erythromelalgia

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Ronin1

Ronin1

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Anyone with experience treating. 24 yo severe hand and foot pattern. Appears to be primary. Failed oral meds ets. Hasn’t had any interventional treatment.
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Have treated two patients with SCS, both were in fellowship, one was early in the year and followed him for 8-9 months and he was doing well. Second only followed a month or so, was doing well at that time.

I just saw a 23 year old who had “CRPS from dancing all through high school”. Was on Percocet and getting LSBs over and over for the past 3 years. Been wondering about best way to treat her myself.

Paresthesia free seems to be a requirement for treatment as the tingling made symptoms worse in the two I was a part of, heard others say the same when researching it back then as well.
 
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Ronin1 said:
Anyone with experience treating. 24 yo severe hand and foot pattern. Appears to be primary. Failed oral meds ets. Hasn’t had any interventional treatment.
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Really uncommon diagnosis but often confused with odd neuropathies with vascular issues. I would agree with engaging them with an academic team if possible.

There are many reports of SCS helping for this though
pubmed.ncbi.nlm.nih.gov

Spinal Cord Stimulation for Treatment of Neuropathic Pain Associated With Erythromelalgia - PubMed

Spinal cord stimulation may be a promising treatment of neuropathic pain associated with erythromelalgia.
pubmed.ncbi.nlm.nih.gov pubmed.ncbi.nlm.nih.gov

Case Report and Literature Review: Interventional Management of Erythromelalgia - PMC

Erythromelalgia is a rare and very difficult to treat pain syndrome that usually presents as severe bilateral burning pain in the extremities. Here we present a case of a 34-year-old female with erythromelalgia who we treated successfully with a ...
www.ncbi.nlm.nih.gov www.ncbi.nlm.nih.gov

and at least one on going clinical trial

ClinicalTrials.gov

clinicaltrials.gov clinicaltrials.gov
 
Since it is primary, I think a low dose amlodipine makes the most sense and probably hasn’t been tried or sildenafil.
 
@gdub25
Probably send her to the ketamine queen for psych/infusion under the illusion of treating crps.

you put a system in and it will surely “spread” to the arms.
 
She has been to one University clinic and was not impressed. Going to try one more next week in California where she is in school. The parents are both docs on the same staff with me so I am willing to go the extra mile for them. Keep the ideas coming. Thanks
 
I'm confused... are we talking cervical or thoracic SCS?

because it is my understanding that erythromelelgia is upper and lower extremity disorder...
 
It follows the classic feet, hands, etc pattern of neuropathies. Generally feet over hands in the true cases I've seen.
 
We had a female in her early 30s with this diagnosis during fellwoship. She eventually got a stimulator after going through everything. Turns.out she was a semi rich suburrban housewife hooked on opioids and she was busted and caught.
Of course the university pain clinic overdiagnosed her and she ended up being a pain fellow pratice live model essentially in exchange for opiods
 
Ronin1 said:
Do you have a dosing protocol for lidocaine infusions?

so far she had a series of stellates with only short term benefits.
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We used to do 3 - 5 mg/kg in a 500 mL bag based on IBW if they're morbidly obese, max of 500 mg of Lidocaine. Pretreat with Valium PO and infuse over 60 - 120 min depending on tolerance.
 
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