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

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.

[1]  G. Racz,et al.  Peripheral Nerve Stimulator Implant for Treatment of RSD , 1990 .

[2]  W. Jänig.  Pathobiology of Reflex Sympathetic Dystrophy: Some General Considerations , 1990 .

[3]  Wilfrid Jänig,et al.  Peripheral nerve injury triggers noradrenergic sprouting within dorsal root ganglia , 1993, Nature.

[4]  J. Charlton.  Reflex Sympathetic Dystrophy Non-Invasive Methods of Treatment , 1990 .

[5]  H. Kleinert,et al.  Post-traumatic sympathetic dystrophy. , 1973, The Orthopedic cllinics of North America.

[6]  J. Eisenach,et al.  EPIDURAL CLONIDINE FOR REFRACTORY REFLEX SYMPATHETIC DYSTROPHY , 1991 .

[7]  D. Long,et al.  Peripheral nerve stimulation in the treatment of intractable pain. , 1976, Journal of neurosurgery.

[8]  F. Robaina,et al.  Transcutaneous electrical nerve stimulation and spinal cord stimulation for pain relief in reflex sympathetic dystrophy. , 1989, Stereotactic and functional neurosurgery.

[9]  G. Broggi,et al.  Spinal cord stimulation for treatment of peripheral vascular disease. , 1987, Applied neurophysiology.

[10]  E. Perl,et al.  Adrenergic excitation of cutaneous pain receptors induced by peripheral nerve injury. , 1991, Science.

[11]  J. Bonica.  Causalgia and other reflex sympathetic dystrophies. , 1973, Postgraduate medicine.

[12]  W. Jänig,et al.  The sympathetic nervous system in pain. , 1995, European journal of anaesthesiology. Supplement.

[13]  R. Teasell,et al.  Increased Venous Alpha-Adrenoceptor Responsiveness in Patients with Reflex Sympathetic Dystrophy , 1993, Annals of Internal Medicine.

[14]  Clifford J. Woolf,et al.  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 , 1991, Pain.

[15]  K. Davis,et al.  Systemic alpha-adrenergic blockade with phentolamine: a diagnostic test for sympathetically maintained pain. , 1991, Anesthesiology.

[16]  H. Merskey,et al.  Classification of chronic pain. Descriptions of chronic pain syndromes and definitions of pain terms. Prepared by the International Association for the Study of Pain, Subcommittee on Taxonomy. , 1994, Pain. Supplement.

[17]  Comments, with reply, on "A spiral nerve cuff electrode for peripheral nerve stimulation" by G.G. Naples et al , 1989 .

[18]  G. Racz,et al.  Peripheral stimulator implant for treatment of causalgia caused by electrical burns. , 1988, Texas medicine.

[19]  P. Wall.  Neurosurgical Treatment of Persistent Pain Vol. II Pain and Headache , 1989 .

[20]  Richard B. North,et al.  Spinal cord stimulation for chronic, intractable pain: experience over two decades. , 1993, Neurosurgery.

[21]  A. M. Harvey.  Classification of Chronic Pain—Descriptions of Chronic Pain Syndromes and Definitions of Pain Terms , 1995 .

[22]  L. Carlson,et al.  Treatment of reflex sympathetic dystrophy of the hand with an active "stress loading" program. , 1987, The Journal of hand surgery.

[23]  D. Long.  Stimulation of the peripheral nervous system for pain control. , 1983, Clinical neurosurgery.

[24]  R. W. Kesler,et al.  Reflex sympathetic dystrophy in children: treatment with transcutaneous electric nerve stimulation. , 1988, Pediatrics.

[25]  S. Hassenbusch,et al.  Reflex sympathetic dystrophy: changing concepts and taxonomy , 1995, Pain.

[26]  M. Devor,et al.  Modulation of activity in dorsal root ganglion neurons by sympathetic activation in nerve-injured rats. , 1994, Journal of neurophysiology.

[27]  Gary J. Bennett,et al.  Painful neuropathy: altered central processing maintained dynamically by peripheral input , 1992, Pain.