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Pain Management

Complex Regional Pain Syndrome

10/20/2008

Question:

I am two months post bunion surgery and have had severe nerve pain from the moment I woke up in the recovery room. My foot has also for the first 6 weeks been purple. The purple now is less,but my foot is still discolored and the purple comes back when my I am standing for longer periods of time or in the shower. I am taking Neurtoin and Topomax (100 mg of each) at night which has helped with the burning pain. At one point I was taking up to 400 mg of the Neurtoin as the burning was so bad. The burning is now mostly at night. I also have had chronic nausea and sweating since the surgery. The sweating is not in the foot but more like hot flashes. My surgeon says I do not have Complex Regional Pain Syndrome. What could be causing these symptoms and how can I be sure it`s not Complex Regional Pain Syndrome if no test have been done? Could the Neurotin and Topomax be covering up the "touch pain" sensitivity that I don`t have which is a reason the surgeon says I don`t have Complex Regional Pain Syndrome? I understand that if it is Complex Regional Pain Syndrome that goes untreated, the prognosis is not good.

Answer:

While these could be usual post operative events, they may be more serious. I would recommend a consultation with a neurologist who can do a more detailed evaluation for RSDS/CRPS. If it is a form of RSDS/CRPS the earlier treatment begins the better the prognosis. 

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Response by:

Jeffrey M Robbins, DPM Jeffrey M Robbins, DPM
Clinical Assistant Professor of Surgery
School of Medicine
Case Western Reserve University