What is the role of spinal cord stimulation in the treatment of complex regional pain syndrome type 1 (CRPS 1) (RSD)?

Updated: Mar 09, 2021
  • Author: T P Sudha Rao, MD; Chief Editor: Herbert S Diamond, MD  more...
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Answer

Epidural implantation of a spinal cord stimulator has been shown to provide significant, prolonged pain relief and functional improvement in CRPS (hand or foot). [28, 29] In the United Kingdom, the National Institute for Health and Care Excellence (NICE) recommends spinal cord stimulation as a possible treatment for adults with chronic pain of neuropathic origin, including CRPS, who have had chronic pain for at least 6 months despite standard treatments and have had a successful trial of spinal cord stimulation as part of an assessment by a specialist team. [30]

In the ACCURATE trial, conducted in 152 subjects with CRPS or causalgia in the lower extremities, stimulation of the dorsal root ganglion (DRG) proved more effective than dorsal column (spinal cord stimulation, SCS) stimulation. At 3 months, the percentage of patients reporting ≥50% pain relief and treatment success was greater in the DRG arm than in the SCS arm (81.2% versus 55.7%, respectrively; P < 0.001). [31]

A case series in four patients who had a DRG stimulator implanted after experiencing incomplete relief with SCS stimulation reported that concomitant DRG and SCS stimulation may provide better improvement in pain and function than use of either device alone. When the SCS stimulator was turned off, the patients consistently reported reduced pain relief and function. [32]


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