Spinal Cord Stimulation in Complex Regional Pain Syndrome Type I of Less Than 12-Month Duration Frank van Eijs, MD*, José W. Geurts, MSc † , Jan Van Zundert, MD, PhD †‡ , Catharina G. Faber, MD, PhD § , Alfons G. H. Kessels, MD, MSc ¶ , Elbert A. J. Joosten, PhD † , Maarten van Kleef, MD, PhD † Introduction: Complex regional pain syndrome type 1 (CRPS-1) has a 31% probability of becoming chronic. The early use of spinal cord stimulation (SCS) has been recommended as a strategy to prevent chronicity and functional impairment. Methods: In a prospective study, we treated 74 CRPS-1 patients with a mean disease duration of 17 weeks with standard therapy consisting of physical therapy, topical dimethyl sulfoxide, analgesics, transcutaneous stimulation, and sympathetic blockade. Patients who did not respond to standard therapy were offered a treatment with SCS. In these patients, we investigated the impact on pain, quality of life, and function. Results: Out of these 74 patients treated with standard therapy, six patients were included for early SCS treatment. The overall mean pain relief after one year was 35%. The mental component of the Short Form 36 improved; however, there was no effect on the physical component. None of the SCS treated patients showed a clear improvement in functional outcome. Discussion: We conclude that the feasibility of performing a randomized controlled trial on early SCS therapy in CRPS-1 is low because of the good disease improvement with standard therapy in the first year after onset. This study raises questions about the need to use SCS early in the course of CRPS-1 because of the probable lack of additional benefit compared with SCS in chronic CRPS-1. Keywords: Complex regional pain syndrome, functional restoration, neuropathic pain, prospective study, spinal cord stimulation Conflict of Interest: All authors state no conflict of interest. INTRODUCTION Complex regional pain syndrome type 1 (CRPS-1) is a severe chronic pain condition characterized by sensory, autonomic, motor, and dys- trophic signs and symptoms. It usually occurs after trauma and is characterized by spontaneous and evoked pain, which is dispropor- tionate in severity and duration to the expected course of the initi- ating trauma (1). The reported incidence varies from 5.46 to 26.2 per 100,000 person years. Women are affected 3.4–4 times more often than men (2,3). In general, the outcome of chronic CRPS is not favor- able. After one year, signs and symptoms in patients with CRPS are well developed and pain is refractory, with the majority of patients demonstrating only moderate increase in symptoms over the years (4). In a population-based cohort study of 102 CRPS patients, 31% remained incapable to work after two or more years (5). Of these patients, 64% still showed persistent signs and symptoms 5.8 years after onset of the syndrome (range 2.1–10.8 years). CRPS therefore is a serious condition with a high probability of chronicity and residual impairment. Recommendations from an expert panel suggest con- comitant use of psychologic, rehabilitation, and interventional pain management techniques (6). Therapy aimed at restoring function should be started as soon as possible, as any delay in treatment is likely to worsen outcome. Spinal cord stimulation (SCS) is a more invasive technique to be considered when other treatments fail. A systematic review reports SCS to be an (cost-) effective therapy in the management of patients with chronic CRPS-1 (7). However, despite its efficacy in the treatment of pain, SCS performed in chronic CRPS-1 showed no important improvement in functional outcome (8). Therefore, the early use of SCS (less than one year) for the manage- ment of CRPS was recommended as a strategy to prevent chronicity and possible central sensitization in order to improve pain, Address correspondence to: José W. Geurts, MSc, Department of Anesthesio- logy and Pain Management, Maastricht University Medical Centre, Mail Box 5800, 6202 AZ Maastricht, The Netherlands. Email: jose.geurts@mumc.nl * Department of Anesthesiology and Pain Therapy, St Elisabeth Hospital, Tilburg, The Netherlands; † Department of Anesthesiology and Pain Medicine, Maastricht University Medical Centre, Maastricht, The Netherlands; ‡ Department of Anesthesiology and Multidisciplinary Pain Centre, Hospital Oost-Limburg, Genk, Belgium; § Department of Neurology, Maastricht University Medical Centre, Maastricht, The Netherlands; and ¶ Department of Clinical Epidemiology and Medical Technology Assessment, Maastricht University Medical Centre, Maastricht, The Netherlands For more information on author guidelines, an explanation of our peer review process, and conflict of interest informed consent policies, please go to http:// www.wiley.com/bw/submit.asp?ref=1094-7159&site=1 Neuromodulation: Technology at the Neural Interface Received: June 1, 2011 Revised: October 13, 2011 Accepted: November 28, 2011 (onlinelibrary.wiley.com) DOI: 10.1111/j.1525-1403.2011.00424.x 144 www.neuromodulationjournal.com Neuromodulation 2012; 15: 144–150 © 2012 International Neuromodulation Society