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.