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.