Imagine one day you stub your toe and the pain that would usually go away after a day or so, just keeps getting worse. Then the pain spreads to your whole foot which turns red and starts to swell. After a while your whole lower leg gets involved, you are having trouble walking and you can’t even put a sock on because your foot is so sensitive.
This kind of runaway pain response, called Complex Regional Pain Syndrome (CRPS), is rare but does actually happen. Dr. Christopher J. Winfree who heads both our Centers for Pain and Peripheral Nerve Surgery spoke at this year’s annual meeting of the American Association of Neurological Surgeons (AANS) and outlined a number of state of the art Neuromodulation techniques that can help people with this extreme condition.
If left untreated, CRPS can lead to irreversible changes in the soft tissue of the leg and even the bone can become more porous. While the exact cause is unknown, it is theorized that either the nervous system or the immune system get a sort of glitch in them and go haywire. No matter the cause, the pain can be unrelenting and treatment essential.
The first lines of treatment for CRPS are usually pain medications and antidepressants. Physical therapy can be prescribed to help with desensitization training and to mitigate any loss of strength, motion, and function. In more extreme cases, the patient is sent to a pain specialist like Dr. Winfree. As a pain specialist who is also a neurosurgeon, he employs a variety of neuromodulation techniques.
Neuromodulation is the process whereby an implantable device is used to reversibly alter the activity of the nervous system. This may be accomplished using small doses of medications or a weak electrical current. By altering the activity of certain pathways in the nervous system, pain may be immediately and dramatically relieved. Pain Center Website
In particular, Dr. Winfree spoke at this year’s AANS meeting about the individual or combined use of three types of neuromodulation: Spinal Nerve Root Stimulation, Peripheral Nerve Stimulation, and Subcutaneous Peripheral Nerve Stimulation. While there are many factors that determine which procedure is used it is largely based on where exactly the pain is. “Sometimes”, says Dr. Winfree, “CRPS is largely within the confines of a single peripheral nerve or nerve root distribution.” When this is the case, that nerve can be targeted either where it comes out of the spinal cord using Spinal Nerve Root Stimulation or closer to the area of pain using Peripheral Nerve Stimulation.
Dr. Winfree says however, that “CRPS typically exceeds the confines of a single peripheral nerve or nerve root distribution” in which case a combination of one or more of these techniques along with Subcutaneous Peripheral Nerve Stimulation can give the most pain relief. The word subcutaneous means “just under the skin” and that is exactly where they put the stimulator with this technique, right where the pain is. Sometimes this method is used alone but only a small area can be targeted at a time so might not be enough.
See previous blog Turn up the static when Pain Won’t Stop Calling for more about nerve stimulation
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