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BJA Advance Access published online on January 22, 2004
British Journal of Anaesthesia, doi:10.1093/bja/aeh072
© 2004 by The Board of Management and Trustees of the British Journal of Anaesthesia
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Accepted October 3, 2003

Clinical Investigation

Spinal cord stimulation in complex regional pain syndrome: cervical and lumbar devices are comparably effective

T. Forouzanfar 1, M. A. Kemler 2, W. E. J. Weber 1, A. G. H. Kessels 3, M. van Kleef 4*

1 Pain Management and Research Centre, Department of Anaesthesiology, University Hospital Maastricht, Maastricht, The Netherlands
2 Department of Surgery, University Hospital Maastricht, Maastricht, The Netherlands
3 Department of Clinical Epidemiology and Medical Technology Assessment, University Hospital Maastricht, Maastricht, The Netherlands
4 Pain Management and Research Centre, Department of Anaesthesiology, University Hospital Maastricht, Maastricht, The Netherlands; Pain Management and Research Centre, University Hospital Maastricht, P.O. Box 5800, 6202 AZ Maastricht, The Netherlands

* To whom correspondence should be addressed. E-mail: MVK{at}sane.azm.nl.


  Abstract

Background. Spinal cord stimulation (SCS) has been used since 1967 for the treatment of patients with chronic pain. However, long-term effects of this treatment have not been reported. The present study investigated the long-term effects of cervical and lumbar SCS in patients with complex regional pain syndrome type I.

Methods. Thirty-six patients with a definitive implant were included in this study. A pain diary was obtained from all patients before treatment and 6 months and 1 and 2 years after implantation. All patients were asked to complete a seven-point Global Perceived Effect (GPE) scale and the Euroqol-5D (EQ-5D) at each post-implant assessment point.

Results. The pain intensity was reduced at 6 months, 1 and 2 years after implantation (P<0.05). However, the repeated measures ANOVA showed a statistically significant, linear increase in the visual analogue scale score (P=0.03). According to the GPE, at least 42% of the cervical SCS patients and 47% of the lumbar SCS patients reported at least ‘much improvement’. The health status of the patients, as measured on the EQ-5D, was improved after treatment (P<0.05). This improvement was noted both from the social and from the patients’ perspective. Complications and adverse effects occurred in 64% of the patients and consisted mainly of technical defects. There were no differences between cervical and lumbar groups with regard to outcome measures.

Conclusion. SCS reduced the pain intensity and improves health status in the majority of the CRPS I patients in this study. There was no difference in pain relief and complications between cervical and lumbar SCS.

Br J Anaesth 2004

Keywords: Keywords: complications, complex regional pain syndrome; spinal cord, electrical stimulation, cervical; spinal cord, electrical stimulation, lumbar


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