Autonomic Dysfunction Lyme Pain: Could It Explain CRPS?
Autonomic dysfunction Lyme pain may help explain severe, unexplained pain syndromes such as complex regional pain syndrome (CRPS) in patients with Lyme disease.
The article published in Clinical Autonomic Research cites several cases demonstrating how infections can affect the autonomic nervous system.
In one case, a 46-year-old patient reported increasing pain and swelling in his left foot. The pain became so severe that his leg became dysfunctional. “Even the slightest contact with the skin of the affected area caused unbearable pain.” [2]
CRPS and Lyme Disease: A Possible Connection
A patient described in the literature was initially diagnosed with CRPS of unknown cause until he later recalled a tick bite on his left foot.
He reported a 5 cm erythema migrans (EM) rash that resolved over two weeks, along with Lyme disease symptoms including stiff muscles, a swollen knee, fatigue, depression, headaches, and dizziness.
On examination, the patient had a thickened, swollen, and painful foot. The diagnosis of Lyme-associated CRPS was supported by serologic testing, PCR detection of B. burgdorferi, and clinical response to treatment.
Response to Treatment
The patient was treated with a 4-week course of ceftriaxone.
After two weeks, he was able to stand without support. By the end of treatment, he could walk independently, swelling resolved, and myalgia disappeared.
His depression and headaches also improved. Pain was reduced by approximately 75%, and treatment was continued with doxycycline for an additional three weeks.
How Autonomic Dysfunction May Drive Lyme Pain
Autonomic dysfunction Lyme pain may arise when infection affects the autonomic nervous system, which regulates involuntary functions such as heart rate, circulation, and digestion.
Although less common than inflammatory or immune-mediated causes, infectious diseases can disrupt autonomic pathways and contribute to abnormal pain signaling.
Artal notes that the pathogenesis of CRPS-like pain remains unclear but may involve immune mechanisms or persistence of infection within tissues.
Clinical Perspective
Autonomic dysfunction Lyme pain should be considered in patients presenting with severe, unexplained pain syndromes, particularly when accompanied by neurologic or systemic symptoms.
Conditions such as complex regional pain syndrome may, in some cases, have an infectious trigger.
Recognition of this potential link may lead to more targeted evaluation and treatment.
Clinical Takeaway
Autonomic dysfunction Lyme pain may contribute to severe neuropathic pain syndromes, including CRPS-like presentations.
In selected patients, identifying an infectious trigger may open the door to treatment approaches beyond standard pain management strategies.
References
- Artal FJC. Infectious diseases causing autonomic dysfunction. Clin Auton Res. 2017.
- Sibanc B, Lesnicar G. Complex regional pain syndrome and Lyme borreliosis: two different diseases? Infection. 2002;30(6):396-399.
- Gila L, Guerrero A, Astarloa R, Marti P, Gutierrez JM. Reflex sympathetic dystrophy and Lyme disease. Enferm Infecc Microbiol Clin. 1990;8(1):32-35.
- Bruckbauer HR, Preac Mursic V, Herzer P, Hofmann H. Sudeck’s atrophy in Lyme borreliosis. Infection. 1997;25(6):372-376.
- Neumann A, Schlesier M, Schneider H, Vogt A, Peter HH. Borrelia-reactive T lymphocytes in Lyme arthritis. Rheumatol Int. 1989;9(3-5):237-241.
Dr. Daniel Cameron, MD, MPH
Lyme disease clinician with over 30 years of experience and past president of ILADS.
Symptoms • Testing • Coinfections • Recovery • Pediatric • Prevention
I was actually diagnosed with a form of autonomic dysfunction (P.O.T.S.) before finding out I had untreated Lyme..I believe that is what caused, triggered, of flared the P.O.T.S.
So in this case, treating for lyme disease improved the autonomic nervous system dysfunction. Is the reverse also true? Is treating the autonomic nervous system dysfunction helpful in recovering from lyme disease?
Good question.
Unfortunately nearly 6 years of Lyme treatment for a CDC positive case has not helped to improve my autonomic dysfunction which manifests as generalized autonomic insufficiency and leaves me with nearly no control of hypotension or heart rate and pacemaker dependent since my 20’s. How do you know when to give up on trying to improve permanently and how to differentiate between active Lyme and permanent nerve damage?
For some individuals, it can persist. A number of specialists including cardiologists and POTS specialist weigh. It can still be difficult. We need more answers.
I’m CDC Lyme positive and clinical diagnosis for bartenella & babesia. Currently participating in the ‘Buffalo protocol’ for TBI, aka Traumatic Brain Injury for TBI aka Tick Borne Illness. The Dr is trying to adjust dopamine levels to increase energy levels as well as sympathetic / parasympathetic PT to ‘retrain’ autonomic cardio. I would love to learn more about what sympathetic / parasympathetic / autonomic / autoimmune issues are and how they relate to each other. Also, just how common is it to undergo concussion protocol to recover from persistent tick/internal parasite symptoms.
You are asking all the right questions.
I suffered from Lyme Disease pretty severely for about 5 months but still went to work half a day (reduced). Just as I improved most symptoms through antibiotics, I realized I had a cluster of symptoms related to POTS and was assigned compression stockings by a neurologist. I am wondering the same. More treatment for Lyme Disease or just accept the debilitating syndrome?
I treat central neuropathic pain in my clinic with ketamine infusion therapy. The most common condition we treat is CRPS. The correlation between CPRS and preexisting Lyme is clear. I now strongly encourage all CRPS patients to be tested by an ILADS specialist.
I discussed the topic in one of my Lyme Disease Science Blogs titles Could ketamine help manage pain in patients with post-treatment Lyme disease syndrome?
See my blog at https://danielcameronmd.com/ketamine-help-manage-pain-patients-post-treatment-lyme-disease-syndrome/
I wish this wonderfull doctor worked in London hospitals as well as scotland. This doctor could save my hubbys life. my hubby is on feeding tubes and is dying i belive from lyme disease. His whole nervous system is not working properly its obvious to me but sadly hes just been diagnosed with an eating disorder and forse fed.
this is not an eating disorder and the uclh hodpital are wrong to diagnose that based on no facts. My partner has pain everywhere moving round , numb patches , had heart attack in his 30s, feels sick all the time, has lost many teeth, his digestive system seems to be packing up , can hardly breath and his nervous /vagus nerve affected. This is probably Lyme disease but hes had no help or treatment for that so he gets sicker every day. Its hard to watch your loved one dying at 40 years of age. Lyme disease test is rubbish and people are just not getting help , instead any other disorder is pulled out of a hat. my whole family are sick ! im amazed Dr Cameron is making these connections , i wish he was our doctor here. shout out to Daniel Cameron who is obviously a man other hospitals should listen too ! !
I would like to learn more. My family has had Lyme for almost 40 years
I encourage my patients to look a second time at a tick-borne illness even if it has been 40 years.