High frequency spinal cord stimulation can be more effective than traditional spinal cord stimulation in treating complex regional pain syndrome

Abstract

Abstract Introduction: This case report demonstrates the effectiveness of high frequency 10 kHz spinal cord stimulation (HF10 therapy SCS) in the treatment of Complex Regional Pain Syndrome (CRPS) when compared with other treatment modalities including traditional SCS. Traditional SCS is believed to exert its action through stimulating the dorsal columns mitigating the hyperexcitable afferent signals from the periphery. Hf10 SCS delivers more stimulation to the dorsal horns targeting specifically the wide dynamic range neurons (pain projecting neurons). This creates a greater potential to suppress the sympathetic overactivity seen in CRPS while additionally removing the paresthesia's generated with dorsal column stimulation, which many find unpleasant. Patient concerns: 59-year-old Caucasian male presented with classic right lower limb symptoms of CRPS and longstanding low back pain with right-sided radiculopathy. Diagnosis: The patient developed CRPS after right leg open thrombectomy. Interventions: The patient received para-sagittal steroid epidural injections and lumbar sympathetic blocks with inadequate pain relief. He failed to improve using traditional SCS and was referred for evaluation using high frequency 10 kHz spinal cord stimulator, which the SENZA-RCT showed superior pain relief when compared to traditional stimulation. Outcome: This case is unique because the patient had no improvement with traditional SCS and reported 100% relief of CRPS pain and associated symptoms and 40% reduction in back pain while using HF10. This also is significant because back pain tends to be refractory when treated with traditional SCS. Conclusion: High frequency 10 kHz spinal cord stimulator might be an effective means of managing the symptoms of CRPS and reducing axial back pain.