The Shared Gabaminergic Mechanism Lends Itself to Treatment of Dystonia in Complex Regional Pain Syndrome With Spinal Cord Stimulation

The authors present the case of a 49-year-old female patient with complex regional pain syndrome–Type I (CRPSI) who was suffering from nonhealing wounds and giant bullae, which dramatically improved after spinal cord stimulation (SCS). The scientific literature concerning severe cutaneous manifestations of CRPS-I and their treatment is reviewed. Nonhealing wounds and bullae are rare manifestations of CRPS-I that are extremely difficult to treat. Immediate improvement of both wounds and bullae after SCS, such as in this case, has not been reported previously in literature. Considering the rapidly progressive nature of these severe skin manifestations, immediate treatment, possibly with SCS, is mandatory.

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Spinal cord stimulation for complex regional pain syndrome

10.1109/iembs.2009.5334418 ◽

2009 ◽

Cited By ~ 3

Author(s):

M. Shrivastav ◽

S. Musley

Keyword(s):

Spinal Cord ◽

Complex Regional Pain Syndrome ◽

Spinal Cord Stimulation ◽

Pain Syndrome

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Spinal cord stimulation for complex regional pain syndrome type 1 with dystonia: a case report and discussion of the literature

F1000Research ◽

10.12688/f1000research.3771.1 ◽

2014 ◽

Vol 3 ◽

pp. 97 ◽

Cited By ~ 1

Author(s):

Caroline Voet ◽

Bernard le Polain de Waroux ◽

Patrice Forget ◽

Ronald Deumens ◽

Etienne Masquelier

Keyword(s):

Spinal Cord ◽

Nervous System ◽

Case Report ◽

Complex Regional Pain Syndrome ◽

Spinal Cord Stimulation ◽

Behavioural Change ◽

Pain Syndrome ◽

Social Model ◽

Syndrome Type

Background: Complex Regional Pain Syndrome type 1 (CRPS-1) is a debilitating chronic pain disorder, the physiopathology of which can lead to dystonia associated with changes in the autonomic, central and peripheral nervous system. An interdisciplinary approach (pharmacological, interventional and psychological therapies in conjunction with a rehabilitation pathway) is central to progress towards pain reduction and restoration of function.Aim: This case report aims to stimulate reflection and development of mechanism-based therapeutic strategies concerning CRPS associated with dystonia.Case description: A 31 year old female CRPS-1 patient presented with dystonia of the right foot following ligamentoplasty for chronic ankle instability. She did not have a satisfactory response to the usual therapies. Multiple anesthetic blocks (popliteal, epidural and intrathecal) were not associated with significant anesthesia and analgesia. Mobilization of the foot by a physiotherapist was not possible. A multidisciplinary approach with psychological support, physiotherapy and spinal cord stimulation (SCS) brought pain relief, rehabilitation and improvement in the quality of life.Conclusion: The present case report demonstrates the occurrence of multilevel (peripheral and central) pathological modifications in the nervous system of a CRPS-1 patient with dystonia. This conclusion is based on the patient’s pain being resistant to anesthetic blocks at different levels and the favourable, at least initially, response to SCS. The importance of the bio-psycho-social model is also suggested, permitting behavioural change.

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Cost‐Effectiveness of Dorsal Root Ganglion Stimulation or Spinal Cord Stimulation for Complex Regional Pain Syndrome

Neuromodulation Technology at the Neural Interface ◽

10.1111/ner.13134 ◽

2020 ◽

Author(s):

Nagy Mekhail ◽

Timothy R. Deer ◽

Lawrence Poree ◽

Peter S. Staats ◽

Allen W. Burton ◽

...

Keyword(s):

Spinal Cord ◽

Cost Effectiveness ◽

Dorsal Root Ganglion ◽

Complex Regional Pain Syndrome ◽

Spinal Cord Stimulation ◽

Dorsal Root ◽

Pain Syndrome

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Spinal Cord Stimulation Is Effective in Management of Complex Regional Pain Syndrome I: Fact or Fiction

Neurosurgery ◽

10.1227/neu.0b013e3182181e60 ◽

2011 ◽

Vol 69 (3) ◽

pp. 566-580 ◽

Cited By ~ 71

Author(s):

Krishna Kumar ◽

Syed Rizvi ◽

Sharon Bishop Bnurs

Keyword(s):

Quality Of Life ◽

Spinal Cord ◽

Functional Status ◽

Complex Regional Pain Syndrome ◽

Spinal Cord Stimulation ◽

Pain Syndrome ◽

Sf 36

Abstract BACKGROUND: Complex regional pain syndrome (CRPS) I is a debilitating neuropathic pain disorder characterized by burning pain and allodynia. Spinal cord stimulation (SCS) is effective in the treatment of CRPS I in the medium term but its long-term efficacy and ability to improve functional status remains controversial. OBJECTIVE: To evaluate the ability of SCS to improve pain, functional status, and quality of life in the long term. METHODS: We retrospectively analyzed 25 patients over a mean follow-up period of 88 months. The parameters for evaluation were visual analog scale (VAS), Oswestry Disability Index (ODI), Beck Depression Inventory (BDI), EuroQoL-5D (EQ-5D) and Short Form 36 (SF-36), and drug consumption. Evaluations were conducted at point of entry, 3 months, 12 months, and last follow-up at 88 months (mean). RESULTS: At baseline, the mean scores were VAS 8.4, ODI 70%, BDI 28, EQ-5D 0.30, and SF-36 24. In general, maximum improvement was recorded at follow-up at 3 months (VAS 4.8, ODI 45%, BDI 15, EQ-5D 0.57, and SF-36 45). At last follow-up, scores were 5.6, 50%, 19, 0.57, and 40, respectively. Despite some regression, at last follow-up benefits were maintained and found to be statistically significant (P < .001) compared with baseline. Medication usage declined. SCS did not prevent disease spread to other limbs. Best results were achieved in stage I CRPS I, patients under 40 years of age, and those receiving SCS within 1 year of disease onset. CONCLUSION: SCS improves pain, quality of life, and functional status over the long term and consequently merits early consideration in the treatment continuum.

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