Full recovery from CRPS type 1 after introduction of fentanyl transdermal patch: a case report

Abstract

In Japan, use of the fentanyl transdermal patch was finally approved in 2010 for the treatment of intractable pain. Complex regional pain syndrome (CRPS) is one of the diseases/syndromes associated with pain that is often difficult to diagnose and treat. We report a case of CRPS type 1 which was refractory to prior treatments administered at several institutions, but introduced to resolve after initiation of treatment with the fentanyl transdermal patch. The patient was a 54-year-old woman. After 2 sites surgery, spinal decompression and fixation of L4/5 and L3/4, she began to suffer from bilateral numbness and coldness over the region extending from the lateral femur to the crus, as well as severe pain and heat sensation in the right sole. Bilateral thermal distance was 10 degrees. Although various treatments, including drug therapy, were administered at some clinics, the visual analog scale (VAS) score remained at approximately 70 mm. For seven months since her initial visit to closely our outpatient pain clinic, she was treated by several blocks along with rehabilitation therapy. However, the VAS score only decreased to 50 to 60 mm, and no further relief of symptoms could be obtained. Then, use of the fentanyl transdermal patch was initiated at the dose of 2.1 mg. This resulted in a dramatic reduction of the VAS score to 0 to 10 mm within 1 week, and the symptoms were relieved within 3 weeks to the level of no difference in the temperature of lower extremities. After two months the treatment was discontinued altogether according to the patient's wishes, however, no sign of CRPS recurrence has been observed at the present time. In this case, the course to the introduction of the fentanyl transdermal patch may also be important as a part of multidisciplinary treatment.