Combined Use of Spinal Cord Stimulation and Intrathecal Therapy for Treatment of Complex Regional Pain Syndrome, Type 1
Alexander E. Yakovlev, MD, Comprehensive Pain Management of The Fox Valley, SC, Appleton, Wisconsin, USA
INTRODUCTION
Patients with Complex Regional Pain Syndrome (CRPS), Type 1 may continue to experience intractable pain despite conventional treatments including pain medications, sympathetic blocks, and physical therapy. Spinal cord stimulation (SCS) has been used to treat patients with CRPS, Type 1. Unfortunately, not all the patients have adequate pain control despite the use of neuromodulation techniques.
MATERIALS AND METHODS
The patient is a 42 year old female, with history of CRPS, Type 1 in the right upper extremity. Patient underwent placement of SCS, which gave the patient excellent pain relief for 16 months after implantation of RestoreUltra (Medtronic Inc., Minneapolis,
MN) rechargeable generator and two 8-electrode standard Octad Leads at C4-C5-C6-C7 level. The pain in the right arm came back despite adequate stimulation. She failed conservative therapy and repeated sympathetic blocks. She had successful intrathecal trial with morphine.Two weeks later patient underwent intrathecal pump placement.
RESULTS
After implantation of intrathecal device the patient reported complete relief of the pain by combined use of SCS and intrathecal pump. She was able to discontinue use of all oral pain medications. She was able to return to social, occupational and sport activities.
IMAGE
CONCLUSION
The use of multiple device therapies can be an effective and safe option in the management of severe intractable pain for patients who exhausted traditional and even advanced treatments like neuromodulation techniques.
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