An 11-year-old girl, without known drug allergies or a history of interest, was admitted to Pediatrics due to episodes of sudden and recurrent crises of severe and disabling pain in the right shoulder radiating to the distal third of the forearm.
After study by EMG and MRI by Pediatric Neurology is diagnosed with PTS.
Due to the difficulty in controlling pain crises with NSAI and chloride consultation, they make an interconsultation sheet to our Pain Unit for treatment adjustment.
Upon arrival, the patient had his right arm immobilized in a sling.
After anamnesis and careful physical examination, the patient presented severe pain in the right shoulder radiating to the forearm, with a VAS of 7 at rest, which increased to 9 in attempts to mobilize the limb.
alodin, feeling paraesthesia and cramps especially in the forearm
In addition, it refers undesirable effects of treatment with a dose of 0.1 mg/kg/8 h.
The LANSS (16/24) and DN-4 (7/10) scales were used to confirm the important neuropatic component of the disease.
After these findings we started removing paulatin chloride and prescribed paracetamol 650 mg/8 h, 5% lidocaine patches (Versatis(r))) in the forearm for 12 h, removing pregabalin (LLA) and nighttime
We performed an interconsultation sheet with Rehabilitation.
Five days later the patient was discharged due to symptomatic improvement.
Monthly reviews are planned in consultation.
In the first review, it is necessary to increase pregabalin (Lyrica(r) 75 mg/12 h to control baseline pain, increasing to 75 mg/8 h during seizures, which in this case are already of lower intensity and duration.
5 % lidocaine (Versatis(r)) is maintained in patches and seasons are alternated with paracetamol or metamizole.
With this treatment, approximately 3 months without sprouts were adhered to, although given the course of the disease, the pain worsened significantly at 6 months after starting treatment.
Oxcarbamazepine 300 mg/24 h was added with improvement.
He is currently being followed up by our unit.
Pain intensity was lower (EVA at rest 4, at movement 7), with shorter crises (5-8 days) and more frequent in time (every 2-3 months).
Current recommendations focus on preventing pain crises with NSAIDs and chloride.
However, the neurophatic component of PTS often makes these drugs insufficient, so 5 % lidocaine patches (Versatis(r)), pregabalin (Lyrica ocarbamaze, according to our experience)
Randomized clinical trials are needed to establish the indication of these drugs as an alternative treatment.
