Identification and Treatment of New Inflammatory Triggers for Complex Regional Pain Syndrome: Small Intestinal Bacterial Overgrowth and Obstructive Sleep Apnea

A A Case Rep. 2016 May 1;6(9):272-6. doi: 10.1213/XAA.0000000000000292.


Complex regional pain syndrome (CRPS) is evoked by conditions that may be associated with local and/or systemic inflammation. We present a case of long-standing CRPS in a patient with Ehlers-Danlos syndrome in which prolonged remission was attained by directing therapy toward concomitant small intestinal bacterial overgrowth, obstructive sleep apnea, and potential increased microglia activity. We theorize that cytokine production produced by small intestinal bacterial overgrowth and obstructive sleep apnea may act as stimuli for ongoing CRPS symptoms. CRPS may also benefit from the properties of low-dose naltrexone that blocks microglia Toll-like receptors and induces production of endorphins that regulate and reduce inflammation.

Publication types

  • Case Reports

MeSH terms

  • Blind Loop Syndrome / blood
  • Blind Loop Syndrome / complications
  • Blind Loop Syndrome / drug therapy*
  • C-Reactive Protein / metabolism
  • Complex Regional Pain Syndromes / blood
  • Complex Regional Pain Syndromes / complications
  • Complex Regional Pain Syndromes / drug therapy*
  • Female
  • Humans
  • Inflammation Mediators* / blood
  • Middle Aged
  • Naltrexone / therapeutic use
  • Pain Management / methods*
  • Pain Measurement / methods
  • Rifamycins / therapeutic use
  • Rifaximin
  • Sleep Apnea, Obstructive / blood
  • Sleep Apnea, Obstructive / complications
  • Sleep Apnea, Obstructive / drug therapy*
  • Treatment Outcome


  • Inflammation Mediators
  • Rifamycins
  • Naltrexone
  • C-Reactive Protein
  • Rifaximin