Case Report
Successful Treatment of Intractable Complex Regional Pain Syndrome Type I of the Knee With Dorsal Root Ganglion Stimulation: A Case Report

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Objectives

To report on the efficacy of dorsal root ganglion stimulation in a patient with complex regional pain syndrome (CRPS) type I of the knee.

Materials and Methods

A 48-year-old woman with CRPS type I of the right knee, diagnosed according to the Budapest criteria set, received DRG stimulation for intractable CRPS type I of the knee.

Results

After a successful trial period with three DRG stimulation leads on spinal levels L2, L3, and L4 (covering 90% of the painful area of her knee), a definitive pulse generator was implanted. Three months after implantation, the entire painful area was covered, and the patient reported a numeric rating scale score of 1–2.

Conclusion

Placement of three DRG stimulation leads at levels L2, L3, and L4 in a patient with intractable CRPS type I of the knee resulted in major pain relief. We recommend further investigation of the effect of DRG stimulation on pain due to CRPS of the knee.

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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Source(s) of financial support: None declared.

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