Pain Pract. 2017 Apr 18. doi: 10.1111/papr.12582. [Epub ahead of print]
Goebel A1,2, Lewis S3, Phillip R3, Sharma M1.
1Walton Centre NHS Foundation Trust, Liverpool, United Kingdom.
2Pain Research Institute, University of Liverpool, Liverpool, United Kingdom.
3Defense Medical Rehabilitation Centre Headley Court, Epson, Surrey, United Kingdom.
Limb amputation is sometimes being performed in long-standing complex regional pain syndrome (CRPS), although little evidence is available guiding management decisions, including how CRPS recurrence should be managed. This report details the management of a young soldier with CRPS recurrence 2 years after midtibial amputation for CRPS. Conventional spinal cord stimulation did not achieve paraesthetic coverage, or pain relief in the stump, whereas L4 dorsal root ganglion stimulation achieved both coverage and initially modest pain relief, and over time, substantial pain relief. Implications are discussed. Current evidence does not support the use of amputation to improve either pain or function in CRPS. Dorsal root ganglion stimulation should be considered in those exceptional cases under review for referral for consideration of amputation, before referral, and in those patients with CRPS recurrence in the stump after amputation. This article is protected by copyright. All rights reserved.
This article is protected by copyright. All rights reserved.