Case ReportSuccessful Treatment of Intractable Complex Regional Pain Syndrome Type I of the Knee With Dorsal Root Ganglion Stimulation: A Case Report
Section snippets
INTRODUCTION
Complex regional pain syndrome (CRPS) is a collection of locally appearing painful conditions that mainly occur distally and exceed in both intensity and duration the expected clinical course of the original trauma. In a minority of patients, the condition is restricted to the knee. Recently, a systematic review was performed to find evidence for the diagnosis of CRPS of the knee. The authors concluded that this diagnosis has been described before and the best therapy is yet to be found (1).
History
We retrospectively present a case of CRPS in a 48-year-old woman who suffered complaints of the right knee for five years. One week after a diagnostic arthroscopy to rule out any meniscal problem, she developed CRPS type I of the knee. This patient was referred to our department for a second opinion. She had already been extensively treated with different types of oral medication. In addition, a lumbar sympathetic block resulted in no clinically significant relief of symptoms, and physical
DISCUSSION
This patient with CRPS type I of the knee failed to respond to multidisciplinary pain management. The symptoms fit the Budapest criteria set, but infrapatellar nerve injury should be considered as differential diagnostic (5). An electromyography was not performed, so we cannot be 100% sure that there was no demonstrable nerve damage. In case of nerve damage, the diagnosis should be CRPS type II. The DRG stimulation therapy resulted in a clinically significant result: The pain level dropped from
CONCLUSION
This report indicates DRG stimulation to be an effective therapy for reducing chronic neuropathic pain due to CRPS of the knee. Stimulating the DRG totally covered the entire painful area, and up to three months post-implant the initial NRS score of 9 had decreased to 1–2. Long-term results are not yet available, and more patients with similar complaints need to be investigated. If such studies replicate the present findings, a controlled study should be performed in order to draw more definite
Authorship Statements
Drs. van Bussel and Huygen designed and conducted the study. Dr. van Bussel prepared the manuscript draft with important intellectual input from Drs. Stronks and Huygen. All authors approved the final manuscript.
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A multicenter, prospective trial to assess the safety and performance of the spinal modulation dorsal root ganglion neurostimulator system in the treatment of chronic pain
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Source(s) of financial support: None declared.