Anesth Pain Med.  2016 Jul;11(3):295-298. 10.17085/apm.2016.11.3.295.

Ultrasound-guided placement of a permanent peripheral nerve stimulator in a patient with complex regional pain syndrome: A case report

• Chung W
• Kim Y
• Lee J
• Lee S
• Kim Y
• Shin Y
• Lee W
• Ko Y

• KMID: 2344935
• DOI: http://doi.org/10.17085/apm.2016.11.3.295

Abstract

A 56-year-old man complained of continuous pain in the right foot that began 6 months after undergoing surgery on the right calcaneus bone. The patient was diagnosed with complex regional pain syndrome (CRPS) type I and was treated with medication, lumbar sympathetic ganglion blocks, epidural nerve blocks, and spinal cord stimulation. However, all treatments were halted because they were ineffective or complications developed. Peripheral nerve stimulation (PNS) was planned after confirming the analgesic effects of a sciatic nerve block, and the patient received PNS via minimally invasive ultrasound-guided electrode placement. PNS reduced the pain intensity and the incidence of paroxysmal pain. Other than discomfort at the battery insertion site (resolved with re-implantation), the patient developed no complications. These results suggest that ultrasound-guided minimally invasive PNS is a safe and effective treatment for patients with CRPS in the lower extremities.

Keyword

Complex regional pain syndromes; Implantable neurostimulator; Neuropathic pain; Pain management; Sciatic nerve; Ultrasonography

MeSH Terms

Calcaneus
Complex Regional Pain Syndromes
Electrodes
Foot
Ganglia, Sympathetic
Humans
Implantable Neurostimulators
Incidence
Lower Extremity
Middle Aged
Nerve Block
Neuralgia
Pain Management
Peripheral Nerves*
Sciatic Nerve
Spinal Cord Stimulation
Ultrasonography

Figure

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  Fig. 1 Anteroposterior and lateral views of the spinal cord stimulation insertion site.

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  Fig. 2 Peripheral nerve stimulation site on ultrasonography and simple X-ray: 1, electrode and 2, sciatic nerve.

Reference

1. Jo JY, Lee SJ, Kim YH. Spinal cord stimulation with sympathetically independent pain and sympathetically maintained pain. Anesth Pain Med. 2013; 8:86–90.

2. Marinus J, Moseley GL, Birklein F, Baron R, Maihöfner C, Kingery WS, et al. Clinical features and pathophysiology of complex regional pain syndrome. Lancet Neurol. 2011; 10:637–48. DOI: 10.1016/S1474-4422(11)70106-5.

3. Rho RH, Brewer RP, Lamer TJ, Wilson PR. Complex regional pain syndrome. Mayo Clin Proc. 2002; 77:174–80. DOI: 10.1016/S0025-6196(11)62332-X. PMID: 11838651.

4. Moon DE. Diagnosis and treatment of complex regional pain syndrome. J Korean Med Assoc. 2006; 49:688–700. DOI: 10.5124/jkma.2006.49.8.688.

5. Jeon IC, Kim MS, Kim SH. Median nerve stimulation in a patient with complex regional pain syndrome type II. J Korean Neurosurg Soc. 2009; 46:273–6. DOI: 10.3340/jkns.2009.46.3.273. PMID: 19844632. PMCID: PMC2764030.

6. Kim WY, Moon DE, Choi JH, Park CM, Han SM, Kim SH. The effect of spinal cord stimulation in patients with complex regional pain syndrome. Korean J Pain. 2006; 19:152–8. DOI: 10.3344/kjp.2006.19.2.152.

7. Mirone G, Natale M, Rotondo M. Peripheral median nerve stimulation for the treatment of iatrogenic complex regional pain syndrome (CRPS) type II after carpal tunnel surgery. J Clin Neurosci. 2009; 16:825–7. DOI: 10.1016/j.jocn.2008.09.006. PMID: 19297168.

8. Hassenbusch SJ, Stanton-Hicks M, Schoppa D, Walsh JG, Covington EC. Long-term results of peripheral nerve stimulation for reflex sympathetic dystrophy. J Neurosurg. 1996; 84:415–23. DOI: 10.3171/jns.1996.84.3.0415. PMID: 8609552.

9. Huntoon MA, Burgher AH. Ultrasound-guided permanent implantation of peripheral nerve stimulation (PNS) system for neuropathic pain of the extremities: original cases and outcomes. Pain Med. 2009; 10:1369–77. DOI: 10.1111/j.1526-4637.2009.00745.x. PMID: 20021597.

10. Marhofer P, Greher M, Kapral S. Ultrasound guidance in regional anaesthesia. Br J Anaesth. 2005; 94:7–17. DOI: 10.1093/bja/aei002. PMID: 15277302.

11. Mobbs RJ, Nair S, Blum P. Peripheral nerve stimulation for the treatment of chronic pain. J Clin Neurosci. 2007; 14:216–21. DOI: 10.1016/j.jocn.2005.11.007. PMID: 17258129.