gms | German Medical Science

Objective: We performed more than 350 peripheral nerve stimulation procedures since 1991. We mostly treated patients with Causalgia (CRPS II). Incomplete or complete lesion of the stimulated peripheral nerves was determined in all patients. Surgical treatment failed or wouldn't be indicated in all cases. All patients have extensively been treated with conservative pain therapy.

Methods: The aim was to define a standardised method, which would be as objective as possible, to verify the success of treatment, by measuring the pain-related disability assessment, the subjective intensity of pain and the subjective perception of pain. A long-term follow-up was arranged in addition to determine social and occupational re-integration. The implantation of the stimulating device, proximal to the lesion, was performed after microsurgical neurolysis of the peripheral nerves. Post surgically patients were to test stimulate with a stimulation unit externally connected to the lead. After concluding and discussing the results of the trial stimulation period, a stimulation unit was permanently implanted in most (more than 85%) cases, with a remarkable reduction of pain. Only in very few cases, the evaluation of the trial stimulation period was unsatisfactory for the patient and did not indicate the implantation of permanent devices.

Results: After implanting the stimulator unit, an average pain-related disability of 10% was achieved by all the patients fitted with a permanent implant. More than 85% of the patients have used the permanent stimulation device implants with lasting well to excellent success. The stimulator system was removed in only 12 cases, due to full and permanent pain relief, due to a malfunction or lack of lasting success.

Conclusions: In conclusion, PNS should be considered as an effective opportunity for pain relief in causalgia (CRPS II).