Jose J. Monsivais* and Erica Kozorosky
Purpose: The purpose of this study was to investigate the prevalence and incidence of antecedent and current infections with neurotropic viruses in a patient population with chronic neuropathic pain and presenting with Complex Regional Pain Syndrome (CRPS). The diagnosis was based on the International Association for the Study of Pain criteria.
Methods: This study investigated a pool of 409 patients who presented over a 10 year period with neuropathic pain and a history of one of the following diagnoses: Carpal tunnel syndrome, cubital tunnel syndrome, brachial plexopathy, or radiculopathy, or had received a nerve block, chemodenervation, or a brachial plexus block for relief of neuropathic symptoms and presented with acute symptoms suggestive of CRPS. Evaluations included physical assessments, antibody titer screening, inflammatory markers, skin biopsy results, and electro diagnostic studies when indicated.
Results: A total of 74 patients out of 409 neuropathic pain patients (prevalence 18.1%) had at least one positive titer of the following: Cytomegalovirus (CMV), Epstein-Barr Virus (EBV), Herpes simplex virus 1 and 2 (HSV), Parvovirus, Varicella- Zoster (VZV), or COVID-19. The most commonly associated pathogen found in this study was HSV-1 (n=22, 5.37%), followed by HSV-2, EBV, CMV, and Parvo (all n=8, 1.95%), VZV (n=7, 1.71%), and COVID (n=6, 1.47%). A total of 8 out of 74 patients (incidence 10.8%) met criteria for acute infectious neuropathy and required antiviral therapy with successful resolution of symptoms for over one year. The median nerve was most frequently involved.
Conclusions: If infectious neuropathies are not considered, there is the risk of using CRPS as the only diagnosis, thereby increasing morbidity, chronicity, and in some cases ongoing nerve damage. Patient screening for infectious neuropathies should include neurotropic viral screening as part of the routine workup. In our series, a prevalence of 18.1% was a significant frequency that triggered a more comprehensive workup. These conditions are treatable and a satisfactory response is highly probable.
Published Date: 2024-06-27; Received Date: 2024-05-28
