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
Cervical spinal cord stimulation for neuropathic pain after brachial plexus avulsion injury: case report