title: Pain Relief in CRPS-II after Spinal Cord and Motor Cortex Simultaneous Dual Stimulation.
abstract: We describe a case of a 30-year-old woman who suffered a traumatic injury of the right brachial plexus, developing severe complex regional pain syndrome type II (CRPS-II). After clinical treatment failure, spinal cord stimulation (SCS) was indicated with initial positive pain control. However, after 2 years her pain progressively returned to almost baseline intensity before SCS. Additional motor cortex electrode implant was then proposed as a rescue therapy and connected to the same pulse generator. This method allowed simultaneous stimulation of the motor cortex and SCS in cycling mode with independent stimulation parameters in each site. At 2 years follow-up, the patient reported sustained improvement in pain with dual stimulation, reduction of painful crises, and improvement in quality of life. The encouraging results in this case suggests that this can be an option as add-on therapy over SCS as a possible rescue therapy in the management of CRPS-II. However, comparative studies must be performed in order to determine the effectiveness of this therapy.
  
  
  
  Chronic neuropathic pain, Complex regional pain syndrome Type II, brachial plexus injury, motor cortex stimulation, spinal cord stimulation.
authors.affiliation: Pain Center and Division of Functional Neurosurgery, Department of Neurology, School of Medicine, University of São Paulo, Brazil.
authors.forename: William Oc
authors.initials: WO
authors.lastname: Lopez
authors.affiliation: Pain Center and Division of Functional Neurosurgery, Department of Neurology, School of Medicine, University of São Paulo, Brazil.
authors.forename: Danilo C
authors.initials: DC
authors.lastname: Barbosa
authors.forename: Manoel J
authors.initials: MJ
authors.lastname: Teixera
authors.affiliation: Pain Center and Division of Functional Neurosurgery, Department of Neurology, School of Medicine, University of São Paulo, Brazil.
authors.forename: Martin
authors.initials: M
authors.lastname: Paiz
authors.affiliation: Pain Center and Division of Functional Neurosurgery, Department of Neurology, School of Medicine, University of São Paulo, Brazil.
authors.forename: Leonardo
authors.initials: L
authors.lastname: Moura
authors.affiliation: Pain Center and Division of Functional Neurosurgery, Department of Neurology, School of Medicine, University of São Paulo, Brazil.
authors.forename: Bernardo A
authors.initials: BA
authors.lastname: Monaco
authors.forename: Erich T
authors.initials: ET
authors.lastname: Fonoff
mesh_terms: D000328:Adult; D020918:Complex Regional Pain Syndromes / Q000628:therapy*; D046690:Deep Brain Stimulation / Q000379:methods*; D004599:Electric Stimulation Therapy / Q000379:methods; D005260:Female; D006801:Humans; D009044:Motor Cortex; D059408:Pain Management / Q000379:methods*; D062187:Spinal Cord Stimulation / Q000379:methods*