BACKGROUND: Complex regional pain syndrome (CRPS) is characterized by disproportionate pain along with autonomic signs and trophic changes. In rare instances, it can spread to other extremities.

CASE REPORT: We report an unusual case of gradual progression of CRPS to all 4 extremities in a patient who developed CRPS following a traumatic event. Despite receiving adequate medical management, her pain pattern spread to her other extremities, causing significant functional impairment, and she eventually had to undergo minimally invasive procedures, namely stellate ganglion blocks (SGB) and spinal cord stimulators (SCS), for management of her symptoms.

CONCLUSIONS: SGB and SCS have been documented to relieve pain in patients with CRPS. However, they do not appear to prevent progression and spread of the disease. Our patient had a cumulative benefit from SGB. The authors would like to highlight an unusual pattern of evolution of CRPS and advocate research for management of treatment-resistant pain patterns.

KEYWORDS: Budapest criteria, CRPS, Complex regional pain syndrome, case report, spinal cord stimulators, stellate ganglion blocks