A broad spectrum of conditions including neuropathic pain, complex regional pain syndrome (CRPS) and fibromyalgia, have been implicated as causes of chronic pain. There is a need for new and effective treatments that patients can tolerate without significant adverse effects. One potential intervention is hyperbaric oxygen treatment (HBOT). The case reported here is unique in describing repeated HBOT in a patient who developed recurrent post-traumatic CRPS of the lower as well as the upper limbs. In the first event, two months after distortion and abruption of the external right ankle, the patient suffered leg pain, oedema formation, mild hyperaemia, limited mobility of the ankle and CRPS Type 1. In the second event, the same patient suffered fracture-dislocation of the distal radius 1.5 years after the first injury. After the plaster cast was removed the patient developed pain, warmth, colour changes, oedema formation and limited wrist mobility with CRPS Type 1. Pharmacological treatment as well as HBOT were used with significant improvement of functional outcome in both cases. Some studies suggest that patients with a history of CRPS are more likely to develop secondary CRPS compared to the rates reported in the literature among the general population. Patients with a history of CRPS should be counselled that they may be at risk for developing secondary CRPS if they undergo surgery or sustain trauma to another extremity.

Centre of Hyperbaric Medicine Ostrava City Hospital Ostrava Czech Republic

Corresponding author Dr Michal Hajek Center of Hyperbaric Medicine Ostrava City Hospital Nemocnicni 20 728 80 Ostrava Czech Republic

Czech Anaerobic Bacteria Reference Laboratory Faculty of Medicine University of Ostrava Ostrava Czech Republic

Czech National Centre for Evidence Based Healthcare and Knowledge Translation Institute of Biostatistics and Analyses Faculty of Medicine Masaryk University Brno Czech Republic

Department of Biomedical Sciences Institute of Microbiology and Immunology Faculty of Medicine University of Ostrava Ostrava Czech Republic

Department of Forensic Medicine and Medicolegal Expertises Jessenius Faculty of Medicine Comenius University University Hospital Martin Slovak Republic

Department of Military Surgery Faculty of Military Health Sciences University of Defence Hradec Králové Czech Republic

The Institute of Aviation Medicine Prague Czech Republic

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The Effectiveness of Hyperbaric Oxygen Treatment in Patients with Complex Regional Pain Syndrome: A Retrospective Case series