Calcitonin nasal spray effective in limb pain following idiopathic brachial plexitis

A 55-year-old man presented 4 years after developing idiopathic left brachial plexitis. Proximal weakness rapidly resolved, but forearm and intrinsic hand function never returned. He presented to our pain management center with constant, severe, aching, deep left wrist and hand pain. He had been treated unsuccessfully for neuropathic pain with antiepileptics, antidepressants, opioids, and stellate ganglion block. Examination revealed profound left forearm and hand weakness and atrophy. Skin sensation was markedly diminished over the wrist and hand. There was no allodynia or hyperalgesia, but pain was partially reproduced with firm palpation. Plain radiographs revealed marked juxta-articular osteoporosis throughout the left wrist and hand. Calcitonin nasal spray was initiated at 200 international units daily. The patient reported marked reduction of wrist and hand pain within 2 weeks, and pain relief was still satisfactory 5 months after initiating calcitonin.

This case illustrates the important clinical point that persistent limb pain associated with nerve injury is not necessarily neuropathic. A careful interview and examination may reveal other causes of pain and suggest new avenues for effective treatment. In this case, calcitonin nasal spray was highly effective for the treatment of bone pain due to osteoporosis associated with nerve injury.