Ultrasound-Guided Percutaneous Cervical and Upper Thoracic Sympathetic Chain Neuromodulation for Upper Extremity Complex Regional Pain Syndrome.

BACKGROUND

Complex regional pain syndrome (CRPS) comprises a group of conditions characterized by severe, debilitating pain that is disproportionate to any inciting event and is not distributed in a specific nerve distribution or dermatome.

CASE REPORT

A 42-year-old female with a 2-year history of right upper extremity CRPS type I refractory to conventional management underwent an ultrasound-guided and fluoroscopy confirmed percutaneous peripheral nerve stimulation trial with a lead extending from the C6 to the T3 level to cover the cervical and upper thoracic sympathetic chain. The patient subsequently received a permanent ultrasound-guided lead and implantable pulse generator. At 1-month follow-up, the patient's pain intensity had declined from a weekly average of 8/10 to 1/10 on the verbal pain scale with marked improvement in function. The patient continues to be pain-free or experiences only minimal discomfort 7 years after the implant. She experienced no complications and has discontinued all her pain medications since the implant.

CONCLUSION

The placement of a peripheral nerve-stimulating electrode resulted in sustained suppression of intractable pain secondary to CRPS. Ultrasonography guidance enabled the nonsurgical minimally invasive percutaneous approach. Use of ultrasonography may improve the safety of the procedure by permitting direct visualization of the related anatomic structures, thereby reducing the risk of injury to the inferior thyroid artery, vertebral artery, esophagus, intervertebral disc, and pleura.