Case Description
We want to present to your attention a case report of the successful treatment of a patient with CRPS type II using unilateral epidural stimulation. The patient came to us with complaints of burning pain and numbness of 1-3 fingers of the right hand, the lateral surface of the right wrist and lower quarter of the forearm; shooting pain in the projection of the right median nerve from the shoulder to the wrist. The patient had previously suffered an injury to the right hand with damage to the tendons and median nerve and underwent several reconstructive surgeries. After the injury, the appearance of a pronounced pain syndrome was noted. Conservative therapy, physiotherapy, multiple surgical interventions, including Radiofrequency ablation (RFA), Sympathectomy, with a short-term positive effect, were carried out. Taking into account the clinical picture, anamnesis, and using the Budapest criteria, a clinical diagnosis was made - CRPS type II. A decision was made to implant an epidural electrode to perform a stimulation trial. During the stimulation, the most effective pain relief was obtained when the electrode was located in the right side of epidural space at the C4 – Th1 level (Figure 1 A).
Against the background of the therapy, a significant decrease in the severity of the pain syndrome was noted, and the effective parameters of stimulation were determined. The implantation of an impulse generator was performed. After the implantation of an impulse generator (Figure 1 B), the final selection of the stimulation parameters was carried out. Later, the Adaptive-Stim option was installed, which, according to the patient, greatly facilitates everyday life and reduces the time spent on programming the device. Observation of the patient showed that a stable analgesic effect of neurostimulation was achieved. The severity of pain syndrome was assessed using the scales VAS, NTSS-9, DN-4, Pain Detect (Table 1).
Some decrease in efficiency compared with the early postoperative period (when complete regression of pain syndrome was noted) is most likely due to addiction to stimulation.