Reported here is the unpublished long follow-up (22 years and 14 years) of 2 patients with longstanding causalgia initially successfully treated by nerve resection and reported in detail previously in this journal. There are very little such long-term data for causalgia of this nature available. This is a rare opportunity to reevaluate these 2 patients who began their stories not too differently but went on to follow very different paths. One of these patients (CH) had causalgia after a traumatic right infraorbital nerve injury. This pain was relieved by nerve resection with no recurrence of facial pain for over 22 years. The other patient (HG) had many years of intractable complex regional pain syndrome type 2 of the common peroneal and sural nerves after a left leg injury in childhood. HG had 4 years and 4 months of good relief by nerve resection. At this time, severe pain recurrence and incipient gangrene of the left leg required amputation, which saved the leg but did not affect the pain, a worsening severe skin rash, and frequent respiratory infections. The amputated limb pathology suggested an autoimmune response and further tests provided evidence of autoimmune antibodies and immunoglobulin deficiency. Only after immunotherapy did these problems resolve and this improvement has persisted for 4 years and 9 months. There are few long-term assessments of causalgia treated by nerve resection, amputation, and/or immunotherapy. Short-term failures of these treatments may be due to treatable conditions such as immunological abnormalities.

Complex regional pain syndrome (CRPS) is a chronic pain condition that typically affects distal extremities after an injury or noxious event, with symptoms disproportionate to the primary insult. We present the first successful use of a temporary peripheral nerve stimulator (PNS) followed by a permanent PNS system to treat CRPS Type 2 after failed responses to pharmacotherapies, trigger point injections, cervical epidural injections, and sympathetic nerve blocks. An 81-year-old patient developed CRPS Type 2 following a left antecubital peripherally inserted central catheter placement with left-hand paresthesia, edema, weakness, and skin color and temperature asymmetry. He achieved near-complete resolution of symptoms approximately 4 months after permanent PNS placement. This case underscores the morbidity associated with iatrogenic complications, the challenges of managing CRPS when conventional treatments prove insufficient, and the necessity for further research to assess the effectiveness of PNS in improving both function and pain relief for CRPS patients.

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.

This case report describes the use of repetitive transcranial magnetic stimulation (rTMS) combined with sensorimotor training (SMT) to treat an individual with complex regional pain syndrome (CRPS) type 2 with allodynia of the right hand/wrist. After the 9-week intervention, there was a clinically meaningful reduction in pain intensity which continued to 3 months after intervention. Further, clinically meaningful improvements in wrist and hand function and allodynia were observed. Although the use of rTMS for CRPS has been reported, this unique report provides valuable insight into the clinical utility of rTMS plus SMT for the treatment of CRPS and related symptoms.

Complex regional pain syndrome (CRPS) is a poorly understood pain disorder presenting with predominantly neuropathic features. It is often, though not always, associated with an injury to the central or peripheral nervous systems, and in such cases may aggravate the prevailing disability. We describe a unique case of bilateral CRPS arising in a patient following traumatic spinal cord injury.