The effect of spinal cord stimulation in patients with chronic reflex sympathetic dystrophy: Two years' follow‐up of the randomized controlled trial

Abstract

Chronic reflex sympathetic dystrophy is a painful, disabling disorder for which no treatment with proven effect is available. We performed a randomized trial in a 2 to 1 ratio of patients, in which 36 patients were treated with spinal cord stimulation and physical therapy (SCS+PT), and 18 patients received solely PT. Twenty-four SCS+PT patients were given a permanent spinal cord stimulation system after successful test stimulation; the remaining 12 patients received no permanent system. We assessed pain intensity, global perceived effect, functional status, and health-related quality of life. Patients were examined before randomization, before implantation, and also at 1, 3, 6, 12, and 24 months thereafter. At 2 years, three patients were excluded from the analysis. The intention-to-treat analysis showed improvements in the SCS+PT group concerning pain intensity (-2.1 vs 0.0 cm; p < 0.001) and global perceived effect (43% vs 6% "much improved"; p = 0.001). There was no clinically important improvement of functional status. Health-related quality of life improved only in the group receiving spinal cord stimulation. After careful selection and successful test stimulation, spinal cord stimulation results in a long-term pain reduction and health-related quality of life improvement in chronic reflex sympathetic dystrophy.

Mode of Action of Spinal Cord Stimulation in Neuropathic Pain

“…The most typical example of such pain is Complex Regional Pain Syndrome (CRPS) of both types, which is known to have a relatively high likelihood of responding to SCS. 38 There are several studies demonstrating that the efficacy of SCS is related to the temporary outcome of sympathetic blockades, i.e., stellate, lumbar sympathetic blocks, or regional guanethidine blocks. 39 However, there are also studies reporting that also patients who have failed to respond to sympathetic block may benefit from SCS.…”

Spinal cord stimulation in the treatment of neuropathic pain: Current perspectives of indications, cost-effectiveness, complications and results

“…In terms of the neuropathic pain etiology, SCS has been applied in the treatment of deafferentation pain, central pain, phantom limb pain (PLP), causalgia, myelopathy, oncologic pain, lumbosacral fibrosis, postherpetic neuralgia (PHN), FBSS, CRPS, reflex sympathetic dystrophy (RSD), spinal cord, brainstem or brain injury, and others (3,(13)(14)(15)22,32,33,38,42,43,(46)(47)(48)(49)(50)(51)(52)(53)(54)(55)(56)(57).…”

“…• Patients with medical intractability of neuropathic pain (20,22,26,32,38,(45)(46)(47)(48)(49) During the surgical procedure of trial implantation, patients should be asked to indicate the location of parenthesis (change of sensibility correlated to the spinal segment stimulated) since it is relevant to confirm that the resultant parenthesis overlaps with the painful area to achieve good analgesia (20)(21)(22)26,28,45).…”

“…Furthermore, the low rates of electrode breakage, change of amplitude of pulse by bodily movements, unwanted stimulation, unsatisfactory positioning of the electrode or generator, urinary disturbances, cerebrospinal fluid leakage, subcutaneous hematomas, epidural hematomas, deep infections, aseptic meningitis, paralysis, spinal cord injury, headache, asthenia, dizziness, muscle spasms, and pain located at the incision, electrode, or receiver site are risks to be considered during and after the surgical act (13,27,32,(38)(39)(40)(46)(47)(48)(49)68).…”

Spinal cord stimulation for chronic pain management: mini-review

“…In 2004, Kemler et al [24] examined the effects of SCS with physiotherapy compared to physical therapy alone in patients with CRPS type I. They reported that at the 6 month follow-up, the mean decrease in pain score was 2.4 with SCS compared to 0.4 with physical therapy using the visual analog scale (VAS) from 0 (no pain) to 10 (worst possible pain).…”