Chronic Pain Rehabilitation for Upper Extremity Pain Following Stimulator Removal

Am J Case Rep, 2018 · DOI: 10.12659/AJCR.911157 · Published: November 19, 2018

Pain Management Rehabilitation Research Methodology & Design

Simple Explanation

This case report examines the separate and sequential outcomes of spinal cord stimulation (SCS) and interdisciplinary chronic pain rehabilitation program (CPRP) in a 26-year-old patient with a work-related injury resulting in chronic upper extremity pain. The patient was treated within an interdisciplinary CPRP following failure and removal of an SCS. Outcomes were measured by psychological assessments and return-to-work through a 6-month post-CPRP follow-up.

Study Duration

6-month post-CPRP follow-up

Participants

Female, 26, with chronic upper extremity pain

Evidence Level

Level 4: Case Report

Key Findings

1
Pain intensity decreased following SCS placement and CPRP.
2
Pain-related distress, pain interference, and overall affect improved only after CPRP, with sustained improvements at 6-month follow-up.
3
CPRP demonstrated marked improvement in pain, self-reported function, and mood with patient eventually returning to work and maintaining most of these gains 6-months after completing CPRP treatment.

Research Summary

This report is a single subject case study of a unique circumstance in which a patient was provided 2 treatment modalities in a manner creating a natural experimental design. Pain reduction was evidenced following SCS trial and minimally after implantation; however, greater decreases were evidenced following CPRP treatment without the stimulator. CPRP demonstrated marked improvement in pain intensity, self-reported function, and mood, as well as the patient ultimately returning to work, and maintaining most of these gains 6-months after completion of CPRP treatment.

Practical Implications

Treatment Modality

Interdisciplinary approach to chronic pain may be more effective than SCS alone for improving function and mood.

Return to Work

CPRP can facilitate return to work for patients with chronic pain.

Upper Extremity Disorders

CPRP is a viable treatment option for chronic upper extremity pain, an area with limited research.

Study Limitations

1
Generalizability of the findings is limited.
2
The outcomes are based on self-report measures.
3
It is possible that there was a time effect in which there were gradual improvements unrelated to either treatment.

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