Open AccessA Case of Spinal Cord Stimulation in Raynaud’s Phenomenon: Can Subthreshold Sensory Stimulation Have an Effect?
Author(s) -
Ramsin Benyamin
Publication year - 2007
Publication title -
pain physician
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.31
H-Index - 99
eISSN - 2150-1149
pISSN - 1533-3159
DOI - 10.36076/ppj.2007/10/473
Subject(s) - medicine , stimulation , anesthesia , epidural space , sensory system , stellate ganglion , spinal cord , sensory stimulation therapy , spinal cord stimulation , surgery , neuroscience , alternative medicine , pathology , psychiatry , biology
Spinal cord stimulation is currently used to treat a variety of chronic intractablepainful conditions. We report a case of severe Raynaud’s phenomenon in thehands refractory to conservative treatment and responsive to diagnostic stellate ganglion block that was effectively treated with a spinal cord stimulatorplaced in the cervical epidural space. After capturing the affected areas withparesthesias, blood flow in the left hand and fingers significantly improved asevidenced by an increase in skin temperature, a change from cyanotic to pinkappearance and concomitant reduction in pain. Moreover, the patient reportedthat limb ischemia and pain could be managed overnight with stimulation intensities that were below sensory perception thresholds. Thus it seems, at leastin the overnight period, paresthesias were not required to maintain pain relief.This case presents a potential divergence between a requirement for paresthesias and pain relief in spinal cord stimulation therapy for the treatment of Raynaud’s phenomenon. The possible role of the sympathetic nervous system in thisrelationship is also discussed.Key words: spinal cord stimulator, Raynaud’s phenomenon, sensory perception