Impact of spinal cord stimulation on sensory characteristics in complex regional pain syndrome type I: a randomized trial.
BACKGROUND
A randomized trial was performed to assess the effect of spinal cord stimulation (SCS) on detection and pain thresholds for pressure, warmth, and cold and on the extent of mechanical hyperalgesia in patients with chronic complex regional pain syndrome type I.


METHODS
Fifty-four chronic complex regional pain syndrome type I patients were randomized to receive both SCS and physical therapy (SCS+PT; n = 36), or to receive only physical therapy (PT; n = 18). Twenty-four SCS+PT patients responded positively to trial stimulation and underwent SCS implantation. During a 12-month follow-up period, six quantitative sensory testing sessions were performed. The main analysis compared 24 SCS patients with 29 nonimplanted patients--one PT patient was excluded.


RESULTS
SCS showed no effect on detection thresholds for warmth and cold or on pain thresholds for any sensation. The pressure detection threshold initially increased by SCS, but after 3 months, pressure detection thresholds returned to normal. Mechanical hyperalgesia, both dynamic and static, was reduced slightly with SCS.


CONCLUSIONS
Although SCS has previously been shown to cause a significant pain reduction in complex regional pain syndrome type I, the treatment has no long-term effect on detection and pain thresholds for pressure, warmth, or cold. The treatment seems to have only minimal influence on mechanical hyperalgesia.
Kemler
M A
MA
Department of Surgery, Maastricht University Hospital, The Netherlands. kemlerm@@mzv.nl
Reulen
J P
JP
Barendse
G A
GA
van Kleef
M
M
de Vet
H C
HC
van den Wildenberg
F A
FA
D000293:Adolescent; D000328:Adult; D000368:Aged; D003080:Cold Temperature; D004599:Electric Stimulation Therapy; D005260:Female; D005500:Follow-Up Studies; D006358:Hot Temperature; D006801:Humans; D006930:Hyperalgesia / Q000503:physiopathology; D008297:Male; D008875:Middle Aged; D017288:Pain Threshold; D010812:Physical Stimulation; D026741:Physical Therapy Modalities; D012019:Reflex Sympathetic Dystrophy / Q000628:therapy*; D013116:Spinal Cord / Q000502:physiology*