The Response of Neuropathic Pain and Pain in Complex Regional Pain Syndrome I to Carbamazepine and Sustained-Release Morphine in Patients Pretreated with Spinal Cord Stimulation: A Double-Blinded Randomized Study

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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First experience with chronic epidural spinal cord stimulation in Khanty-Mansi autonomous okrug — clinical observations

Neurology Bulletin ◽

10.17816/nb70921 ◽

2021 ◽

Vol LIII (2) ◽

pp. 94-100

Author(s):

Olga A. Bondarenko ◽

Gaspar V. Gavrilov ◽

Vadim A. Padurets ◽

Roman V. Kasich

Keyword(s):

Spinal Cord ◽

Neuropathic Pain ◽

Spinal Cord Stimulation ◽

Pain Syndrome ◽

Chronic Neuropathic Pain ◽

Neuropathic Pain Syndrome ◽

Epidural Stimulation ◽

Cord Injury ◽

Epidural Spinal Cord Stimulation ◽

And Migration

Purpose of the work. The article is devoted to the first experience of epidural stimulation in the Khanty-Mansiysk Autonomous Okrug at the budgetary institution Surgut Clinical Trauma Hospital. Clinical examples are presented for two main indications for the application of this technique (disease of the operated spine, a consequence of spinal cord injury in combination with chronic neuropathic pain syndrome). Research methods. An assessment of the intensity of pain syndrome was given according to a visual analogue scale, the Pain Detect questionnaire; indicators of anxiety, depression on the HADS scale; quality of life according to the Oswestry questionnaire for a follow-up period of 6-12 months in patients with chronic epidural stimulation. Results. A positive assessment of the action during test neurostimulation was 63.3% (38 patients). Of the established permanent systems, a good result was achieved and persisted for 12 months or more in 96% (24 patients). It was necessary to change the stimulation parameters in 13% (3 patients). Revision of permanent systems was performed in 20% (5 patients), due to the progression of the degenerative-dystrophic process of the spine, damage and migration of system elements. Conclusions. Chronic epidural spinal cord stimulation has established itself as a personalized, highly effective, minimally invasive and safe method of treating chronic neuropathic pain syndromes. Multicomponent corrective action is of scientific interest and requires further study.

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

Regional Anesthesia and Pain Medicine ◽

10.1097/00115550-200809001-00036 ◽

2008 ◽

Vol 33 (Sup 1) ◽

pp. e21

Author(s):

L. Radhakrishnan ◽

S. Kapur ◽

H. Mutagi ◽

J. Raphael

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

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 in the treatment of neuropathic pain: Current perspectives of indications, cost-effectiveness, complications and results

Journal of Health Sciences ◽

10.17532/jhsci.2017.399 ◽

2017 ◽

Vol 7 (2) ◽

pp. 68-79 ◽

Cited By ~ 2

Author(s):

Bruno Camporeze ◽

Renata Faria Simm ◽

Iracema Araújo Estevão ◽

Luis Roberto Mathias Junior ◽

Paulo Henrique Pires de Aguiar ◽

...

Keyword(s):

Spinal Cord ◽

Neuropathic Pain ◽

Cost Effectiveness ◽

Literature Review ◽

Spinal Cord Stimulation ◽

Pain Syndrome ◽

Cost Effective ◽

Medical Conditions ◽

Reduction Of Pain ◽

Bibliographic Search

Introduction: The spinal cord stimulation (SCS) has been described as a valuable neuromodulating procedure in the management of chronic and medically untreated neuropathic pain. Although, many studies have discussed the use of this technique, a question still remains regarding its efficacy in different medical conditions with different etiology in the long term. The aim of this paper is to discuss the risks, complications, cost-effectiveness and results of SCS in patients affected by chronic neuropathic pain based on the comprehensive literature review. Methods: Bibliographic search of references from 1950 to 2016 using the databases MEDLINE, LILACS, SciELO, PubMed, and applied language as selection criteria, choosing preferably recent articles written in Portuguese, Spanish or English. Results: Based on literature review, SCS is a safe, reversible, adjustable and nondestructive surgical procedure demonstrating a significant effect in the reduction of pain intensity and improvement in quality of life in these patients. Furthermore, in spite of the initial high cost to its application, SCS has been associated with lower rates of complications and high rates of cost-effectiveness when compared to standard therapies. Conclusion: Although used in medical conditions with different etiology, the procedure is still an effective and a cost-effective approach to neuropathic pain, mainly in patients affected by failed back pain syndrome (FBSS) and complex regional pain syndrome (CRPS).

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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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