Effect of spinal cord stimulation in Type I complex regional pain syndrome with 2 rare severe cutaneous manifestations

Case report

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The authors present the case of a 49-year-old female patient with complex regional pain syndrome–Type I (CRPSI) who was suffering from nonhealing wounds and giant bullae, which dramatically improved after spinal cord stimulation (SCS). The scientific literature concerning severe cutaneous manifestations of CRPS-I and their treatment is reviewed. Nonhealing wounds and bullae are rare manifestations of CRPS-I that are extremely difficult to treat. Immediate improvement of both wounds and bullae after SCS, such as in this case, has not been reported previously in literature. Considering the rapidly progressive nature of these severe skin manifestations, immediate treatment, possibly with SCS, is mandatory.

Abbreviations used in this paper: CRPS = complex regional pain syndrome; SCS = spinal cord stimulation.

Article Information

Address correspondence to: Kim Rijkers, M.D., Department of Neurosurgery, Maastricht University Hospital, P. Debyelaan 25, PO Box 5800, 6202 AZ Maastricht, The Netherlands. email: kimrijkers@gmail.com.

© AANS, except where prohibited by US copyright law.

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Figures

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    Photograph depicting the right leg of our patient after discontinuation of SCS. The photograph was taken 2 weeks after the first surgery. The knee is visible in the upper-right corner of the photograph. Giant bullae on the right leg developed as a result of inadequate stimulation.

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    Photograph depicting the right leg of our patient, taken 5 days after additional adequate stimulation in the lower limbs.

References

  • 1

    de Takats G: Reflex dystrophy of the extremities. Arch Surg 34:9399561937

  • 2

    Doupe JCUllen CHChance GQ: Post-traumatic pain and the causalgic syndrome. J Neurol Neurosurg Psychiatry 7:33481944

  • 3

    Harden RN: Complex regional pain syndrome. Br J Anaesth 87:991062001

  • 4

    Heijmans-Antonissen CWesseldijk FMunnikes RJHuygen FJvan der Meijden PHop WC: Multiplex bead array assay for detection of 25 soluble cytokines in blister fluid of patients with complex regional pain syndrome type 1. Mediators Inflamm 2006:K1K82006

    • Search Google Scholar
    • Export Citation
  • 5

    Hilten JJFactor IV: movement disorders and dystrophia—pathophysiology and measurement. Wilson PRStanton-Hicks MHardon RN: CRPS: Current Diagnosis and Therapy SeattleIASP Press2005. Vol 32:119138

    • Search Google Scholar
    • Export Citation
  • 6

    Huygen FJDe Bruijn AGDe Bruin MTGroeneweg JGKlein JZijistra FJ: Evidence for local inflammation in complex regional pain syndrome type 1. Mediators Inflamm 11:47512002

    • Search Google Scholar
    • Export Citation
  • 7

    Kemler MABarendse GAvan Kleef Mde Vet HCRijks CPFurnee CA: Spinal cord stimulation in patients with chronic reflex sympathetic dystrophy. N Engl J Med 343:6186242000

    • Search Google Scholar
    • Export Citation
  • 8

    Kemler MAReulen JPBarendse GAvan Kleef Mde Vet HCvan den Wildenberg FA: Impact of spinal cord stimulation on sensory characteristics in complex regional pain syndrome type I: a randomized trial. Anesthesiology 95:72802001

    • Search Google Scholar
    • Export Citation
  • 9

    Linderoth BForeman RDSpinal cord stimulation: mechanisms of action. Burchiel KJ: Surgical Management of Pain New YorkThieme2002. 505526

    • Search Google Scholar
    • Export Citation
  • 10

    Melzack RWall PD: Pain mechanisms: a new theory. Science 150:9719791965

  • 11

    Merskey HBogduk N: Classification of Chronic Pain: Descriptions of Chronic Pain Syndromes and Definition of Pain Terms ed 2SeattleIASP Press1994

    • Search Google Scholar
    • Export Citation
  • 12

    Oaklander ALBirklein FFactor I: sensory changes—pathophysiology and measurement. Wilson PRStanton-Hicks MHardon RN: CRPS: Current Diagnosis and Therapy SeattleIASP Press2005. Vol 32:5979

    • Search Google Scholar
    • Export Citation
  • 13

    Sandroni PFactor III: sudomotor changes and edema—pathophysiology and measurement. Wilson PRStanton-Hicks MHardon RN: CRPS: Current Diagnosis and Therapy SeattleIASP Press2005. Vol 32:107118

    • Search Google Scholar
    • Export Citation
  • 14

    Shelton RMLewis CW: Reflex sympathetic dystrophy: a review. J Am Acad Dermatol 22:5135201990

  • 15

    Sundaram SWebster GF: Vascular diseases are the most common cutaneous manifestations of reflex sympathetic dystrophy. J Am Acad Dermatol 44:105010512001

    • Search Google Scholar
    • Export Citation
  • 16

    Taylor RSVan Buyten JPBuchser E: Spinal cord stimulation for complex regional pain syndrome: a systematic review of the clinical and cost-effectiveness literature and assessment of prognostic factors. Eur J Pain 10:911012006

    • Search Google Scholar
    • Export Citation
  • 17

    Veldman PHReynen HMArntz IEGoris RJ: Signs and symptoms of reflex sympathetic dystrophy: prospective study of 829 patients. Lancet 342:101210161993

    • Search Google Scholar
    • Export Citation
  • 18

    Vergara AIsarría MJPrado Sánchez-Caminero MGuerra A: [Reflex sympathetic dystrophy: description of a case with skin lesions.]. Actas Dermosifiliogr 96:5295302005. (Span)

    • Search Google Scholar
    • Export Citation
  • 19

    Wagner DLHathaway RC: An unusual cutaneous presentation of reflex sympathetic dystrophy. Anesthesiology 83:112211241995

  • 20

    Wasner GBaron RFactor II: vasomotor changes—pathophysiology and measurement. Wilson PRStanton-Hicks MHardon RN: CRPS: Current Diagnosis and Therapy SeattleIASP Press2005. Vol 32:81106

    • Search Google Scholar
    • Export Citation
  • 21

    Webster GFIozzo RVSchwartzman RJTahmoush AJKnobler RLJacoby RA: Reflex sympathetic dystrophy: occurrence of chronic edema and nonimmune bullous skin lesions. J Am Acad Dermatol 28:29321993

    • Search Google Scholar
    • Export Citation
  • 22

    Webster GFSchwartzman RJJacoby RAKnobler RLUitto JJ: Reflex sympathetic dystrophy. Occurrence of inflammatory skin lesions in patients with stages II and III disease. Arch Dermatol 127:154115441991

    • Search Google Scholar
    • Export Citation
  • 23

    Wilson PRStanton-Hicks MHardon RN: CRPS: Current Diagnosis and Therapy SeattleIASP Press2005. Vol 32:

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