Introduction: 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.After 2 years pain returned progressively 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.
Methods: This method allowed simultaneous stimulation of the motor cortex and SCS in cycling mode with independent stimulation parameters in each site. A blinded trial to confirm MCS effect to pain control programming the MCS to the minimum possible values until to turned it off for 1 week, leaving the SCS turned on.
Results: At 2 years follow-up, the patient reported an improvement of pain from 8/10 to 3/10 (60%) in the VAS with double stimulation (SCS plus MCS) and improved quality of life, SF-36 score of 121 points (42%).
Conclusions: The encouraging results in this case suggests that this can be an option as add-on therapy over spinal cord stimulation as a possible rescue therapy in the management of CRPS-II. How ever comparative studies must be performed in order to determine the effectiveness of this therapy.
Patient Care: It will improve in regarding to alleviate the complex pain, bringing a better quality of life and gain limb's movement.
Learning Objectives: Identify an effective treatment for CRPS-II, in case of treatment failure by spinal cord stimulation.
References: Fonoff ET, Hamani C, Ciampi de Andrade D, Yeng LT, Marcolin MA, Jacobsen Teixeira M. Pain relief and functional recovery in patients with complex regional pain syndrome after motor cortex stimulation. Stereotact Funct Neurosurg. 2011;89:167–72.
Kemler MA, De Vet HCW, Barendse GAM, Van Den Wildenberg FAJM, Van Kleef M. The effect of spinal cord stimulation in patients with chronic reflex sympathetic dystrophy: two years’ follow-up of the randomized controlled trial. Ann Neurol. 2004;55:13–8.