Lumbar sympathetic block for pain relief and healing of chronic vascular ulcer on lower limb in patient with antiphospholipid syndrome and immune thrombocytopenic purpura

Abstract

Lower extremity ulcer is an infrequent but disabling complication of long-standing connective tissue disease such as antiphospholipid syndrome (APS). We reported a case of a 51-year-old female suffering from APS and immune thrombocytopenic purpura who was referred to our pain clinic with a history of 1-year chronic pain on the dorsal part of the bilateral foot. She also had a poor healing vascular ulcer on her right leg. Drug therapy managed to control her bilateral foot pain, but her chronic ulcer pain was not resolved, resulting in her decision to finally quit being a teacher. She even underwent 24 sessions of hyperbaric oxygen therapy but with unsatisfactory outcome. Later, a trial of lumbar sympathetic block was offered to her. Surprisingly, she responded very well. The chronic ulcer healed completely after her second session, and she was no longer dependent on any pain killer.