Impact of the use of neurostimulation for the management of a patient with complex pain syndrome and severe trophic changes. Case report
Keywords:
Complex regional pain syndrome, Neurostimulation, Causalgia
Abstract
Introduction: Limb trauma and surgery are frequent causes of complex regional pain syndrome (CRPS). Some cases are very difficult to manage despite the use of high-dose analgesics, anti-inflammatory agents and physical therapy; hence the need to look for interventional therapies to slow its progression.
Case description and results: We present the case of a patient diagnosed with CRPS type I with severe trophic changes and marked functional limitation, managed with multiple pharmacological therapies and nerve blocks without apparent improvement. The patient decided to try neurostimulation with favourable results and substantial improvement months later reported as «100% improvement» of pain; reduced oedema; progressive recovery of the normal appearance of the hand; partial recovery of strength, and improved function attributable to the use of this additional therapy.
Conclusion: Neurostimulation has a noticeable impact on the course of the complex regional pain syndrome accompanied by trophic changes in patients with a poor response to there commended pharmacological management. Early initiation of this intervention facilitates functional and psychological recovery of the patients, who are usually in the productive stage of their lives.
References
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11. Merskey H, Bogduk N. Classification of chronic pain: Descriptions of chronic pain syndromes and definitions of pain terms. Seattle, WA: IASP Press; 1994.
12. Harden RN, Bruehl S, Stanton-Hicks M, Wilson PR. Proposed new diagnostic criteria for complex regional pain syndrome. Pain Med. 2007;8:326-31.
13. Oerlemans HM, Ootendorp R, de Boo T, van der Laan L, Severens JL. Adyuvant physical therapy versus occupational therapy in patients with reflex sympathetic dystrophy/complex regional pain syndrome type I. Arch Phys Med Rehabil. 2000;81:49-56.
14. Yung CO, Bruehl SP. Complex regional pain syndrome. Curr Treat Options Neurol. 2003;5:499-511.
15. Christensen K, Jensen EM, Noer I. The reflex dystrophy syndrome response to treatment with systemic corticosteroids. Acta Chir Scand. 1982;148:653-5.
16. Melzac R, Wall PD. Pain mechanisms: A new theory. Science. 1965;150:971-9.
17. Cruccu G, Aziz TZ, Garcia-Larrea L, Hansson P, Jensen TS, Lefaucheur JP, Simpson BA, et al. EFNS guidelines on neurostimulation therapy for neuropathic pain. Eur J Neurol. 2007;14:952-70.
18. Schwartzman RJ, McLellan TL. Reflex sympathetic dystrophy: A review. Arch Neurol. 2001;44:555-61.
19. Price DD, Long S, Wilsey B, Rafii A. Analysis of peak magnitude and duration of analgesia produced by local anesthetics injected into sympathetic ganglia of complex regional pain syndrome patients. Clin J Pain. 1998;14:116-226.
20. Forouzanfar T, Kemler MA, Weber WE, Kessels AG, van Kleef M. Spinal cord stimulation in complex regional pain syndrome: Cervical and lumbar devices are comparably effective. Br J Anaesth. 2004;92:348-53.
21. Kemler MA, de Vet HC, Barendse GA, van den Wildenberg FA, van Kleef M. The effect of spinal cord stimulation in patients with chronic reflex sympathetic dystrophy: Two years' follow-up of the randomized controlled trial. Ann Neurol. 2004;55:13-8.
22. Hassenbusch SJ, Stanton-Hicks M, Schoppa D, Walsh JG, Covington EC. Long-term results of peripheral nerve stimulation for reflex sympathetic dystrophy. J Neurosurg. 1996;84:415-23.
23. Kemler MA, Reulen JP, Barendse GA, van Kleef M, de Vet HC, van de Wildenberg F.A. Impact of spinal cord stimulation on sensory characteristics in complex regional pain síndrome type I: randomized trial. Anesthesiology. 2001;95:72-80.
24. Kemler MA, de Vet HC, Barendse GA, van den Wildenberg FA, van Kleef M. Effect of spinal cord stimulation for chronic complex regional pain syndrome type I: Five-year final follow-up of patients in a randomized controlled trial. J Neurosurg. 2008;108:292-8.
2. Sandroni P, Benrud-Larson LM, McClelland RL, Low PA. Complex regional pain syndrome type 1: Incidence and prevalence in Olmsted county, a population -based study. Pain. 2003;103:199-207.
3. De Mos M, de Bruijn AG, Huygen FJ, Dieleman JP, Stricker BH, Sturkenboom MC. The incidence of complex regional pain syndrome: A population-based study. Pain. 2007;129:12-20.
4. Schwartzman RJ, Erwin KL, Alexander GM. The natural history of complex regional pain syndrome. Clin J Pain. 2009;25:273-80.
5. De Mos M, Huygen FJ, van der Hoeven-Borgman M, Dieleman JP, Stricker BH, Sturkenboom MC. Referral and treatment patterns for complex regional pain syndrome in the Netherlands. Acta Anaesthesiol Scand. 2009;53:816-25.
6. Atkins RM, Duckworth T, Kains JA. Features of algodystrophy after Colles' fracture. J Bone Joint Surg Brit. 1990;72:105-10.
7. Janig W, Baron R. Complex regional pain syndrome: Mystery explained? Lancet Neurol. 2003;2:687-97.
8. Rodríguez R, Isaza AM. Síndrome doloroso regional complejo. Rev Colomb Anestesiol. 2011;39:71-83.
9. Birklein F, Schmelz M. Neuropeptides, neurogenic inflammation and complex regional pain syndrome (CRPS). Neurosci Lett. 2008;437:199-202.
10. Gibbs GF, Drummond PD, Finch PM, Phillips JK. Unravelling the pathophysiology of complex regional pain syndrome: Focus on sympathetically maintained pain. Clin Exp Pharmacol Physiol. 2008;35:717-24.
11. Merskey H, Bogduk N. Classification of chronic pain: Descriptions of chronic pain syndromes and definitions of pain terms. Seattle, WA: IASP Press; 1994.
12. Harden RN, Bruehl S, Stanton-Hicks M, Wilson PR. Proposed new diagnostic criteria for complex regional pain syndrome. Pain Med. 2007;8:326-31.
13. Oerlemans HM, Ootendorp R, de Boo T, van der Laan L, Severens JL. Adyuvant physical therapy versus occupational therapy in patients with reflex sympathetic dystrophy/complex regional pain syndrome type I. Arch Phys Med Rehabil. 2000;81:49-56.
14. Yung CO, Bruehl SP. Complex regional pain syndrome. Curr Treat Options Neurol. 2003;5:499-511.
15. Christensen K, Jensen EM, Noer I. The reflex dystrophy syndrome response to treatment with systemic corticosteroids. Acta Chir Scand. 1982;148:653-5.
16. Melzac R, Wall PD. Pain mechanisms: A new theory. Science. 1965;150:971-9.
17. Cruccu G, Aziz TZ, Garcia-Larrea L, Hansson P, Jensen TS, Lefaucheur JP, Simpson BA, et al. EFNS guidelines on neurostimulation therapy for neuropathic pain. Eur J Neurol. 2007;14:952-70.
18. Schwartzman RJ, McLellan TL. Reflex sympathetic dystrophy: A review. Arch Neurol. 2001;44:555-61.
19. Price DD, Long S, Wilsey B, Rafii A. Analysis of peak magnitude and duration of analgesia produced by local anesthetics injected into sympathetic ganglia of complex regional pain syndrome patients. Clin J Pain. 1998;14:116-226.
20. Forouzanfar T, Kemler MA, Weber WE, Kessels AG, van Kleef M. Spinal cord stimulation in complex regional pain syndrome: Cervical and lumbar devices are comparably effective. Br J Anaesth. 2004;92:348-53.
21. Kemler MA, de Vet HC, Barendse GA, van den Wildenberg FA, van Kleef M. The effect of spinal cord stimulation in patients with chronic reflex sympathetic dystrophy: Two years' follow-up of the randomized controlled trial. Ann Neurol. 2004;55:13-8.
22. Hassenbusch SJ, Stanton-Hicks M, Schoppa D, Walsh JG, Covington EC. Long-term results of peripheral nerve stimulation for reflex sympathetic dystrophy. J Neurosurg. 1996;84:415-23.
23. Kemler MA, Reulen JP, Barendse GA, van Kleef M, de Vet HC, van de Wildenberg F.A. Impact of spinal cord stimulation on sensory characteristics in complex regional pain síndrome type I: randomized trial. Anesthesiology. 2001;95:72-80.
24. Kemler MA, de Vet HC, Barendse GA, van den Wildenberg FA, van Kleef M. Effect of spinal cord stimulation for chronic complex regional pain syndrome type I: Five-year final follow-up of patients in a randomized controlled trial. J Neurosurg. 2008;108:292-8.
How to Cite
1.
Villegas Pineda MH, Herrera C, León Martínez T, Ordoñez Fernández V. Impact of the use of neurostimulation for the management of a patient with complex pain syndrome and severe trophic changes. Case report. Colomb. J. Anesthesiol. [Internet]. 2014 Oct. 1 [cited 2024 Apr. 20];42(4):321-4. Available from: https://www.revcolanest.com.co/index.php/rca/article/view/254
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Published
2014-10-01
How to Cite
1.
Villegas Pineda MH, Herrera C, León Martínez T, Ordoñez Fernández V. Impact of the use of neurostimulation for the management of a patient with complex pain syndrome and severe trophic changes. Case report. Colomb. J. Anesthesiol. [Internet]. 2014 Oct. 1 [cited 2024 Apr. 20];42(4):321-4. Available from: https://www.revcolanest.com.co/index.php/rca/article/view/254
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Case Report / Case Series
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