Spinal cord stimulation in sympathetically maintained complex regional pain syndrome type I with severe disability. A prospective clinical study.
OBJECTIVE
In this prospective trial we assessed the long-term effect of spinal cord stimulation (SCS) on the improvement of functional status in complex regional pain syndrome type I (CRPS I).


METHODS
A prerequisite for eligibility to SCS treatment was the responsiveness of patients to sympathetic nerve block. In 29 patients with chronic sympathetically maintained CRPS I, the efficacy of SCS on deep pain, allodynia and functional disability was determined. Pain intensity was estimated during SCS free intervals of 45 min (inactivation test) every 3 months and compared with that under SCS treatment.


RESULTS
On SCS treatment, both deep pain and allodynia could be permanently reduced from 10 to 0-2 on a 10 cm visual analogue scale (VAS) (p<0.01). During the inactivation tests, reoccurrence of pain up to 8 VAS (quartiles 6-8) was measured. Considerable impairments in daily living activities, objectified by the pain disability index, were also restored (p<0.01). After a follow-up period of 35.6+/-21 months, 12 of 16 patients with affected upper limb showed significant increase of the fist grip strength from 0 to 0.35 (quartiles 0.1-0.5) kg compared with 0.9 (quartiles 0.7-1.1) kg on the unaffected side (p<0.01). Eight of ten patients with lower limb disability resumed walking without crutches. Previous pain medication could be significantly reduced (p<0.01).


CONCLUSIONS
As a result of permanent pain relief under long-term SCS combined with physiotherapy, the functional status and the quality of life could be significantly improved in sympathetically maintained CRPS I.
Harke
Henning
H
Department of Anesthesia and Pain Therapy, Klinikum Krefeld, Lutherplatz 40, D-47805 Krefeld, Germany. harke@klinikum-krefeld.de
Gretenkort
Peter
P
Ladleif
Hans Ulrich
HU
Rahman
Salah
S
D000203:Activities of Daily Living / Q000523:psychology; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000700:Analgesics / Q000627:therapeutic use; D000701:Analgesics, Opioid / Q000627:therapeutic use; D000928:Antidepressive Agents / Q000627:therapeutic use; D001340:Autonomic Nerve Block / Q000191:economics / Q000295:instrumentation / Q000379:methods*; D004599:Electric Stimulation Therapy / Q000379:methods*; D004567:Electrodes, Implanted / Q000191:economics; D005260:Female; D006801:Humans; D006930:Hyperalgesia / Q000503:physiopathology / Q000628:therapy; D008297:Male; D008875:Middle Aged; D019635:Neurosurgical Procedures / Q000191:economics / Q000379:methods; D010147:Pain Measurement; D017060:Patient Satisfaction / Q000706:statistics & numerical data; D011446:Prospective Studies; D011788:Quality of Life / Q000523:psychology; D012019:Reflex Sympathetic Dystrophy / Q000503:physiopathology / Q000628:therapy*; D013116:Spinal Cord / Q000502:physiology* / Q000601:surgery; D013564:Sympathetic Nervous System / Q000503:physiopathology*; D016896:Treatment Outcome
D000700:Analgesics; D000701:Analgesics, Opioid; D000928:Antidepressive Agents