically important effect of topical lidocaine for reducing severe allodynia allowed the patient to participate in rehabilitation strategies to further manage the debilitating consequences of her CRPS, including decreased range of motion (ROM) and function.  The immediate pain relief from topical lidocaine allowed the patient to tolerate physical therapy sessions directed at her CRPS.  A successful outcome was measured subjectively and objectively by our patient’s reduction in symptoms and improvement in ROM and function, respectively. This case study provides preliminary support for improved pain and functional outcome with early adjunct treatment of CRPS with topical lidocaine.