title: Spinal cord stimulation in complex regional pain syndrome type I of less than 12-month duration.
abstract: BACKGROUND
  Complex regional pain syndrome type 1 (CRPS-1) has a 31% probability of becoming chronic. The early use of spinal cord stimulation (SCS) has been recommended as a strategy to prevent chronicity and functional impairment.
  
  
  METHODS
  In a prospective study, we treated 74 CRPS-1 patients with a mean disease duration of 17 weeks with standard therapy consisting of physical therapy, topical dimethyl sulfoxide, analgesics, transcutaneous stimulation, and sympathetic blockade. Patients who did not respond to standard therapy were offered a treatment with SCS. In these patients, we investigated the impact on pain, quality of life, and function.
  
  
  RESULTS
  Out of these 74 patients treated with standard therapy, six patients were included for early SCS treatment. The overall mean pain relief after one year was 35%. The mental component of the Short Form 36 improved; however, there was no effect on the physical component. None of the SCS treated patients showed a clear improvement in functional outcome.
  
  
  CONCLUSIONS
  We conclude that the feasibility of performing a randomized controlled trial on early SCS therapy in CRPS-1 is low because of the good disease improvement with standard therapy in the first year after onset. This study raises questions about the need to use SCS early in the course of CRPS-1 because of the probable lack of additional benefit compared with SCS in chronic CRPS-1.
authors.affiliation: Department of Anesthesiology and Pain Therapy, St Elisabeth Hospital, Tilburg, The Netherlands.
authors.forename: Frank
authors.initials: F
authors.lastname: van Eijs
authors.forename: José W
authors.initials: JW
authors.lastname: Geurts
authors.forename: Jan
authors.initials: J
authors.lastname: Van Zundert
authors.forename: Catharina G
authors.initials: CG
authors.lastname: Faber
authors.forename: Alfons G H
authors.initials: AG
authors.lastname: Kessels
authors.forename: Elbert A J
authors.initials: EA
authors.lastname: Joosten
authors.forename: Maarten
authors.initials: M
authors.lastname: van Kleef
mesh_terms: D000328:Adult; D000700:Analgesics / Q000627:therapeutic use; D004121:Dimethyl Sulfoxide / Q000627:therapeutic use; D004599:Electric Stimulation Therapy / Q000379:methods*; D004567:Electrodes, Implanted; D005260:Female; D005500:Follow-Up Studies; D016166:Free Radical Scavengers / Q000627:therapeutic use; D006801:Humans; D008875:Middle Aged; D010147:Pain Measurement; D026741:Physical Therapy Modalities; D011446:Prospective Studies; D011788:Quality of Life; D012019:Reflex Sympathetic Dystrophy / Q000503:physiopathology / Q000628:therapy*; D013116:Spinal Cord / Q000502:physiology*; D016896:Treatment Outcome; D055815:Young Adult
chemical_list: D000700:Analgesics; D016166:Free Radical Scavengers; D004121:Dimethyl Sulfoxide