Introduction
CRPS is a type of severe pain syndrome and can be triggered by previous surgery or trauma. CRPS involves vasomotor changes such as changes in color and temperature of the skin, edema, increased sensitivity to touch, and a limited range of movement.1 Depending on the presence of nerve damage, CRPS is divided into two types. CRPS type II is associated with a confirmed peripheral nerve injury, while CRPS type I is not associated with an apparent peripheral nerve injury.1,2 There are four diagnostic tools for CRPS in adult populations. These include the Veldman criteria, IASP criteria, Budapest Criteria, and Budapest Research Criteria.3,4
The complex treatment of CRPS includes pharmacotherapy, nerve blocks, physical and psychological measures, and rTMS.1,5Despite the ongoing therapy, sometimes patients still have persistent, burning pain. It leads to the disability of patients and a decrease in the quality of life. Also, the long-lasting, severe pain can result in psychological disorders such as depression and anxiety. Therefore, controlling CRPS-induced pain is a challenge in clinical practice.1 Intractable CRPS that fail more conservative treatments may undergo neuromodulation in the form of spinal cord stimulation (SCS), dorsal root ganglion stimulation (DRG), or peripheral nerve stimulation (PNS). Such factors will generally determine the choice of which modality is more suitable as pain localized to a specific nerve territory or pain that is felt mainly distal in an extremity.2
Destructive interventions in the DREZ zone for pain management have been used for many years, and the effectiveness of such interventions remains at a high level.6 Unilateral epidural stimulation, and stimulation of the DREZ zone were described much less often in the literature. However, in our opinion, the effectiveness of unilateral stimulation and DREZ - stimulation is not inferior, and in some cases, even exceeds destructive interventions.