Liste-149
ELECTRICAL SPINAL CORD
STIMULATION FOR REFLEX SYMPATHETIC DYSTROPHY
M. Kemler, G. Barendse*, F. v.d. Wildenberg and M. van Kleef*.
Purpose: To retrospectively assess the
clinical efficacy and possible adverse effects of electrical spinal cord
stimulation (ESCS) in the treatment of reflex sympathetic dystrophy (RSD).
Methods:
All studied patients suffered severe pain due to RSD. The diagnosis RSD
(Complex Regional Pain Syndrome, type 1) was based on the criteria of the
International Association for the Study of Pain. All patients had previously
been treated by physical therapy, transcutaneous
electrical nerve stimulation, and syrmpathetic
blockages, without lasting success. The ESCS‑system was implanted only
after a positive one week test period.
From
all patients the pain was rated prior to placement (by means of Visual Analogue
Scale, VAS), one month after placement, and at the end of follow‑up.
Besides, patients were asked to score their RSD situation at the end of follow‑up,
as compared to before start of the treatment on a seven‑point scale,
indicating: best ever, much improved, improved, not unproved/not worse, worse,
much worse, worst ever.
Results:
Of 23 patients, treated between 1991 and 1997, 18 reported improvement during
the test‑period (78%). The others noted no effect (2 cases) or more pain
(3 cases). Permanent placement was not performed in these patients. The mean painscore of 18 patients one month following placement of
the ESCS‑system was 4.2 (range: 1 7). With three patients the system was
removed 8 to 20 months following placement, because of no effect (2 cases) and
an infected lead wound (1 case). At the end of follow‑up (mean: 32;
range: 6‑79 months) 15 patients still had an implanted system. Their mean
painscore had decreased from 7.9 to 5.4 (p<0.001).
For the other 8 patients the painscore had not
changed significantly. Thirteen patients with an ESCS‑system scored much
improved or improved as a global perceived effect and were regarded successful
(57%).
Conclusion: In this retrospective series,
the majority of RSD patients report a subjective improvement by ESCS. To
confirm these findings, a prospective randomized trial is undertaken.