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.