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A case report of wireless peripheral nerve stimulation for complex regional pain syndrome type-I of the upper extremity: 1 year follow up.

Abstract

Background Complex regional pain syndrome (CRPS) is a chronic disabling painful disorder with limited options to achieve therapeutic relief. CRPS type I which follows trauma, may not show obvious damage to the nervous structures and remains dubious in its pathophysiology and also its response to conservative treatment or interventional pain management is elusive. Spinal cord and dorsal root ganglion stimulation (SCS, DRGS) provide good relief, mainly for causalgia or CRPS I of lower extremities but not very encouraging for upper extremity CRPS I. we reported earlier, a case of CRPS I of right arm treated successfully by wireless peripheral nerve stimulation (WPNS) with short term follow up. Here we present 1-year follow-up of this patient. Objective To present the first case of WPNS for CRPS I with a year follow up. The patient had minimally invasive peripheral nerve stimulation (PNS), without implantable pulse generator (IPG) or its accessories. Case report This was a case of refractory CRPS I after blunt trauma to the right forearm of a young female. She underwent placement of two Stimwave electrodes (Leads: FR4A-RCV-A0 with tines, Generation 1 and FR4A-RCV-B0 with tines, Generation 1) in her forearm under intraoperative electrophysiological and ultrasound guidance along radial and median nerves. This WPNS required no IPG. At high frequency (HF) stimulation (HF 10 kHz/32 μs, 2.0 mA), patient had shown remarkable relief in pain, allodynia and temperature impairment. At 5 months she started driving without opioid consumption, while allodynia disappeared. At 1 year follow up she was relieved of pain [visual analogue scale (VAS) score of 4 from 7] and Kapanji Index (Score) improved to 7-8. Both hands look similar in color and temperature. She never made unscheduled visits to the clinic or visited emergency room for any complications related to the WPNS. Conclusions CRPS I involving upper extremity remain difficult to manage with conventional SCS or DRGS because of equipment related adverse events. Minimally invasive WPNS in this case had shown consistent relief without any complications or side effects related to the wireless technology or the technique at the end of 1 year. Implications This is the first case illustration of WPNS for CRPS I, successfully treated and followed up for 1 year.

Authors+Show Affiliations

Schmerzklinik Basel, Hirschgässlein 11-15, Basel 4051, Switzerland.Mgr, Parimed GmbH, Unter Sagi 6, Stansstad 6362, Switzerland.

Pub Type(s)

Case Reports

Language

eng

PubMed ID

31442205

Citation

Herschkowitz, Daniel, and Jana Kubias. "A Case Report of Wireless Peripheral Nerve Stimulation for Complex Regional Pain Syndrome type-I of the Upper Extremity: 1 Year Follow Up." Scandinavian Journal of Pain, 2019.
Herschkowitz D, Kubias J. A case report of wireless peripheral nerve stimulation for complex regional pain syndrome type-I of the upper extremity: 1 year follow up. Scand J Pain. 2019.
Herschkowitz, D., & Kubias, J. (2019). A case report of wireless peripheral nerve stimulation for complex regional pain syndrome type-I of the upper extremity: 1 year follow up. Scandinavian Journal of Pain, doi:10.1515/sjpain-2019-0071.
Herschkowitz D, Kubias J. A Case Report of Wireless Peripheral Nerve Stimulation for Complex Regional Pain Syndrome type-I of the Upper Extremity: 1 Year Follow Up. Scand J Pain. 2019 Aug 23; PubMed PMID: 31442205.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - A case report of wireless peripheral nerve stimulation for complex regional pain syndrome type-I of the upper extremity: 1 year follow up. AU - Herschkowitz,Daniel, AU - Kubias,Jana, Y1 - 2019/08/23/ PY - 2019/05/02/received PY - 2019/07/11/accepted PY - 2019/8/24/entrez PY - 2019/8/24/pubmed PY - 2019/8/24/medline KW - complex regional pain syndrome KW - neuromodulation KW - peripheral nerve stimulation KW - upper extremity KW - wireless stimulation JF - Scandinavian journal of pain JO - Scand J Pain N2 - Background Complex regional pain syndrome (CRPS) is a chronic disabling painful disorder with limited options to achieve therapeutic relief. CRPS type I which follows trauma, may not show obvious damage to the nervous structures and remains dubious in its pathophysiology and also its response to conservative treatment or interventional pain management is elusive. Spinal cord and dorsal root ganglion stimulation (SCS, DRGS) provide good relief, mainly for causalgia or CRPS I of lower extremities but not very encouraging for upper extremity CRPS I. we reported earlier, a case of CRPS I of right arm treated successfully by wireless peripheral nerve stimulation (WPNS) with short term follow up. Here we present 1-year follow-up of this patient. Objective To present the first case of WPNS for CRPS I with a year follow up. The patient had minimally invasive peripheral nerve stimulation (PNS), without implantable pulse generator (IPG) or its accessories. Case report This was a case of refractory CRPS I after blunt trauma to the right forearm of a young female. She underwent placement of two Stimwave electrodes (Leads: FR4A-RCV-A0 with tines, Generation 1 and FR4A-RCV-B0 with tines, Generation 1) in her forearm under intraoperative electrophysiological and ultrasound guidance along radial and median nerves. This WPNS required no IPG. At high frequency (HF) stimulation (HF 10 kHz/32 μs, 2.0 mA), patient had shown remarkable relief in pain, allodynia and temperature impairment. At 5 months she started driving without opioid consumption, while allodynia disappeared. At 1 year follow up she was relieved of pain [visual analogue scale (VAS) score of 4 from 7] and Kapanji Index (Score) improved to 7-8. Both hands look similar in color and temperature. She never made unscheduled visits to the clinic or visited emergency room for any complications related to the WPNS. Conclusions CRPS I involving upper extremity remain difficult to manage with conventional SCS or DRGS because of equipment related adverse events. Minimally invasive WPNS in this case had shown consistent relief without any complications or side effects related to the wireless technology or the technique at the end of 1 year. Implications This is the first case illustration of WPNS for CRPS I, successfully treated and followed up for 1 year. SN - 1877-8879 UR - https://www.unboundmedicine.com/medline/citation/31442205/A_case_report_of_wireless_peripheral_nerve_stimulation_for_complex_regional_pain_syndrome_type-I_of_the_upper_extremity:_1_year_follow_up L2 - https://linkinghub.elsevier.com/retrieve/pii//j/sjpain.ahead-of-print/sjpain-2019-0071/sjpain-2019-0071.xml DB - PRIME DP - Unbound Medicine ER -
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