Early Intervention with Peripheral Nerve Stimulation for Complex Regional Pain Syndrome

• Published in: Pain medicine (Malden, Mass.) Vol. 20; no. 3; p. 608
• Format: Journal Article
• Language: English
• Published: Oxford University Press 01.03.2019
• Subjects: Care and treatment; Complex regional pain syndromes; Nerves, Peripheral; Neural stimulation; United States
• ISSN: 1526-2375; 1526-4637

Introduction: Complex regional pain syndrome (CRPS) is a debilitating condition that is frequently refractory to treatment. Until recently, peripheral nerve stimulation (PNS) has largely been ignored as a treatment option due to lack of user-friendly, commercially available systems. We present a case of a patient who developed CRPS who underwent successful treatment with PNS. Methods: Informed consent was obtained for this case presentation. A single-lead percutaneous PNS system (StimRouter, Bioness, Inc.) was used. The median nerve was targeted with ultrasound in the midforearm due to ease of placement, patient ergonomics, and decreased risk of migration. Case Report: A 52-year-old man presented for pain management after suffering a forearm laceration. He underwent complex median nerve repair but had escalating, diffuse, nondermatomal pain in the arm and hand and was diagnosed with CRPS type II. He failed numerous medications and was unable to participate in desensitization therapy. An ultrasound-guided right median nerve block at the midforearm provided a 90% reduction in pain. We then proceeded with placement of an implantable median nerve PNS system (Figure 1). An out-of-plane approach was employed in order to place the lead parallel with the median nerve (Figure 2). The patient is currently tolerating the implant without complication. During his first postprocedure follow-up when the device was turned on, he reported excellent coverage of the pain distribution of his right hand and a 70-80% decrease in his pain. Discussion: Percutaneous stimulation is a viable alternative to other therapies in the treatment of CRPS, especially early in the treatment course.