J Korean Neurosurg Soc.  2009 Sep;46(3):273-276. 10.3340/jkns.2009.46.3.273.

Median Nerve Stimulation in a Patient with Complex Regional Pain Syndrome Type II

• Jeon IC
• Kim MS
• Kim SH

• KMID: 2138420
• DOI: http://doi.org/10.3340/jkns.2009.46.3.273

Abstract

A 54-year-old man experienced injury to the second finger of his left hand due to damage from a paintball gun shot 8 years prior, and the metacarpo-phalangeal joint was amputated. He gradually developed mechanical allodynia and burning pain, and there were trophic changes of the thenar muscle and he reported coldness on his left hand and forearm. A neuroma was found on the left second common digital nerve and was removed, but his symptoms continued despite various conservative treatments including a morphine infusion pump on his left arm. We therefore attempted median nerve stimulation to treat the chronic pain. The procedure was performed in two stages. The first procedure involved exposure of the median nerve on the mid-humerus level and placing of the electrode. The trial stimulation lasted for 7 days and the patient's symptoms improved. The second procedure involved implantation of a pulse generator on the left subclavian area. The mechanical allodynia and pain relief score, based on the visual analogue scale, decreased from 9 before surgery to 4 after surgery. The patient's activity improved markedly, but trophic changes and vasomotor symptom recovered only moderately. In conclusion, median nerve stimulation can improve chronic pain from complex regional pain syndrome type II.

Keyword

Complex regional pain syndrome; Median nerve; Peripheral nerve stimulation

MeSH Terms

Arm
Burns
Causalgia
Chronic Pain
Cold Temperature
Electrodes
Fingers
Forearm
Hand
Humans
Hyperalgesia
Infusion Pumps
Joints
Median Nerve
Middle Aged
Morphine
Muscles
Neuroma
Morphine