Correspondence
Spinal Cord Stimulation for Chronic Reflex Sympathetic Dystrophy — Five-Year Follow-up
N Engl J Med 2006; 354:2394-2396June 1, 2006
- Article
To the Editor:
Reflex sympathetic dystrophy is a painful, disabling disorder of unknown pathophysiological origin that usually commences after trauma to or surgery on a limb. In chronic cases, the syndrome leads to extreme pain, disability, and an inability to work, symptoms that dramatically change the lives of both patients and their families.1,2 We undertook the present trial to determine whether treatment of chronic reflex sympathetic dystrophy with spinal cord stimulation and physical therapy is more effective than treatment with physical therapy alone.
In spinal cord stimulation, an electrode is positioned in the epidural space on the dorsal aspect of the spinal cord at the level of the nerve roots innervating the painful area. Electrical current from the electrode brings about paresthesia, a sensation that suppresses the pain. At follow-up at six months and at two years, we found that spinal cord stimulation had reduced pain by more than 50 percent but had not affected allodynia, hypoesthesia, or function.3-5
The methods of the study have been previously described.3 In short, 36 patients with reflex sympathetic dystrophy were randomly assigned to receive spinal cord stimulation and physical therapy (stimulation group) and 18 patients to receive physical therapy only (control group). Twenty-four patients in the stimulation group were given a permanent spinal cord stimulator after successful test stimulation; the remaining 12 patients received no permanent spinal cord stimulator. Figure 1Figure 1
Study Protocol. shows the study design.At five years, 10 patients were excluded from the study, and the analysis compared 31 patients in the stimulation group with 13 controls. The mean pain intensity in the stimulation group was reduced from baseline by 1.7 cm, as compared with 1.0 cm in the control group (P=0.25) (Figure 2Figure 2
A Comparison of Visual-Analogue Pain Scores of Patients Receiving Spinal Cord Stimulation and Controls.). Similar results were obtained at follow-up at three years (–1.6 in the stimulation group vs. –0.7 in the control group, P=0.29) and at four years (–1.7 vs. –1.0, P=0.42).The long-term follow-up analysis demonstrates that the pain-alleviating effect of spinal cord stimulation in chronic reflex sympathetic dystrophy diminishes with time, as compared with that in a control group, and is no longer statistically significant after three years.
5 ReferencesMarius A. Kemler, M.D., Ph.D.
Academic Medical Center, 1100 DD Amsterdam, the NetherlandsHenrica C.W. de Vet, Ph.D.
Vrije Universiteit Medical Center, 1007 MB Amsterdam, the NetherlandsGerard A.M. Barendse, M.D.
Frans A.J.M. van den Wildenberg, M.D., Ph.D.
Maarten van Kleef, M.D., Ph.D.
Maastricht University Hospital, 6202 AZ Maastricht, the Netherlands
mvk@anaesth.azm. nl 1
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Kemler MA ,Reulen JPH ,Barendse GAM ,van Kleef M ,de Vet HCW ,van den Wildenberg FAJM . Impact of spinal cord stimulation on sensory characteristics in complex regional pain syndrome type I: a randomized trial. Anesthesiology 2001;95:72-80
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