1. 2016;19;E631-E635Pain Relief in CRPS-II after Spinal Cord and Motor Cortex Simultaneous Dual Stimulation
   Case Report
   William OC Lopez, MD, Danilo C. Barbosa, MD, Manoel J Teixera, MD, PhD, Martin Paiz, MD, Leonardo Moura, MD, Bernardo A. Monaco, MD, and Erich T Fonoff, MD, PhD.

We describe a case of a 30-year-old woman who suffered a traumatic injury of the right brachial plexus, developing severe complex regional pain syndrome type II (CRPS-II). After clinical treatment failure, spinal cord stimulation (SCS) was indicated with initial positive pain control. However, after 2 years her pain progressively returned to almost baseline intensity before SCS. Additional motor cortex electrode implant was then proposed as a rescue therapy and connected to the same pulse generator. This method allowed simultaneous stimulation of the motor cortex and SCS in cycling mode with independent stimulation parameters in each site. At 2 years follow-up, the patient reported sustained improvement in pain with dual stimulation, reduction of painful crises, and improvement in quality of life. The encouraging results in this case suggests that this can be an option as add-on therapy over SCS as a possible rescue therapy in the management of CRPS-II. However, comparative studies must be performed in order to determine the effectiveness of this therapy.

Key words: Chronic neuropathic pain, Complex regional pain syndrome Type II, brachial plexus injury, motor cortex stimulation, spinal cord stimulation