Abstract
Background: 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. 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. Despite
the ongoing therapy, sometimes patients still have persistent, burning
pain. Intractable CRPS that fail more conservative treatments may
undergo neuromodulation.
Case Description: We want to present to your attention a case
report of the successful treatment of a patient with CRPS type II using
epidural unilateral 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. A clinical diagnosis was made - CRPS type II.
During the stimulation trial, the most effective pain relief was
obtained when the electrode was located in the right side of epidural
space at the C4 – Th1 level. The implantation of an impulse generator
was performed, the final selection of the stimulation parameters was
carried out. Observation of the patient showed that a stable analgesic
effect of neurostimulation was achieved using standard neuromodulation
regimens and Adaptive Stim option.
Conclusion: Unilateral stimulation is an effective type of SCS in
the treatment of pain syndromes. It may make sense for some patients to
have neuromodulation instead of DREZ ablation.