title: Electroencephalographic evoked pain response is suppressed by spinal cord stimulation in complex regional pain syndrome: a case report.
abstract: Pain is a subjective response that limits assessment. The purpose of this case report was to explore how the objectivity of the electroencephalographic response to thermal stimuli would be affected by concurrent spinal cord stimulation. A patient had been implanted with a spinal cord stimulator for the management of complex regional pain syndrome of both hands for 8 years. Following ethical approval and written informed consent we induced thermal stimuli using the Medoc PATHWAY Pain & Sensory Evaluation System on the right hand of the patient with the spinal cord stimulator switched off and with the spinal cord stimulator switched on. The patient reported a clinically significant reduction in thermal induced pain using the numerical rating scale (71.4 % reduction) with spinal cord stimulator switched on. Analysis of electroencephalogram recordings indicated the occurrence of contact heat evoked potentials (N2-P2) with spinal cord stimulator off, but not with spinal cord stimulator on. This case report suggests that thermal pain can be reduced in complex regional pain syndrome patients with the use of spinal cord stimulation and offers objective validation of the reported outcomes with this treatment.
authors.affiliation: Faculty of Health, Birmingham City University, Birmingham, UK.
authors.forename: Nicholas
authors.initials: N
authors.lastname: Hylands-White
authors.affiliation: Department of Public Health, Epidemiology and Biostatistics, University of Birmingham, Room 124, Murray Learning Centre, Birmingham, B15 2TT, UK. r.duarte@bham.ac.uk.
authors.forename: Rui V
authors.initials: RV
authors.lastname: Duarte
authors.affiliation: School of Health, University of Northampton, Northampton, UK.
authors.forename: Paul
authors.initials: P
authors.lastname: Beeson
authors.affiliation: BUIC, School of Psychology, University of Birmingham, Birmingham, UK.
authors.forename: Stephen D
authors.initials: SD
authors.lastname: Mayhew
authors.affiliation: Faculty of Health, Birmingham City University, Birmingham, UK.|Department of Pain Management, Russells Hall Hospital, Dudley, UK.
authors.forename: Jon H
authors.initials: JH
authors.lastname: Raphael
mesh_terms: D020918:Complex Regional Pain Syndromes / Q000628:therapy*; D004566:Electrodes; D004567:Electrodes, Implanted; D004569:Electroencephalography / Q000379:methods*; D005071:Evoked Potentials; D005260:Female; D006358:Hot Temperature; D006801:Humans; D008875:Middle Aged; D009437:Neuralgia / Q000503:physiopathology; D010146:Pain / Q000503:physiopathology*; D059408:Pain Management / Q000379:methods; D010147:Pain Measurement / Q000379:methods*; D013116:Spinal Cord / Q000473:pathology; D062187:Spinal Cord Stimulation / Q000379:methods*
keywords: Complex regional pain syndrome; Contact heat evoked potentials; Electroencephalography (EEG); Spinal cord stimulation