The effect of spinal cord stimulation in patients with chronic reflex sympathetic dystrophy: two years' follow-up of the randomized controlled trial.
Chronic reflex sympathetic dystrophy is a painful, disabling disorder for which no treatment with proven effect is available. We performed a randomized trial in a 2 to 1 ratio of patients, in which 36 patients were treated with spinal cord stimulation and physical therapy (SCS+PT), and 18 patients received solely PT. Twenty-four SCS+PT patients were given a permanent spinal cord stimulation system after successful test stimulation; the remaining 12 patients received no permanent system. We assessed pain intensity, global perceived effect, functional status, and health-related quality of life. Patients were examined before randomization, before implantation, and also at 1, 3, 6, 12, and 24 months thereafter. At 2 years, three patients were excluded from the analysis. The intention-to-treat analysis showed improvements in the SCS+PT group concerning pain intensity (-2.1 vs 0.0 cm; p < 0.001) and global perceived effect (43% vs 6% "much improved"; p = 0.001). There was no clinically important improvement of functional status. Health-related quality of life improved only in the group receiving spinal cord stimulation. After careful selection and successful test stimulation, spinal cord stimulation results in a long-term pain reduction and health-related quality of life improvement in chronic reflex sympathetic dystrophy.
Kemler
Marius A
MA
Department of Plastic Surgery, Medical Center Leeuwarden, Leeuwarden. Marius.Kemler@ZNB.nl
De Vet
Henrica C W
HC
Barendse
Gerard A M
GA
Van Den Wildenberg
Frans A J M
FA
Van Kleef
Maarten
M
D000293:Adolescent; D000328:Adult; D000368:Aged; D002908:Chronic Disease / Q000628:therapy; D004599:Electric Stimulation Therapy / Q000379:methods; D005500:Follow-Up Studies; D006801:Humans; D008875:Middle Aged; D059408:Pain Management; D026741:Physical Therapy Modalities; D011446:Prospective Studies; D011788:Quality of Life; D020127:Recovery of Function; D012019:Reflex Sympathetic Dystrophy / Q000628:therapy*; D013116:Spinal Cord / Q000502:physiology*; D016896:Treatment Outcome