Simonyan Armen Samvelovich, Tyurnikov Vladimir Mikhaylovich, Simonyan Anna Dmitrievna, Gushcha Artem Olegovich
Neurosurgery Department Research Center of Neurology Moscow Russia.
Neurology Department Burnasyan FMBC Research Center of FMBA of Russia Moscow Russia.
Clin Case Rep. 2022 Jan 20;10(1):e05305. doi: 10.1002/ccr3.5305. eCollection 2022 Jan.
CRPS is a type of severe pain syndrome and can be triggered by previous surgery or trauma. CRPS involves vasomotor changes such as changes in color and temperature of the skin, edema, increased sensitivity to touch, and a limited range of movement. Depending on the presence of nerve damage, CRPS is divided into two types. CRPS type II is associated with a confirmed peripheral nerve injury, while CRPS type I is not associated with an apparent peripheral nerve injury. Despite the ongoing therapy, sometimes, patients still have persistent, burning pain. Intractable CRPS that fail more conservative treatments may undergo neuromodulation. We want to present to your attention a case report of the successful treatment of a patient with CRPS type II using epidural unilateral stimulation. The 44-year-old woman came to us with complaints of burning pain and numbness of 1-3 fingers of the right hand, the lateral surface of the right wrist, and lower quarter of the forearm, and shooting pain in the projection of the right median nerve from the shoulder to the wrist. A clinical diagnosis was made-CRPS type II. During the stimulation trial, the most effective pain relief was obtained when the electrode was located in the right side of epidural space at the C4-Th1 level. The implantation of a pulse generator was performed, and the final selection of the stimulation parameters was carried out (Pulse width: 60 ms, Rate: 210 Hz, and Amplitude: 0.9-1.6 V). The severity of pain syndrome was measured using validated scales in the preoperative period (VAS: 8-9, Pain Detect: 22, NTSS-9: 4.62, and DN4: 8), in the early postoperative period (VAS: 0-1, Pain Detect: 6, NTSS -9: 0.66, and DN4: 1), and after 12 months (VAS: 0-2, Pain Detect: 6, NTSS-9: 0.99, and DN4: 1). Observation during 12 months showed that a stable analgesic effect of neurostimulation was achieved using standard neuromodulation regimens and the adaptive stim option. Unilateral stimulation is an effective type of SCS in the treatment of pain syndromes. adaptive stim is usually not applicable for lead implantation at the cervical level. Nevertheless, the rational use of stimulation at threshold values allowed our patient to use adaptive stim in a non-standard situation.
复杂性区域疼痛综合征（CRPS）是一种严重的疼痛综合征，可由先前的手术或创伤引发。CRPS涉及血管运动变化，如皮肤颜色和温度改变、水肿、触觉敏感性增加以及活动范围受限。根据神经损伤的情况，CRPS分为两种类型。CRPS II型与确诊的周围神经损伤相关，而CRPS I型与明显的周围神经损伤无关。尽管进行了持续治疗，但有时患者仍会有持续的灼痛。对于更保守治疗无效的难治性CRPS可能会进行神经调节。我们想向您介绍一例使用硬膜外单侧刺激成功治疗CRPS II型患者的病例报告。这位44岁的女性前来就诊，主诉右手1 - 3指、右腕外侧和前臂下四分之一处有灼痛和麻木感，以及从肩部到腕部的右正中神经投射区域有刺痛。临床诊断为CRPS II型。在刺激试验中，当电极位于C4 - Th1水平硬膜外间隙右侧时，获得了最有效的疼痛缓解。进行了脉冲发生器植入，并进行了刺激参数的最终选择（脉冲宽度：60毫秒，频率：210赫兹，幅度：0.9 - 1.6伏）。在术前（视觉模拟评分法[VAS]：8 - 9，疼痛检测：22，神经病理性疼痛症状评分-9[NTSS - 9]：4.62，DN4：8）、术后早期（VAS：0 - 1，疼痛检测：6，NTSS - 9：0.66，DN4：1）以及12个月后（VAS：0 - 2，疼痛检测：6，NTSS - 9：0.99，DN4：1）使用经过验证的量表测量疼痛综合征的严重程度。12个月的观察表明，使用标准神经调节方案和自适应刺激选项可实现神经刺激的稳定镇痛效果。单侧刺激是治疗疼痛综合征的一种有效类型的脊髓刺激（SCS）。自适应刺激通常不适用于颈椎水平的电极植入。然而，合理使用阈值刺激使我们的患者能够在非标准情况下使用自适应刺激。
