Complex regional pain syndrome (CRPS) is a devastating posttraumatic neuroinflammatory condition with both autoinflammatory and autoimmune features, characterized by unrelenting severe pain and disability, with the majority of affected patients being unable to function socially or vocationally. Remission is more likely in children than adults, and if treatment is started early. Once established, there are no universally effective treatments, and these are desperately needed. A single limb is often involved, but there can be multi-limb spread, and systemic autonomic manifestations. We describe a case of long-standing CRPS with multi-limb spread and systemic autonomic features, controlled only with very high dose oral corticosteroids, which led to several complications. Multiple other treatment modalities failed or were insufficient to control the CRPS and allow tapering of the corticosteroids, but the patient had a dramatic response to hyperbaric oxygen therapy (HBOT), allowing a reduction in prednisone dose to just over the physiologic range. When symptoms started to increase several months later, a second course of HBOT treatments allowed reduction in prednisone dose into the physiologic range while still controlling CRPS symptoms. This case is unique in that it shows that HBOT can be effective in long-standing CRPS, both initially, and for subsequent flares, and adds to the evidence supporting HBOT as a potential treatment for this condition.

HBOT effect on prednisone dose for symptom control

中文翻译：

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高压氧疗法成功治疗了长期存在的复杂区域性疼痛综合征。

复杂的区域性疼痛综合征（CRPS）是一种具有自体炎症和自身免疫特征的毁灭性创伤后神经炎性疾病，其特征是无情的严重疼痛和残疾，大多数受影响的患者无法进行社交或职业活动。儿童和成年人的缓解可能性更大，而且如果提早开始治疗的话。一旦确立，就没有普遍有效的治疗方法，这是迫切需要的。通常只涉及一个肢体，但可能会出现多肢蔓延和全身自主神经表现。我们描述了一例具有多肢扩散和全身自主神经功能的长期CRPS病例，仅通过非常高剂量的口服皮质类固醇激素才能控制，这导致了许多并发症。多种其他治疗方式均无效或不足以控制CRPS并逐渐减少皮质类固醇，但患者对高压氧疗法（HBOT）产生了戏剧性的反应，从而将泼尼松的剂量减少至刚好超过生理范围。当症状在几个月后开始增加时，第二次HBOT治疗可以使泼尼松剂量减少至生理范围，同时仍控制CRPS症状。该案例的独特之处在于，它表明HBOT在长期CRPS初期和随后的耀斑中均有效，并增加了支持HBOT作为该病潜在治疗方法的证据。可将泼尼松剂量减少至刚好超过生理范围。当症状在几个月后开始增加时，第二次HBOT治疗可以使泼尼松剂量减少至生理范围，同时仍控制CRPS症状。该案例的独特之处在于，它表明HBOT在长期CRPS初期和随后的耀斑中均有效，并增加了支持HBOT作为该病潜在治疗方法的证据。可将泼尼松剂量减少至刚好超过生理范围。当症状在几个月后开始增加时，第二次HBOT治疗可以使泼尼松剂量减少至生理范围，同时仍控制CRPS症状。该案例的独特之处在于，它表明HBOT在长期CRPS初期和随后的耀斑中均有效，并增加了支持HBOT作为该病潜在治疗方法的证据。

HBOT对强的松剂量的症状控制作用