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Introduction Case Report Conclusion This case report presents an instance of an S‐Series™ slim paddle lead fracturing during extraction, highlighting potential risks associated with the removal of this lead.A 47‐year‐old male with complex regional pain syndrome type 2, unresponsive to pharmacotherapy, had undergone the implantation of two spinal cord stimulator (SCS) leads, an Octrode™ cylindrical and an S‐series™ slim paddle, using the Epiducer™ system (St Jude Medical) 9 years earlier, with a subsequent intrathecal baclofen pump installed 1 year after SCS. Initially, these interventions stabilized the patient's pain symptoms. However, the diminishing effectiveness of SCS, coupled with a decrease in battery life and increased opioid consumption, necessitated recent surgical procedures. These included the removal and replacement of the implantable pulse generator (IPG) and leads to improve pain management and ensure MRI compatibility. During the removal of the S‐series™ slim paddle type lead, complications arose, leading to the retention of an electrode fragment, which necessitated abandoning the replacement of both the IPG and lead. Post‐surgical assessments revealed no new neurological impairments, and imaging studies confirmed the stable position of the retained fragment. The patient was discharged with a continued comprehensive pain management plan.This case highlights the challenges and risks of percutaneous removal of slim paddle type leads, emphasizing the need for careful procedural planning and consideration of surgical options to avoid complications. Further research is needed to evaluate the long‐term durability and removal risks of various SCS lead types. [ABSTRACT FROM AUTHOR]

Background/Importance: Dietary interventions, vitamins, and nutritional supplementation are playing an increasingly important role in the management of neuropathic pain. Current pharmacological treatments are poorly tolerated and ineffective in many cases. Objective: This systematic review aims to study the efficacy of dietary interventions, vitamins, and nutritional supplementation in the management of chronic neuropathic pain in adults. Evidence Review: The review followed PRISMA guidelines and was registered with PROSPERO (#CRD42022300312). Ten databases and gray literature, including Embase.com, MEDLINE and Web of Science, were systematically searched using a combination of keywords and controlled vocabulary related to chronic neuropathic pain and oral non‐pharmacological supplements. Studies on adult humans published between 2000 and 2021 were considered for inclusion. The Cochrane Handbook was used to assess risk of bias, and Grading of Recommendations Assessment, Development, and Evaluation was used to determine overall quality of evidence. Findings: Forty studies were included in the final review, and results were categorized according to pain type including pain related to chemotherapy‐induced peripheral neuropathy (CIPN, 22 studies, including 3 prospective cohorts), diabetic peripheral neuropathy (DPN, 13 studies, including 2 prospective), complex regional pain syndrome (CRPS‐I, 3 studies, including 1 prospective), and other (2 studies, both RCT). The CIPN studies used various interventions including goshajinkigan (4 studies), vitamin E (5), vitamin B12 (3), glutamine (3), N‐acetyl‐cysteine (2), acetyl‐l‐carnitine (2), guilongtonluofang (1), ninjin'yoeito (1), alpha‐lipoic acid (1), l‐carnosine (1), magnesium and calcium (1), crocin (1), and antioxidants (1), with some studies involving multiple interventions. All CIPN studies involved varying cancers and/or chemotherapies, advising caution for generalizability of results. Interventions for DPN included alpha‐lipoic acid (5 studies), vitamin B12 (3), acetyl‐l‐carnitine (3), vitamin E (1), vitamin D (2), and a low‐fat plant‐based diet (1). Vitamin C was studied to treat CRPS‐I (3 studies, including 1 prospective). Magnesium (1) and St. John's wort (1) were studied for other or mixed neuropathologies. Conclusions: Based on the review, we cannot recommend any supplement use for the management of CIPN, although further research into N‐acetyl‐cysteine, l‐carnosine, crocin, and magnesium is warranted. Acetyl‐l‐carnitine was found to be likely ineffective or harmful. Alpha‐lipoic acid was not found effective. Studies with goshajinkigan, vitamin B12, vitamin E, and glutamine had conflicting results regarding efficacy, with one goshajinkigan study finding it harmful. Guilongtonluofang, ninjin'yoeito, and antioxidants showed various degrees of potential effectiveness. Regarding DPN, our review supports the use of alpha‐lipoic acid, acetyl‐l‐carnitine, and vitamin D. The early use of vitamin C prophylaxis for the development of CRPS‐I also seems promising. Further research is warranted to confirm these findings. [ABSTRACT FROM AUTHOR]

Introduction: Complex regional pain syndrome (CRPS) is characterized by nociplastic pain with alterations in sympathetic function. Neuromodulation could be a useful alternative therapy option. Dorsal root ganglion (DRG) stimulation has demonstrated better results than conventional spinal cord stimulation (SCS) for patients with CRPS in lower limbs. Methods: We report a case series of seven patients treated with cervical DRG stimulation for CRPS of the hand that required neuromodulation for pain relief, after no response with other analgesic techniques (medication and interventional). We report retrospective data collection of seven consecutive patients with a 1‐year follow‐up. Results: Seven patients were trialed, and six were implanted with a permanent pulse generator after achieving more than 50% pain relief during 2–7 days of trial phase. The average pain relief (rated on a standard 100 mm visual analog scale) after 1 year of treatment was 64.3% ± 16.6. No major complications were observed during a 1‐year follow‐up. Discussion: The results for cervical DRG stimulation are similar to other DRG stimulation studies for the treatment of refractory CRPS at lower levels. The cervical DRG implant technique guided with C‐arm fluoroscopy and under conscious sedation could be a safe and effective option for relieving pain of the upper limbs CRPS. Monitoring neural status is required for cervical DRG stimulation either with a responder awake patient or with intraoperative neural monitoring in non‐responder patients. [ABSTRACT FROM AUTHOR]

Background: Evaluating the effectiveness of stellate ganglion blockades (SGBs) proves challenging, since the criteria defining a successful blockade are controversial. This may be one reason for the scarcity of studies on this topic, thus forcing clinical guidelines to remain conservative in recommending SGBs. Moreover, factors to predict which patients will benefit from blockade series are not yet available. Objectives: The objectives of this study were to evaluate through a clinical approach SGBs' effectiveness performed under ultrasound guidance (us‐SGB) and to identify factors to predict effectiveness. Methods: We retrospectively analyzed 809 us‐SGBs in 105 patients with complex regional pain syndrome (CRPS) and neuropathic pain syndromes (all potentially including sympathetically maintained pain) regarding pain reduction. Volume and type of local anesthetics, magnitude of pain, temperature of the dorsal hands, heart rate, blood pressure, and occurrence of Horner's syndrome or complications were assessed. Results: Pain reduction after a blockade series was highly significant and showed no significant correlation with change of temperature, vital signs, or Horner's syndrome. For patients with neuropathic pain, the predictive potential for pain reduction following a blockade series lies within the range of pain reduction after the first blockade. In a literature comparison, incidences of complications (hoarseness 3.9%, dysphagia 3.4%, hematoma 0.6%) were lower than in non‐ultrasound‐guided techniques. Conclusions: Data indicate that us‐SGBs are safe and effective in reducing sympathetically maintained pain in patients with CRPS and neuropathic pain syndromes. Pain reduction after the first blockade may predict total pain reduction after a blockade series. Other clinical measures seem unsuitable to predict effectiveness. [ABSTRACT FROM AUTHOR]

Complex regional pain syndrome ( CRPS) is multifactorial condition with complex pathogenesis characterized by spontaneous or stimulus-induced pain that is disproportionate to the inciting event. It is also commonly accompanied by a myriad of autonomic and motor disturbances in highly variable combinations. This condition has been underreported in children until recently. Consequently, the management of CRPS in the pediatric population presents an even greater challenge than in adults, partly because there is a lack of clinical data concerning the efficacy of the diverse treatment methods available, and partly because successful treatment of CRPS involves a multidisciplinary approach. In this retrospective case series, a multidisciplinary management plan is presented in 10 children for whom the standard noninvasive treatment was unsuccessful. Within this management plan, novel drugs were included such as the capsaicin 8% patch, in addition to invasive techniques in patients who did not respond to noninvasive therapies. [ABSTRACT FROM AUTHOR]

Background Few studies have investigated the relationship between injury location, mechanism and their association with complex regional pain syndrome ( CRPS). We conducted a nationwide database survey to explore this issue. Methods This was a population-based case-control study. Five hundred and eighty-nine patients with at least one ambulatory visit or admission with a principal diagnosis of CRPS from 2004 to 2009 were selected. For each CRPS patient, ten age- and sex-matched non- CRPS subjects were randomly selected. The odds ratios ( PLoS One. 2013;8:e57205) and 95% confidence intervals (95% CIs) of risk factors for CRPS were derived from multivariate logistic regression models. Results Injury was a risk factor for CRPS ( OR, 2.96; 95% CI, 2.18 to 4.02) independent of age and sex. In adjusted models, open wound on the upper limbs ( OR 1.25, 95% CI 1.02 to 1.54) conferred higher CRPS risk. Injury mechanisms including nerve and spinal cord injury ( OR 2.42, 95% CI 1.44 to 4.08), muscle and joint sprain and strain ( OR 1.69, 95% CI 1.40 to 2.03), superficial injury ( OR 1.23, 95% CI 1.00 to 1.51), and contusion ( OR 1.44, 95% CI 1.20 to 1.74), but not fracture, increased the risk of CRPS. Conclusion Injury in the extremities rather than the trunk is an important risk factor for CRPS. Certain injury mechanisms confer higher risk of CRPS. This nationwide study demonstrated that injury increased CRPS nearly threefold. Open wound, sprain and strain, superficial injury, contusion, and nerve and spinal cord injury are main injury mechanisms. Injury in the extremities confers a higher risk of CRPS. [ABSTRACT FROM AUTHOR]

Objectives Our goal was to ascertain the prevalence of widespread pain in our cohort of patients with complex regional pain syndrome ( CRPS). Methods We conducted a retrospective analysis of clinical letters and notes. We assessed data from consecutive patients diagnosed with CRPS according to the Budapest criteria, after a referral to one consultant at a tertiary Pain Medicine referral center. Results Between July 2007 and September 2012, 190 patients (149 females) received a diagnosis of CRPS according to the Budapest criteria, and an additional 26 patients received the diagnosis of CRPS NOS (not otherwise specified). The CRPS patients were an average of 44 years of age, and had a median disease duration of 18 months. Before the CRPS incident trigger, a third had already experienced other than everyday pains in the now CRPS-affected limb. Twenty-one patients (11.1%) experienced widespread pain in clinic, which was often not communicated in the referral letters. The types of triggering traumata and frequencies of Budapest signs and symptoms did not differ between patients with or without widespread pain. All patients considered their widespread pain as an important factor affecting their quality of life; for the majority it was of similar severity to the CRPS pain. Additional patients reported CRPS-concomitant regional pains, most commonly headaches/migraines, lower back pain, and irritable bowel syndrome. Discussion In this systematic assessment of the incidence of widespread pain in a large cohort of patients with CRPS, important widespread pain affected > 10% of patients. Our data support the inclusion of routine enquiries about additional pains in the clinical assessment of patients with CRPS. [ABSTRACT FROM AUTHOR]

Background and aims Evidence suggests tumor necrosis factor-alpha (TNF-α) mediates, at least in part, symptoms and signs in complex regional pain syndrome (CRPS). Here, we present a case series of patients with CRPS type 1, in whom the response to the anti- TNF-α adalimumab was assessed. Methods Ten patients with CRPS type 1 were recruited. Assessments were performed before treatment, at 1 week, and 1, 3, and 6 months following 3 biweekly subcutaneous injections (40 mg/0.8 mL) adalimumab (Humira®) and included the followings: Pain intensity using a 0-10 cm visual analog scale; the Short Form of the McGill Pain Questionnaire; the Beck Depression Inventory; the SF-36 questionnaire and mechanical and thermal thresholds (Von frey hair and Thermal Sensory Analyzer, respectively). In addition to the description of individual patient responses, both intention to treat (ITT) and per-protocol (PP) analyses were performed for the entire group. Results Three subgroups of patients were identified (3 patients in each): 'nonresponders', 'partial responders', and 'robust responders' in whom improvement in almost all parameters was noted. Both the ITT and PP analyses demonstrated only a trend toward improvement in mechanical pain thresholds following treatment (ITT χ² = 13.83, P = 0.008; PP χ² = 10.29, P = 0.036). Conclusion These results suggest adalimumab, and possibly other anti- TNF-α, can be potentially useful in some (although not in all) patients with CRPS type 1. These preliminary results along with the growing body of evidence which points to the involvement of TNF-α in the pathogenesis of CRPS justify further studies in this area. [ABSTRACT FROM AUTHOR]

Stellate ganglion block is used for the diagnosis and treatment of sympathetically maintained pain syndromes. Multiple anatomic variations and inaccurate sympathetic block may mislead the diagnosis and prevent patients from receiving potentially beneficial interventions. We describe a novel approach to blockade of the sympathetic chain at C7 and at T2 to T3 with a single-needle injection. With the patient in supine position, the uncinate process of C7 is identified fluoroscopically as a target for insertion of a catheter through a Touhy needle. The catheter is directed caudally to the junction of T2 and T3. Contrast injection confirms the spread to the appropriate levels before injection of local anesthetic. This novel approach to blockade of the upper extremity sympathetic innervation may enhance diagnostic accuracy and therapeutic benefit as compared with traditional approaches to the stellate ganglion alone. This approach may be expected to decrease the risk of pneumothorax when compared with the posterior approach to T2 to T3. [ABSTRACT FROM AUTHOR]