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Schwarm FP, Stein M, Uhl E, Maxeiner H, Kolodziej MA. Spinal cord stimulation for the treatment of complex regional pain syndrome leads to improvement of quality of life, reduction of pain and psychological distress: a retrospective case series with 24 months follow up. Scand J Pain 2019; 20:253-259. [DOI: 10.1515/sjpain-2019-0081] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2019] [Accepted: 09/18/2019] [Indexed: 11/15/2022]
Abstract
Abstract
Background and aims
Complex regional pain syndrome (CRPS) is a common pain condition which is characterized by pain, functional impairment, and trophic changes. Neurosurgical treatment is not widely offered. In this study the treatment with spinal cord stimulation (SCS) was evaluated over 24 months follow up.
Methods
A retrospective case analysis of six patients with severe CRPS was performed. Pain chronicity was recorded with the Mainz Pain Staging System (MPSS). Pain intensity (NRS), activity level and health-related quality of life (EQ-5D-5L), the actual mood state (ASTS), and treatment satisfaction (CSQ-8) were assessed. All patients received conventional pharmacological treatments including multimodal pain therapy through their local pain therapist or in specialized centers as well as physical therapy. A SCS electrode was implanted for trial stimulation. After successful trial a neurostimulator was implanted and connected to the electrode. Patients were retrospectively analyzed before implantation and 6, 12 and 24 months postoperatively. Statistical analysis was performed using Mann–Whitney U and Wilcoxon rank-sum test.
Results
Patients median age was 43 years (IQR25−75 37–43 years). The median MPSS Score was 3 of 3 indicating a high pain chronicity. Median NRS before implantation of the neurostimulator was 8.8 (IQR25−75 7.6–9.3). A reduction to 7.8 (IQR25−75 4.8–8.1; p = 0.14) after 6 months, 6.5 (IQR25−75 3.8–8.1; p = 0.08) after 1 year, and 6.8 (IQR25−75 3.8–8.5; p = 0.15) after 2 years was achieved. Median EQ-5D-5L index value before treatment was 0.27 (IQR25−75 0.25–0.41) indicating a severely lowered quality of life. A significant improvement to 0.53 (IQR25−75 0.26–0.65; p = 0.03) after 6 months, 0.58 (IQR25−75 0.26–0.84; p = 0.03) after 1 year as well as after 2 years was seen. ASTS scale showed an increase of values for positive mood, and a reduction in values for sorrow, fatigue, anger and desperation during the whole follow up period. The treatment satisfaction in the whole cohort with a median CSQ-8 value of 29.5 of 32 was very high.
Conclusion
The results of this small case series showed a significant improvement of the EQ-5D-5L after implantation of a neurostimulator. NRS reduction was not significant but a clear tendency towards reduced values was observed. We therefore conclude that SCS is an alternative option to relieve chronic pain and psychological distress originating from CRPS if non-invasive managements of severe CRPS failed. The preoperative selection plays a crucial role for good results.
Implications
CRPS is difficult to treat. SCS is an alternative option to improve the quality of life and relieve chronic pain originating from severe CRPS if conservative treatment modalities fail. Further psychological distress is reduced in long-term follow up. SCS should be kept in mind for therapy refractory cases.
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Affiliation(s)
| | - Marco Stein
- Department of Neurosurgery , Justus-Liebig-University Giessen , Giessen , Germany
| | - Eberhard Uhl
- Department of Neurosurgery , Justus-Liebig-University Giessen , Giessen , Germany
| | - Hagen Maxeiner
- Department of Anesthesiology, Intensive Care and Pain Therapy , Justus-Liebig-University Giessen , Giessen , Germany
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Vargovich AM, Chorney J, Gross RT, Vowles KE. Chronic Pain Rehabilitation for Upper Extremity Pain Following Stimulator Removal. AMERICAN JOURNAL OF CASE REPORTS 2018; 19:1373-1377. [PMID: 30449882 PMCID: PMC6253559 DOI: 10.12659/ajcr.911157] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Patient: Female, 26 Final Diagnosis: Complex Regional Pain Syndrome (CRPS) Symptoms: Edema • pain • sweating Medication: — Clinical Procedure: — Specialty: General and Internal Medicine
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Affiliation(s)
- Alison M Vargovich
- Department of Family Medicine, West Virginia University, Morgantown, WV, USA.,Department of Medicine, Division of Behavioral Medicine, University at Buffalo, The State University of New York, Buffalo, NY, USA
| | - Jill Chorney
- Centre for Pediatric Pain Research, IWK Health Centre, Halifax, NS, Canada
| | - Richard T Gross
- Department of Behavioral Medicine and Psychiatry, West Virginia University, Morgantown, WV, USA
| | - Kevin E Vowles
- Department of Psychology, University of New Mexico, Albuquerque, NM, USA
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Elsamadicy AA, Yang S, Sergesketter AR, Ashraf B, Charalambous L, Kemeny H, Ejikeme T, Ren X, Pagadala P, Parente B, Xie J, Lad SP. Prevalence and Cost Analysis of Complex Regional Pain Syndrome (CRPS): A Role for Neuromodulation. Neuromodulation 2017; 21:423-430. [PMID: 28961359 DOI: 10.1111/ner.12691] [Citation(s) in RCA: 30] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2017] [Revised: 07/14/2017] [Accepted: 07/31/2017] [Indexed: 11/30/2022]
Abstract
OBJECTIVE The diagnosis and treatment of complex regional pain syndrome (CRPS) is challenging and there is a paucity of data describing its overall cost burden and quantifying its impact on the US healthcare system. The aim of this study was to assess the prevalence and healthcare utilization costs associated with CRPS. MATERIALS AND METHODS A retrospective longitudinal study was performed using the Truven MarketScan® database to identify patients with a new indexed diagnosis of CRPS (Type I, II, or both) from 2001 to 2012. We collected total, outpatient, and pain prescription costs three years prior to CRPS diagnosis (baseline), at year of CRPS diagnosis, and eight-year post-CRPS diagnosis. A longitudinal multivariate analysis was used to model the estimated total and pain prescription cost ratios comparing patients diagnosed before and after CRPS. RESULTS We included 35,316 patients with a newly indexed diagnosis of CRPS (Type I: n = 18,703, Type II: n = 14,599, Unspecified: n = 2014). Baseline characteristics were similar between the CRPS cohorts. Compared to two- and three-year baseline costs, one-year prior to diagnosis for all CRPS patients yielded the highest interquartile median [IQR] costs: total costs $7904[$3469, $16,084]; outpatient costs $6706[$3119, $12,715]; and pain prescription costs $1862[$147, $7649]. At the year of CRPS diagnosis, the median [IQR] costs were significantly higher than baseline costs: total costs $8508[$3943, $16,666]; outpatient costs $7251[$3527, $13,568]; and pain prescription costs $2077[$140, $8856]. Over the eight-year period after CRPS diagnosis, costs between all the years were similar, ranging from the highest (one-year) to lowest (seven-years), $4845 to $3888. The median total cumulative cost 8-years after CRPS diagnosis was $43,026 and $12,037 for pain prescription costs. [Correction added on 06 November 2017 after first online publication: the preceding sentence has been updated to demonstrate the median cumulative cost in replacement of the additive cumulative mean costs.]. During the CRPS diagnosis period, patients are expected to have a total cost 2.17-fold and prescription cost 2.56-fold of their baseline cost annually. CONCLUSIONS Our study demonstrates that there is a significant increase in cost and healthcare resource utilization one-year prior to and around the time of CRPS diagnosis. Furthermore, there is an increased annual cost post-diagnosis compared to baseline costs prior to CRPS diagnosis.
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Affiliation(s)
| | - Siyun Yang
- Department of Biostatistics, Duke University Medical Center, Durham, NC, USA
| | | | - Bilal Ashraf
- Department of Neurosurgery, Duke University Medical Center, Durham, NC, USA
| | - Lefko Charalambous
- Department of Neurosurgery, Duke University Medical Center, Durham, NC, USA
| | - Hanna Kemeny
- Department of Neurosurgery, Duke University Medical Center, Durham, NC, USA
| | - Tiffany Ejikeme
- Department of Neurosurgery, Duke University Medical Center, Durham, NC, USA
| | - Xinru Ren
- Department of Biostatistics, Duke University Medical Center, Durham, NC, USA
| | - Promila Pagadala
- Department of Neurosurgery, Duke University Medical Center, Durham, NC, USA
| | - Beth Parente
- Department of Neurosurgery, Duke University Medical Center, Durham, NC, USA
| | - Jichun Xie
- Department of Biostatistics, Duke University Medical Center, Durham, NC, USA
| | - Shivanand P Lad
- Department of Neurosurgery, Duke University Medical Center, Durham, NC, USA
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