Recurrent migratory sympathetically maintained pain syndrome in a child: a case report

A 10-year-old boy presented with pain and swelling of short duration in his right hand. A traumatic cause was ruled out. He had clinical features suggestive of sympathetic overactivity in the form of hyperesthesia, edema and dry skin. The results of a few baseline investigations performed at this stage were all within normal limits. A provisional diagnosis of sympathetically maintained pain syndrome (SMPS) was made. He responded dramatically to a stellate ganglion block. His symptoms recurred within 3 weeks, though now in the lower limb. Again the clinical features were consistent with SMPS. His response to a lumbar sympathetic block was again dramatic. This case illustrates that the diagnosis of SMPS is essentially clinical and that prompt diagnosis and treatment with sympathetic blocks can be very rewarding.