Acupuncture as an Adjunct to Stellate Ganglion Block For CRPS

Complex regional pain syndrome (CRPS) is a form of severe chronic pain with a protracted course, varied etiology and different treatment modalities. There are two types of CRPS: Type 1 and Type 2. Multimodal pain management is recommended for CRPS. Sympathetic blocks in the form of Stellate ganglion block has been used since time immemorial as a form of diagnostic and therapeutic regional block in CRPS type1. There are a few subsets of patients who also require other supplementary and complimentary therapies for complete relief for their chronic pain. We hereby report a unique case of CRPS type 1 who presented with severe pain in the left arm, forearm and shoulder following a previous fracture of the left radius after a fall. The patient responded partially to left stellate ganglion block after failure of conservative management. Acupuncture is an ancient form of Chinese medicine with clinically proven benefits in a variety of disorders, including chronic pain. We used various acupuncture points in this patient, a week after the stellate ganglion block for a period of 2 weeks to achieve a near-total pain relief as well as significant improvement in arm movements. Acupuncture was supplemented by TENS (transcutaneous electrical nerve stimulation) to the affected arm and daily physiotherapy. This case highlights that with the timely use of acupuncture we can achieve complete pain relief in chronic pain patients, partially responding to regional blocks. The pain scores of the patient dipped from 9 on the NRS (Numeric Rating Scale) at the time of presentation to NRS 1 at the end of the treatment. Assistant Professor, Anesthesia and Intensive care, Dr. Ram Manohar Lohia Hospital and PGIMER, New Delhi, India