Abstract

Background: CRPS can cause debilitating chronic pain and significant functional impairment, often with poor response to conventional treatment approaches. As a result, long-term recovery is infrequently reported.

Case presentation: We present a 12-year-old female who developed CRPS of the right lower extremity following a simple ankle sprain (April 2022). Despite repeated medical and interventional therapies, including inpatient pain management, nerve blocks, spinal stimulator trial, and behavioral pain programs, she continued to deteriorate over ~18 months, and doctors recommended a below-knee amputation. On November 6 2024, she entered the program at The Spero Clinic. At intake, assessments revealed severe neuropathic pain (Neuropathic Pain Symptom Inventory [NPSI] 91/100), major swelling, marked hypersensitivity (allodynia), decreased range of motion (ankle/hip), weakness due to pain inhibition, and functional disability (Lower Extremity Functional Index [LEFI] ~60/80).

Intervention & outcome: Over the subsequent 3–4 months, using a comprehensive multimodal neuro-rehabilitative program, the patient experienced progressive reduction of pain and sensitivity, decreased swelling, restoration of range of motion and strength, normalization of lower extremity circumference, and regained independent, pain-free mobility. At graduation, she was pain-free, walking in regular shoes, and resumed normal activity.

Conclusion: This case illustrates that even severe, treatment-resistant pediatric CRPS may respond to an integrative, autonomic-focused neurorehabilitation model—offering hope for recovery where conventional medical and interventional therapies have failed.

Keywords: CRPS, pediatric CRPS, neuropathic pain, neurorehabilitation, vagus nerve stimulation, neuromuscular re-education, brain retraining, case report

Introduction

Complex Regional Pain Syndrome (CRPS) is a poorly understood, often debilitating pain condition characterized by severe, persistent pain, allodynia, swelling, and impaired motor and autonomic function. Pediatric CRPS is less well described in the literature than adult cases, and

long-term functional recovery remains rare, particularly when initial standard-of-care (pain management, pharmacology, interventional procedures) fails. Case reports play a critical role in illuminating potential effective therapies for such complex, refractory conditions.

Here we present the case of an adolescent with severe, treatment-resistant CRPS of the lower extremity — who, after nearly two years of unsuccessful standard treatment (including a recommendation for amputation), underwent a comprehensive, integrative neurological/rehabilitative program at The Spero Clinic, resulting in full recovery of function and remission of pain. This case may provide valuable insight into alternative treatment pathways and encourage further research.

Case Presentation

Patient Information

• Age / Sex: 12-year-old female at onset (sprain in April 2022)
• Relevant history: Previously healthy, active child; no prior significant medical history

History of Present Illness

In April 2022, the patient suffered a right ankle sprain after falling from a vehicle. Initially managed as a routine sprain. Within days, her foot began to swell and discolor, with increasing pain and hypersensitivity. Over the next several weeks, her symptoms worsened: swelling extended up her leg, pain intensified, and she developed allodynia to touch, temperature, and water. Mobility declined to the point of requiring crutches.

From July 2022 onward, she underwent repeated imaging, evaluations, and laboratory testing, none revealing an anatomical cause. She was frequently told the symptoms were psychological. By late 2022, she experienced escalating pain, widespread hypersensitivity, worsening swelling, emotional distress, and new dermatologic symptoms.

In January 2023, after evaluation at a tertiary center, below-knee amputation was recommended. Over the next year, she underwent multiple unsuccessful interventions, including inpatient pain programs, epidural injection, nerve blocks, spinal stimulator trial, lidocaine catheter infusions, behavioral pain therapy, acupuncture, massage, and other holistic approaches. Across these treatments, her pain remained severe, and functional ability continued to decline, with episodes of syncope triggered by contact with the affected limb.

Clinical Findings & Baseline Assessment (at Admission to Spero Clinic, 6 Nov 2024)

• Severe neuropathic pain: NPSI 91/100
• Edema: Marked swelling of the right lower extremity
• Sensory abnormalities: Extreme allodynia, dermatomal spread of hypersensitivity ● Motor dysfunction: Severely restricted hip/ankle ROM, strength limited by pain ● Functional disability: LEFI ~60/80; difficulty weightbearing
• Psychosocial findings: Distress, fear, reduced quality of life, social withdrawal

Therapeutic Intervention (Spero Clinic Program)

From November 2024, the patient completed a multimodal neurological rehabilitation program centered on autonomic restoration, neuroplasticity, and functional re-integration:

Core Treatment Components

• Vagus Nerve Stimulation (VNS): cervical-based stimulation to regulate autonomic imbalance, reduce neuroinflammation, and modulate pain pathways
• Neuromuscular Re-education (direct-current stimulation): reconditioning dysfunctional muscle–nerve communication, improving joint mobility, and decreasing pain guarding
• Brain-based therapies: including cold-laser photobiomodulation for neuroinflammation reduction and enhanced neural recovery
• Neuromodulation: non-invasive neurostimulation to calm hyperactive pain pathways
• Sound-wave (acoustic) soft-tissue therapy: to break down adhesions and improve neural mobility
• Lymphatic & circulatory support: to reduce edema and enhance tissue healing
• Functional reconditioning: progressive gait training, strengthening, weight-bearing restoration, and mobility retraining
• Brain retraining & psychological support: addressing the cognitive-emotional dimensions of chronic pain, restoring confidence, and reducing fear-based avoidance
• Medication tapering: guided, gradual reduction of analgesics as function improved

This integrative model emphasizes restoring neurological regulation and functional capacity rather than relying on symptom-suppression strategies.

Outcome and Follow-Up

Over a 3–4 month period, the patient demonstrated:

• Steady reduction in pain and hypersensitivity, progressing to full resolution ● Significant reduction in swelling, with near-symmetrical circumference ● Restoration of hip and ankle ROM, and strength returning to 5/5 bilaterally ● Return to independent ambulation, eventually wearing regular footwear ● Emotional recovery, with renewed confidence and social engagement
• Full return to daily activities without pain or restrictions

No adverse events or complications were observed.

Discussion

This case demonstrates the potential effectiveness of a comprehensive neurological rehabilitation model for pediatric CRPS that has not responded to conventional therapies. Traditional CRPS management often focuses on medications and interventional procedures, which may fail to resolve underlying autonomic and neuroplastic dysfunction.

The Spero Clinic’s multimodal approach addresses CRPS as a whole-system disorder involving autonomic dysregulation, sensory amplification, and motor impairment. The patient’s complete

recovery suggests that neuroplasticity-based rehabilitation may be a viable alternative for refractory cases.

Conclusion

• Severe, treatment-resistant CRPS can respond to integrative, autonomic-centered neurorehabilitation.
• Approaches targeting the autonomic nervous system, neuroinflammation, and sensorimotor dysfunction may offer recovery where conventional treatments fail.
• This case supports further exploration of multimodal neurorehabilitation as a viable pathway for complex CRPS presentations.

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