Complete Resolution of Complex Regional Pain Syndrome Following Endometriosis Excision Surgery

Hormonal Modulation of Pain Pathways via Estrogen Receptor β (ERβ)

Background

Complex Regional Pain Syndrome (CRPS) causes severe chronic pain, hypersensitivity, and loss of function. Many patients remain symptomatic despite medications, physical therapy, nerve blocks and procedural interventions.2

Endometriosis involves the growth of endometrial tissue outside the uterus. It may present in the pelvic, abdominal or thoracic cavities. It has been recognized as a systemic inflammatory disease capable of producing central nervous system sensitization and chronic pain amplification.4

Case

27-year-old female

Minor electrocution injury to right hand → rapid onset CRPS

Symptoms:

Pain remained refractory despite:

The patient developed severe gastrointestinal and biliary symptoms with repeatedly normal imaging and biopsy.

Discovery 2.5 Years After CRPS Onset

Outcome

After surgery:

The patient remained symptom-free at 2 week, 3-, 6- and 9-month follow-up without further CRPS treatment.

Clinical Implication

Endometriosis is thought to sensitize the nervous system and may cause and sustain CRPS via crosstalk through inflammatory, hormonal and pain pathways.5-14, 17-20

Endometriosis should be considered in the case of refractory CRPS in females of a reproductive age.