Long-term results of peripheral nerve stimulation for reflex sympathetic dystrophy

Samuel J. Hassenbusch M.D., Ph.D. 1 , Michael Stanton-Hicks M.B.B.S., Dr. Med. 1 , Derek Schoppa B.S. 1 , James G. Walsh R.N. 1 and Edward C. Covington M.D. 1
View More View Less
  • 1 Department of Neurosurgery, M.D. Anderson Cancer Center, Houston, Texas; and Pain Management Center, Division of Anesthesiology, and Department of Neurosurgery, Cleveland Clinic Foundation, Cleveland, Ohio
DOI:
https://doi.org/10.3171/jns.1996.84.3.0415
Restricted access

All currencies in US Dollar

✓ This prospective, consecutive series describes peripheral nerve stimulation (PNS) for treatment of severe reflex sympathetic dystrophy (RSD) or complex regional pain syndrome, in patients with symptoms entirely or mainly in the distribution of one major peripheral nerve. Plate-type electrodes were placed surgically on affected nerves and tested for 2 to 4 days. Programmable generators were implanted if 50% or more pain reduction and objective improvement in physical changes were achieved. Patients were followed for 2 to 4 years and a disinterested third-party interviewer performed final patient evaluations. Of 32 patients tested, 30 (94%) underwent permanent PNS placement. Long-term good or fair relief was experienced in 19 (63%) of 30 patients. In successfully treated patients, allodynic and spontaneous pain was reduced on a scale of 10 from 8.3 ± 0.3 preimplantation to 3.5 ± 0.4 (mean ± standard error of the mean) at latest follow up (p < 0.001). Changes in vasomotor tone and patient activity levels were markedly improved but motor weakness and trophic changes showed less improvement. Six (20%) of the 30 patients undergoing PNS placement returned to part-time or full-time work after being unemployed prestimulator implantation. Initial involvement of more than one major peripheral nerve correlated with a poor or no relief rating (p < 0.01). Operative modifications that minimize technical complications are described. This study indicates that PNS can provide good relief for RSD that is limited to the distribution of one major nerve.

Volume 84: Issue 3 (Mar 1996)

in Journal of Neurosurgery
Cover Volume null: Issue null: Journal of Neurosurgery
Article Information

Contributor Notes

Address reprint requests to: Samuel J. Hassenbusch, M.D., Ph.D., Department of Neurosurgery, C9.075, M.D. Anderson Cancer Center, 1515 Holcombe Boulevard, Houston, Texas 77030.
Headings
References
  • 1.

    Barolat GSchwartzman RWoo R: Epidural spinal cord stimulation in the management of reflex sympathetic dystrophy. Stereotact Funct Neurosurg 53:29–391989Barolat G Schwartzman R Woo R: Epidural spinal cord stimulation in the management of reflex sympathetic dystrophy. Stereotact Funct Neurosurg 53:29–39 1989

    • Search Google Scholar
    • Export Citation
  • 2.

    Bonica JJ: Causalgia and other reflex sympathetic dystrophies in Bonica JJ (ed): The Management of Pained 2. Philadelphia: Lea & Febiger1990 pp 220–243Bonica JJ: Causalgia and other reflex sympathetic dystrophies in Bonica JJ (ed): The Management of Pain ed 2. Philadelphia: Lea & Febiger 1990 pp 220–243

    • Search Google Scholar
    • Export Citation
  • 3.

    Bossi LConoscente FPellerin Iet al: Algodystrophy: treatment. Funct Neurol 4:157–1601977Bossi L Conoscente F Pellerin I et al: Algodystrophy: treatment. Funct Neurol 4:157–160 1977

    • Search Google Scholar
    • Export Citation
  • 4.

    Broggi GServello DFranzini Aet al: Spinal cord stimulation for treatment of peripheral vascular disease. Appl Neurophysiol 50:439–4411987Broggi G Servello D Franzini A et al: Spinal cord stimulation for treatment of peripheral vascular disease. Appl Neurophysiol 50:439–441 1987

    • Search Google Scholar
    • Export Citation
  • 5.

    Campbell JNLong DM: Peripheral nerve stimulation in the treatment of intractable pain. J Neurosurg 45:692–6991976Campbell JN Long DM: Peripheral nerve stimulation in the treatment of intractable pain. J Neurosurg 45:692–699 1976

    • Search Google Scholar
    • Export Citation
  • 6.

    Carron HWeller RW: Treatment of post-traumatic sympathetic dystrophy. Adv Neurol 4:485–4901974Carron H Weller RW: Treatment of post-traumatic sympathetic dystrophy. Adv Neurol 4:485–490 1974

    • Search Google Scholar
    • Export Citation
  • 7.

    Charlton JE: Reflex sympathetic dystrophy: non-invasive methods of treatment in Stanton-Hicks MJänig WBoas RA (eds): Reflex Sympathetic Dystrophy. Norwell, MA: Kluwer1990 pp 151–164Charlton JE: Reflex sympathetic dystrophy: non-invasive methods of treatment in Stanton-Hicks M Jänig W Boas RA (eds): Reflex Sympathetic Dystrophy. Norwell MA: Kluwer 1990 pp 151–164

    • Search Google Scholar
    • Export Citation
  • 8.

    Devor MJänig WMichaelis M: Modulation of activity in dorsal root ganglion neurons by sympathetic activation in nerveinjured rats. J Neurophysiol 71:38–471994Devor M Jänig W Michaelis M: Modulation of activity in dorsal root ganglion neurons by sympathetic activation in nerveinjured rats. J Neurophysiol 71:38–47 1994

    • Search Google Scholar
    • Export Citation
  • 9.

    Gracely RHLynch SABennett GJ: Painful neuropathy: altered central processing maintained dynamically by peripheral input. Pain 51:175–1941992Gracely RH Lynch SA Bennett GJ: Painful neuropathy: altered central processing maintained dynamically by peripheral input. Pain 51:175–194 1992

    • Search Google Scholar
    • Export Citation
  • 10.

    Gybels JMSweet WH: Neurosurgical Treatment of Persistent Pain. Basel: Karger1989 pp 257–281Gybels JM Sweet WH: Neurosurgical Treatment of Persistent Pain. Basel: Karger 1989 pp 257–281

    • Search Google Scholar
    • Export Citation
  • 11.

    Jänig W: Pathobiology of reflex sympathetic dystrophy: some general considerations in Stanton-Hicks MJänigWBoas RA (eds): Reflex Sympathetic Dystrophy. Norwell, MA: Kluwer1990 pp 41–54Jänig W: Pathobiology of reflex sympathetic dystrophy: some general considerations in Stanton-Hicks M Jänig W Boas RA (eds): Reflex Sympathetic Dystrophy. Norwell MA: Kluwer 1990 pp 41–54

    • Search Google Scholar
    • Export Citation
  • 12.

    Jänig W: The sympathetic nervous system in pain: physiology and pathophysiology in Stanton-Hicks M (ed): Pain and the Sympathetic Nervous System. Norwell, MA: Kluwer1990 pp 17–89Jänig W: The sympathetic nervous system in pain: physiology and pathophysiology in Stanton-Hicks M (ed): Pain and the Sympathetic Nervous System. Norwell MA: Kluwer 1990 pp 17–89

    • Search Google Scholar
    • Export Citation
  • 13.

    Jänig WMcLachlan EM: The role of modifications in noradrenergic peripheral pathways after nerve lesions in the generation of pain in Fields HLLiebeskind JC (eds): Progress in Pain Research and Management. Seattle: I.A.S.P.1994 pp 101–128Jänig W McLachlan EM: The role of modifications in noradrenergic peripheral pathways after nerve lesions in the generation of pain in Fields HL Liebeskind JC (eds): Progress in Pain Research and Management. Seattle: I.A.S.P. 1994 pp 101–128

    • Search Google Scholar
    • Export Citation
  • 14.

    Kesler RWSaulsbury FTMiller LTet al: Reflex sympathetic dystrophy in children: treatment with transcutaneous electric nerve stimulation. Pediatrics 82:728–7321988Kesler RW Saulsbury FT Miller LT et al: Reflex sympathetic dystrophy in children: treatment with transcutaneous electric nerve stimulation. Pediatrics 82:728–732 1988

    • Search Google Scholar
    • Export Citation
  • 15.

    Kleinert HECole NMWayne Let al: Post-traumatic sympathetic dystrophy. Orthop Clin North Am 4:917–9271973Kleinert HE Cole NM Wayne L et al: Post-traumatic sympathetic dystrophy. Orthop Clin North Am 4:917–927 1973

    • Search Google Scholar
    • Export Citation
  • 16.

    Law JDSwett JKirsch WM: Retrospective analysis of 22 patients with chronic pain treated by peripheral nerve stimulation. J Neurosurg 52:482–4851980Law JD Swett J Kirsch WM: Retrospective analysis of 22 patients with chronic pain treated by peripheral nerve stimulation. J Neurosurg 52:482–485 1980

    • Search Google Scholar
    • Export Citation
  • 17.

    Long DM: Stimulation of the peripheral nervous system for pain control. Clin Neurosurg 31:323–3431984Long DM: Stimulation of the peripheral nervous system for pain control. Clin Neurosurg 31:323–343 1984

    • Search Google Scholar
    • Export Citation
  • 18.

    Malcolm JArnold OTeasell RWet al: Increased venous alpha-adrenoceptor responsiveness in patients with reflex sympathetic dystrophy. Ann Intern Med 118:619–6211993Malcolm J Arnold O Teasell RW et al: Increased venous alpha-adrenoceptor responsiveness in patients with reflex sympathetic dystrophy. Ann Intern Med 118:619–621 1993

    • Search Google Scholar
    • Export Citation
  • 19.

    McLachlan EMJänig WDevor Met al: Peripheral nerve injury triggers noradrenergic sprouting within dorsal root ganglia. Nature 363:543–5461993McLachlan EM Jänig W Devor M et al: Peripheral nerve injury triggers noradrenergic sprouting within dorsal root ganglia. Nature 363:543–546 1993

    • Search Google Scholar
    • Export Citation
  • 20.

    Merskey H: Classification of chronic pain: descriptions of chronic pain syndromes and definitions of pain terms. Pain (Suppl 3):S1–S2251986Merskey H: Classification of chronic pain: descriptions of chronic pain syndromes and definitions of pain terms. Pain (Suppl 3): S1–S225 1986

    • Search Google Scholar
    • Export Citation
  • 21.

    Merskey HBogduk N (eds): Classification of Chronic Pain. Descriptions of Chronic Pain Syndromes and Definitions of Pain Termsed 2. Seattle: I.A.S.P.1994 pp 40–43Merskey H Bogduk N (eds): Classification of Chronic Pain. Descriptions of Chronic Pain Syndromes and Definitions of Pain Terms ed 2. Seattle: I.A.S.P. 1994 pp 40–43

    • Search Google Scholar
    • Export Citation
  • 22.

    Muller AFarcot JM: Système nerveux sympathique, douleur et morphine par voie péridural. Agressologie 32:283–2861991Muller A Farcot JM: Système nerveux sympathique douleur et morphine par voie péridural. Agressologie 32:283–286 1991

    • Search Google Scholar
    • Export Citation
  • 23.

    North RBKidd DHZahurak Met al: Spinal cord stimulation for chronic, intractable pain: experience over two decades. Neurosurgery 32:384–3951993North RB Kidd DH Zahurak M et al: Spinal cord stimulation for chronic intractable pain: experience over two decades. Neurosurgery 32:384–395 1993

    • Search Google Scholar
    • Export Citation
  • 24.

    Racz GBBrowne TLewis R Jr: Peripheral stimulator implant for treatment of causalgia caused by electrical burns. Tex Med 84:45–501988Racz GB Browne T Lewis R Jr: Peripheral stimulator implant for treatment of causalgia caused by electrical burns. Tex Med 84:45–50 1988

    • Search Google Scholar
    • Export Citation
  • 25.

    Racz GBHeavner JE: Comments on “A Spiral Nerve Cuff Electrode for Peripheral Nerve Stimulation.” IEEE Trans Biomed Eng 36:1140–11411989Racz GB Heavner JE: Comments on “A Spiral Nerve Cuff Electrode for Peripheral Nerve Stimulation.” IEEE Trans Biomed Eng 36:1140–1141 1989

    • Search Google Scholar
    • Export Citation
  • 26.

    Racz GBLewis RHeavner JEet al: Peripheral nerve stimulator implant for treatment of causalgia in Stanton-Hicks M (ed): Pain and the Sympathetic Nervous System. Norwell, MA: Kluwer1990 pp 225–239Racz GB Lewis R Heavner JE et al: Peripheral nerve stimulator implant for treatment of causalgia in Stanton-Hicks M (ed): Pain and the Sympathetic Nervous System. Norwell MA: Kluwer 1990 pp 225–239

    • Search Google Scholar
    • Export Citation
  • 27.

    Racz GBLewis RHeavner JEet al: Peripheral nerve stimulator implant for treatment of causalgia in Stanton-Hicks MJänigWBoas RA (eds): Reflex Sympathetic Dystrophy. Norwell, MA: Kluwer1990 pp 135–141Racz GB Lewis R Heavner JE et al: Peripheral nerve stimulator implant for treatment of causalgia in Stanton-Hicks M Jänig W Boas RA (eds): Reflex Sympathetic Dystrophy. Norwell MA: Kluwer 1990 pp 135–141

    • Search Google Scholar
    • Export Citation
  • 28.

    Raj PCannella JKelly Jet al: Multi-discliplinary management of reflex sympathetic dystrophy in Stanton-Hicks MJänig WBoas RA (eds): Reflex Sympathetic Dystrophy. Norwell, MA: Kluwer1990 pp 165–172Raj P Cannella J Kelly J et al: Multi-discliplinary management of reflex sympathetic dystrophy in Stanton-Hicks M Jänig W Boas RA (eds): Reflex Sympathetic Dystrophy. Norwell MA: Kluwer 1990 pp 165–172

    • Search Google Scholar
    • Export Citation
  • 29.

    Raja SNTreede RDDavis KDet al: Systemic alpha-adrenergic blockade with phentolamine: a diagnostic test for sympathetically-maintained pain. Anesthesiology 74:691–6981991Raja SN Treede RD Davis KD et al: Systemic alpha-adrenergic blockade with phentolamine: a diagnostic test for sympathetically-maintained pain. Anesthesiology 74:691–698 1991

    • Search Google Scholar
    • Export Citation
  • 30.

    Rauck RLEisenach JCJackson KEet al: Epidural clonidine for refractory reflex sympathetic dystrophy. Anesthesiology 75 (Suppl):A6571991 (Abstract)Rauck RL Eisenach JC Jackson KE et al: Epidural clonidine for refractory reflex sympathetic dystrophy. Anesthesiology 75 (Suppl): A657 1991 (Abstract)

    • Search Google Scholar
    • Export Citation
  • 31.

    Robaina FJDominguez MDíaz Met al: Spinal cord stimulation for relief of chronic pain in vasospastic disorders of the upper limbs. Neurosurgery 24:63–671989Robaina FJ Dominguez M Díaz M et al: Spinal cord stimulation for relief of chronic pain in vasospastic disorders of the upper limbs. Neurosurgery 24:63–67 1989

    • Search Google Scholar
    • Export Citation
  • 32.

    Robaina FJRodriguez JLde Vera JAet al: Transcutaneous electrical nerve stimulation and spinal cord stimulation for pain relief in reflex sympathetic dystrophy. Stereotact Funct Neurosurg 52:53–621989Robaina FJ Rodriguez JL de Vera JA et al: Transcutaneous electrical nerve stimulation and spinal cord stimulation for pain relief in reflex sympathetic dystrophy. Stereotact Funct Neurosurg 52:53–62 1989

    • Search Google Scholar
    • Export Citation
  • 33.

    Sato JPerl ER: Adrenergic excitation of cutaneous pain receptors induced by peripheral nerve injury. Science 251:1608–16101991Sato J Perl ER: Adrenergic excitation of cutaneous pain receptors induced by peripheral nerve injury. Science 251:1608–1610 1991

    • Search Google Scholar
    • Export Citation
  • 34.

    Stanton-Hicks MJänig WHassenbusch SJet al: Reflex sympathetic dystrophy: changing concepts and taxonomy. Pain (In press1996) Stanton-Hicks M Jänig W Hassenbusch SJ et al: Reflex sympathetic dystrophy: changing concepts and taxonomy. Pain (In press 1996)

    • Search Google Scholar
    • Export Citation
  • 35.

    Sweet WH: Causalgia; sympathetic dystrophy (Sudeck's atrophy) in Wilkins RHRengachary SS (eds): Neurosurgery. New York: McGraw-Hill1985 pp 1886–1893Sweet WH: Causalgia; sympathetic dystrophy (Sudeck's atrophy) in Wilkins RH Rengachary SS (eds): Neurosurgery. New York: McGraw-Hill 1985 pp 1886–1893

    • Search Google Scholar
    • Export Citation
  • 36.

    Tasker RRLougheed WM: Neurosurgical techniques of sympathetic interruption in Stanton-Hicks M (ed): Pain and the Sympathetic Nervous System. Norwell, MA: Kluwer1990 pp 165–190Tasker RR Lougheed WM: Neurosurgical techniques of sympathetic interruption in Stanton-Hicks M (ed): Pain and the Sympathetic Nervous System. Norwell MA: Kluwer 1990 pp 165–190

    • Search Google Scholar
    • Export Citation
  • 37.

    Watson HKCarlson L: Treatment of reflex sympathetic dystrophy of the hand with an active “stress loading” program. J Hand Surg 12:779–7851987Watson HK Carlson L: Treatment of reflex sympathetic dystrophy of the hand with an active “stress loading” program. J Hand Surg 12:779–785 1987

    • Search Google Scholar
    • Export Citation
  • 38.

    Wilson PR: Sympathetically maintained pain: diagnosis, measurement, and efficacy of treatment in Stanton-Hicks M (ed): Pain and the Sympathetic Nervous System. Norwell, MA: Kluwer1990 pp 91–124Wilson PR: Sympathetically maintained pain: diagnosis measurement and efficacy of treatment in Stanton-Hicks M (ed): Pain and the Sympathetic Nervous System. Norwell MA: Kluwer 1990 pp 91–124

    • Search Google Scholar
    • Export Citation
  • 39.

    Woolf CJThompson SWN: The induction and maintenance of central sensitization is dependent on N-methyl-D-aspartic acid receptor activation; implications for the treatment of post-injury pain hypersensitivity states. Pain 44:293–2991991Woolf CJ Thompson SWN: The induction and maintenance of central sensitization is dependent on N-methyl-D-aspartic acid receptor activation; implications for the treatment of post-injury pain hypersensitivity states. Pain 44:293–299 1991

    • Search Google Scholar
    • Export Citation
TrendMD
Cited By
Metrics

Metrics

All Time Past Year Past 30 Days
Abstract Views 692 678 27
Full Text Views 215 114 1
PDF Downloads 101 45 1
EPUB Downloads 0 0 0
PubMed
Google Scholar