A Severe Case of Complex Regional Pain Syndrome I (Reflex Sympathetic Dystrophy) Managed with Spinal Cord Stimulation

Pain Practice
Volume 10 Issue 1, Pages 78 - 83
Bernard Canlas, MD*; Thomas Drake, PA-C*; Eric Gabriel, MD †
*Institute of Pain Management, P.A., Jacksonville, Florida; † St. Vincent's Brain and Spine Institute, Jacksonville, Florida, U.S.A.
Correspondence to Bernard R. Canlas, MD, Institute of Pain Management, P.A.––4243 Sunbeam Road Ste.6 Jacksonville, FL 32257, U.S.A. E-mail: drcanlas@comcast.net.
Disclosure: Dr.Canlas and Dr. Gabriel are guest consultants of St. Jude Neuromodulation division. Dr. Canlas' has stock ownership with St. Jude Medical.

ABSTRACT
Complex regional pain syndrome is a condition that usually affects the upper or lower extremities. The cause is not clearly understood. We report a case of a severe form of a rapidly progressive complex regional pain syndrome type I developing after a right shoulder injury managed with spinal cord stimulation (SCS). After failed conservative treatments, a rechargeable SCS system was implanted in the cervical spine. Allodynia and dystonia improved but the patient subsequently developed similar symptoms in lower right extremity followed by her lower left extremity. The patient became wheelchair bound. A second rechargeable SCS with a paddle electrode was implanted for the lower extremity coverage. The patient's allodynia and skin lesions improved significantly. However, over time, her initial symptoms reappeared which included skin breakdown. Due to the need for frequent recharging, the system was removed. During explantation of the surgical paddle lead, it was noted by the neurosurgeon that the contacts of the paddle lead were detached from the lead. After successful implantation of another SCS system, the patient was able to reduce her medications and is now able to ambulate with the use of a left elbow crutch.