Abstract
Background: Fibromyalgia and complex regional pain syndrome (CRPS) are both chronic pain syndromes with pathophysiologic mechanisms related to autonomic nervous system dysregulation and central sensitization. Both syndromes are considered difficult to treat with conventional pain therapies. Case presentations: Here we describe a female veteran with fibromyalgia and a male veteran with CRPS, both of whom failed multiple pharmacologic, physical and psychological therapies for pain, but responded to percutaneous electrical neural field stimulation (PENFS) targeted at the auricular branches of the cranial nerves. Discussion: While PENFS applied to the body has been previously described for treatment of localized pain, PENFS effects on cranial nerve branches of the ear is not well-known, particularly when used for regional and full-body pain syndromes such as those described here. PENFS of the ear is a minimally-invasive, non-pharmacologic therapy that could lead to improved quality of life and decreased reliance on medication. However, further research is needed to guide clinical application, particularly in complex pain patients.
Highlights
Chronic pain syndromes encompass a poorly defined group of symptoms, including the chief perceptive state of ongoing pain
We present two cases of peri-auricular percutaneous electrical neural field stimulation (PENFS) use in patients seen in our specialist pain medicine clinic at the Veterans Affairs Medical Center in Atlanta (GA, USA), with chronic pain syndromes refractory to multiple therapeutic interventions
After the third and final application, she returned to the clinic stating she had on-going complete relief of pain attributed to fibromyalgia
Summary
The introduction describes well the complexity of fibromyalgia and complex regional pain syndrome (CRPS), including the hypotheses these syndromes are sympathetically mediated entities. Case Presentation- Case 2 For the patient with CRPS (case two) there is no mention of abnormal sympathetic tone in the affected extremity: swelling, edema, skin color changes, and temperature changes. This is important, as extremity: swelling, edema, skin color changes, and temperature changes. This is important, as normalization of such findings (i.e. temperature difference between affected and unaffected leg during PENFS application) would support the notion that PENFS works by decreasing sympathetic tone, possibly in a similar way as a sympathetic block would act
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