title: Pain relief and functional recovery in patients with complex regional pain syndrome after motor cortex stimulation.
abstract: In addition to pain and neurovegetative symptoms, patients with severe forms of complex regional pain syndrome (CRPS) develop a broad range of symptoms, including sensory disturbances, motor impairment and dystonic posturing. While most patients respond to medical therapy, some are considered refractory and become surgical candidates. To date, the most commonly used surgical procedure for CRPS has been spinal cord stimulation. This therapy often leads to important analgesic effects, but no sensory or motor improvements. We report on 2 patients with pain related to CRPS and severe functional deficits treated with motor cortex stimulation (MCS) who not only had significant analgesic effects, but also improvements in sensory and motor symptoms. In the long term (27 and 36 months after surgery), visual analog scale pain scores were improved by 60-70% as compared to baseline. There was also a significant increase in the range of motion in the joints of the affected limbs and an improvement in allodynia, hyperpathia and hypoesthesia. Positron emission tomography scan in both subjects revealed that MCS influenced regions involved in the circuitry of pain.
authors.affiliation: Department of Neurology, Division of Functional Neurosurgery of the Institute of Psychiatry, University of São Paulo School of Medicine, São Paulo, Brazil. fonoffet@usp.br
authors.forename: Erich Talamoni
authors.initials: ET
authors.lastname: Fonoff
authors.forename: Clement
authors.initials: C
authors.lastname: Hamani
authors.forename: Daniel
authors.initials: D
authors.lastname: Ciampi de Andrade
authors.forename: Lin Tchia
authors.initials: LT
authors.lastname: Yeng
authors.forename: Marco Antonio
authors.initials: MA
authors.lastname: Marcolin
authors.forename: Manoel
authors.initials: M
authors.lastname: Jacobsen Teixeira
mesh_terms: D000328:Adult; D020918:Complex Regional Pain Syndromes / Q000503:physiopathology / Q000628:therapy*; D004599:Electric Stimulation Therapy / Q000379:methods*; D006801:Humans; D008297:Male; D009044:Motor Cortex / Q000503:physiopathology / Q000601:surgery*; D010147:Pain Measurement; D020127:Recovery of Function; D016896:Treatment Outcome