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ANALGESIA

Successful Intravenous Regional Block with Low-Dose Tumor Necrosis Factor- Antibody Infliximab for Treatment of Complex Regional Pain Syndrome 1

Michael Bernateck, MD^*, Roman Rolke, MD, Frank Birklein, MD, Rolf-Detlef Treede, MD, Matthias Fink, MD, and Matthias Karst, MD^*

From the *Department of Anesthesiology, Pain Clinic, Hannover Medical School; Department of Neurology; Institute of Physiology and Pathophysiology, University of Mainz; and Department of Physical Medicine and Rehabilitation, Hannover Medical School, Germany.

Address correspondence and reprint requests to Michael Bernateck, MD, Hannover Medical School, Department of Anesthesiology, Pain Clinic, Carl-Neuberg-St. 1, 30625 Hannover, Germany. Address e-mail to bernateck.michael{at}mh-hannover.de.

Abstract

Cytokines, particularly tumor necrosis factor-, may play an important role in the mediation of mechanical hyperalgesia and autonomic signs in complex regional pain syndrome 1. We performed an IV regional block with low-dose administration of the tumor necrosis factor- antibody, infliximab, in a patient with typical clinical signs of complex regional pain syndrome 1 (moderate pain, edema, hyperhidrosis, elevated skin temperature compared with the contralateral side). A significant improvement of clinical variables was observed 24 h after infliximab treatment. Almost complete remission was reached within 8 wk, but sensory signs improved only after 6 mo. No adverse events were observed.