Complex Regional Pain Syndrome Status Post Coronary Artery Bypass Grafting: A Case Report

Friday, October 24, 2025

12:00 PM - 1:30 PM MT

Location: Kiosk 4

Poster Presenter(s)

Suha Qasem, MD

Resident physician
One Brooklyn Health System/Kingsbrook Jewish Medical Center PM&R Program
Brooklyn, New York

Co-Author(s)

MR

Marc Ross, MD

Chair Department of physical medicine and rehabilitation
One Brooklyn Health
New York, New York
ST

Samuel Thampi, MD

Attending Physician
Kingsbrook Jewish Medical Center
Huntington Station, New York
CC

Charlene Canales, DO

Resident physician
One Brooklyn Health System/Kingsbrook Jewish Medical Center PM&R Program
Brooklyn, New York
MS

Michael Sposito, MD

Resident Physician
One Brooklyn Health System/Kingsbrook Jewish Medical Center PM&R Program
Latham, New York
DS

Daniel Sanchez, MD

Resident
One Brooklyn Health System/Kingsbrook Jewish Medical Center PM&R Program
Brooklyn, New York
Panayotis Jusakos, MD

Resident Physician
One Brooklyn Health System/Kingsbrook Jewish Medical Center PM&R Program
Brooklyn, New York

Disclosure(s):

Suha Qasem, MD: No financial relationships to disclose

Samuel Thampi, MD: No financial relationships to disclose

Panayotis Jusakos, MD: No financial relationships to disclose

Case Diagnosis: Complex Regional Pain Syndrome (CRPS) Type I of the Right Upper Extremity Status Post Coronary Artery Bypass Grafting (CABG)

Case Description or Program Description: A 48-year-old female with SLE, Sjögren's syndrome, cerebrovascular accident, hypertension, dyslipidemia, and chronic kidney disease underwent triple-vessel CABG for high-grade stenosis of the left anterior descending and right coronary artery. Postoperatively, she developed severe right upper extremity pain, swelling, and hyperesthesia. Pain initially localized to the right chest wall, radiating bilaterally to the neck and worsening with movement, lying down, and coughing. The pain was sharp, achy, and burning, peaking at 10/10. Clinical findings included allodynia, anisothermia, and motor dysfunction. CRPS Type I was diagnosed per Budapest Criteria. CT imaging ruled out structural abnormalities.

Setting: Hospital outpatient rehabilitation / pain clinic

Assessment/Results: Gabapentin, lidocaine patches, and opioids were initiated with limited response. At six weeks post-CABG, pain remained severe (10/10) with significant functional impairment. By 12 weeks, pain improved to 5/10. However, mobility deficits persisted despite targeted pain management. Interventional strategies such as sympathetic nerve block, epidural infusion, and spinal cord stimulation were considered but not immediately pursued. Rehabilitation was delayed due to severe pain, limiting early mobilization.

Discussion (relevance): CRPS Type I is a rare but serious postoperative complication following CABG, linked to sympathetic dysfunction and inflammation. Risk factors such as autoimmune disease, vascular pathology, and female sex likely contributed. Early recognition and intervention are crucial to prevent disability. Despite growing awareness, CRPS remains under recognized in cardiac surgery populations, often leading to delayed diagnosis. Given CABG's increasing use in high-risk patients with autoimmune co-morbidities, preoperative risk stratification for CRPS is vital to improving outcomes.

Conclusions: CRPS should be considered in patients with persistent, disproportionate limb pain following CABG. A multidisciplinary treatment approach, integrating early pain control and rehabilitative therapy, is essential to maximizing recovery and reducing disability.