Cervical Spinal Cord Stimulation Treatment of Deafferentation Pain from Brachial Plexus Avulsion Injury Complicated by Complex Regional Pain Syndrome

Abstract

Brachial plexus avulsion is a rare and debilitating condition frequently associated with severe, intractable neuropathic pain. Interventional treatment modalities include dorsal root entry zone lesioning, stellate ganglion blockade, and neuromodulation such as spinal cord stimulation. We present a case of a 42-year-old woman with a traumatic left upper extremity brachial plexus avulsion injury after a motor vehicle accident and treatment of deafferentation pain complicated by complex regional pain syndrome type II. Previous unsuccessful interventions included repeated stellate ganglion blocks, transcutaneous electrical nerve stimulation, and opioid medication. After a successful trial of cervical spinal cord stimulator lead placement, she went on to an uneventful permanent implantation procedure. Spinal cord stimulation is an effective treatment for deafferentation pain and complex regional pain syndrome type II secondary to brachial plexopathy refractory to pharmacotherapy and conventional interventional attempts to modulate pain.