Effect of spinal cord stimulation for chronic complex regional pain syndrome Type I: five-year final follow-up of patients in a randomized controlled trial

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Chronic complex regional pain syndrome–Type I (CRPS-I) is a painful, disabling disorder for which no treatment with proven effect is available. In the present randomized controlled trial, the authors assessed the effectiveness of spinal cord stimulation (SCS) in reducing pain due to CRPS-I at the 5-year follow-up.

Methods

The authors performed a randomized trial in a 2:1 ratio in which 36 patients with CRPS-I were allocated to receive SCS and physical therapy (PT) and 18 patients to receive PT alone. Twenty-four patients who received SCS+PT also underwent placement of a permanent spinal cord stimulator after successful test stimulation; the remaining 12 patients did not receive a permanent stimulator. The authors assessed pain intensity, global perceived effect, treatment satisfaction, and health-related quality of life. Patients were examined before randomization, before implantation, and every year until 5 years thereafter. Ten patients were excluded from the final analysis.

Results

At 5 years posttreatment, SCS+PT produced results similar to those following PT for pain relief and all other measured variables. In a subgroup analysis, the results with regard to global perceived effect (p = 0.02) and pain relief (p = 0.06) in 20 patients with an implant exceeded those in 13 patients who received PT.

Conclusions

Despite the diminishing effectiveness of SCS over time, 95% of patients with an implant would repeat the treatment for the same result.

Abbreviations used in this paper:CRPS-I = complex regional pain syndrome–Type I; EQ-5D = EuroQol-5D; PT = physical therapy; QOL = quality of life; SCS = spinal cord stimulation; SD = standard deviation; VAS = visual analog scale.

Article Information

Address correspondence to: M. A. Kemler, M.D., Ph.D., Department of Plastic Surgery, Martini Hospital, P.O. Box 30033, 9700 RM Groningen, The Netherlands. email: M.Kemler@mzh.nl.

© AANS, except where prohibited by US copyright law.

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Figures

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    Flowchart illustrating the study protocol and indicating the groups compared in the main and subgroup analysis. n = number of patients; − = negative response; + = positive response.

  • View in gallery

    Bar graph demonstrating the mean (± SD) VAS pain scores in patients with complex CRPS-I. The groups in the main analysis are represented by white and gray bars, whereas the subgroup of patients with an implant at the final follow-up is represented by black bars.

  • View in gallery

    Bar graph depicting the global perceived effect scores at 2 years in 31 patients in the SCS+PT treatment group and 13 patients in the PT treatment group. 1 = worst ever; 2 = much worse; 3 = worse; 4 = not improved/not worse; 5 = improved; 6 = much improved; 7 = best ever.

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