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Final Program

981 - Peripheral Nerve Stimulation for Causalgia Secondary to Traumatic Post-Surgical Hand Pain may Provide Long-Term Relief when Conservative and Surgical Management is Unsuccessful

Friday, February 28, 2025
5:00 PM - 6:30 PM MST
Case Diagnosis: Compressive and entrapment neuropathies are common pathologies that negatively affect activities of daily living and may result in weakness, loss of dexterity, sensory changes, and pain in specific distributions. Causalgia, commonly referred to as complex regional pain syndrome type II, refers to a state of pain from a peripheral nerve injury that typically begins after fracture, surgery, or soft-tissue injury.  Despite the high frequency of these ailments, there is limited data exploring the management of causalgia in traumatic post-surgical hand pain.

Case Description:

A 55-year-old female patient continued to have pain in her right hand after a wrist fracture and open reduction and internal fixation. After carpal tunnel release, anterior cervical discectomy and fusion for a cervical disc herniation and myelopathy, and ulnar release, she continued to have pain. Treatment included a 60-day percutaneous peripheral nerve stimulator, followed by a permanent median nerve implant. A pain scale from 0 to 10 is used to assess treatment efficacy. The value 0 is equivalent to no pain, and 10 is the worst pain she has ever experienced.

Discussions:

The patient reported an 85-90% improvement in pain for 60 days in the 4th and 5th digits of her right hand during the temporary peripheral nerve stimulator placement but continued having right thumb pain. A permanent median nerve implant was placed. This resulted in the complete resolution of her right-hand pain. She continues to have 100% pain relief six months later.

Conclusions: Peripheral nerve stimulation can be an effective long-term treatment of causalgia of the median and ulnar nerves when conservative and surgical approaches are ineffective.  While current data is limited, this report may help add to available data to employ new ways of managing chronic pain. This subject requires further research to help increase the scope of chronic pain management and aid in patient outcomes.