In April, 2005 she presented to Caring Medical in Oak Park, Illinois with the hopes that Prolotherapy would offer her some relief. By this time, she was on Norco® 10/325, needing 10-14 tablets per day for pain. She was seeing a psychiatrist for depression, and was taking Cymbalta® for her anxiety and depression. Aside from intense pain she had the following concerns: severe insomnia, night sweats, weight gain of over 60 pounds since her injury, fatigue, and constipation. Her initial physical exam noted a cold, swollen and discolored left foot and ankle. She had significant tenderness (evidenced by dolorimeter measurements) in the ligaments supporting primarily the lateral and medial ankle. Because of her myriad of symptoms, a comprehensive natural medicine laboratory analysis was done which revealed low testosterone and DHEA levels. Natural hormone replacement for testosterone and DHEA were then prescribed. She was also asked to change her diet as she had significant food sensitivities for dairy and moderate sensitivities to gluten and eggs. Her venous blood pH being elevated, she was started on a hypoallergenic vegetarian diet.^**

Prolotherapy was started in the April 2005. Because of the severe pain in her left foot, she received conscious sedation to get through the Prolotherapy treatments. When she was seen for her third treatment in June, 2005 she was happier and reported that her standing tolerance had remarkably increased, and her pain level was down 15%. She continued to improve and was able to start wearing an electromesh sock on her left foot to help her foot tolerate more and more stimulation. The CRPS symptoms gradually improved. By the sixth visit no temperature or color asymmetry was present and the skin sensitivity significantly diminished in the left foot and ankle. By the seventh visit she was off all narcotics and antidepressant medications. Prolotherapy allowed her to finish graduate school, get married and she is now working full time as a social worker. It has been four years since her last Prolotherapy visit and she continues to live a normal, active life.

SUMMARY

To diagnose CRPS, according to the International Association for the Study of Pain Diagnostic Criteria, an initiating noxious event or a cause of immobilization must be present. Complex regional pain syndromes present as amplified somatic, motor, and sympathetic responses to injury or immobilization. CRPS is often precipitated by a deep tissue injury such as a ligament sprain or fracture. Typically, the injury is treated by casting, splinting or orthopedic surgery, which itself requires a period of immobilization. Immobilization itself has been shown to reproduce many of the symptoms of CRPS and itself can contribute to the non-healing of soft tissue injuries such as ligaments. Following trauma, ligaments show poor healing responses which themselves can contribute to a loss of motion of the joint. There is a high density of nociceptors in the ligaments of the body. These nociceptors have heightened activity to injury which can cause an exaggerated vasomotor and sudomotor response in the involved extremity, including edema, changes in skin blood flow, or decreased electrical skin resistance. Since CRPS is an extremely painful condition, patients do not move the involved extremity much. Since ligaments are very sensitive to immobilization, also called stress deprivation, they never heal, though other injuries, like bony fractures, resolve. This non-healed ligament injury continues to activate the sympathetic nervous system and the patient continues with the chronic symptoms, including the severe burning pain of CRPS. While traditional therapies such as physiotherapy, range of motion exercises, and pain medications offer temporary relief, they often do not cure the condition because they do not address the underlying ligament weakness/injury. Prolotherapy, an injection technique designed to stimulate tendon and ligament repair, has shown promise from some anecdotal reports. Prolotherapy, by stimulating ligament regeneration, not only resolves the pain, but also the sympathetic hyperactivity and the related symptoms of CRPS. Prolotherapy is a treatment that patients with CRPS and the doctors who treat them should consider.

** Giraffe Diet Type according to the book The Hauser Diet. Beulah Land Press, Oak Park, IL, 2007.