Presented at the 2012 AAPM Annual Meeting « Back

Dual System Spinal Cord Stimulation for Control of Intractable Pain in Primary Erythromelalgia: A Technical Case Report

Bernard R. Canlas, MD, brenlee8302@gmail.com¹, Kent C. New, MD PhD², Carlos A. Oteyza, Medical Director³, (1) Florida Institute of Pain Medicine, Jacksonville, Florida, (2) St. Vincent's Spine and Brain Institute, Jacksonville, Florida, (3) AAPMR, Jacksonville, Florida

Erythromelalgia (EM) or erythermalgia is a rare syndrome characterized by a constellation of symptoms that includes erythema, swelling, and intense burning pain of the affected extremities. It is distinguished by two forms. Primary, idiopathic EM occurs in the pediatric age group. Secondary EM occurs in adults and is associated with an underlying disease or as a result of drug intake. The management of its symptoms, particularly for pain, is supportive. However, even with use of potent medications including opioids, there are still patients who complain of severe debilitating pain. To date, spinal cord stimulation has been used in a 69-year-old patient with secondary EM, and thalamic stimulation was performed on a 12-year-old boy after a spinal cord stimulator system with a percutaneous lead was explanted due to infection. We report of a 15-year-old female who was diagnosed with primary EM by three major hospitals when she was about 11 years old. The patient complains of severe, burning pain of her upper and lower extremities, including her low back and occasionally her face. She has been managed with different medications, including three different opioid medications. Lumbar sympathetic blocks provided short-term relief. Percutaneous trial with an octrode lead in the cervical and thoracic region was done, which provided significant relief. A permanent paddle implant with a Medtronic 2x8 paddle lead and Medtronic 565 paddle lead in the thoracic lead was done. To date, the patient has stopped most medications, has decreased pain, and has significant functional improvement. References: 1)Waxman, G et al. Erythermalgia: Molecular Basis for an Inherited Pain Syndrome.Trends in Molecular Medicine 11(12):555-562, 2005 2)Grazioti, P et al. Control of Intractable Pain in Erythromelalgia by using spinal cord stimulation. J Pain Symtpom Manage;8:502-504, 1993 3)Delye, H et al. Thalamic stimulation as a treatment for primary erythromelalgia: Technical case report. Neurosurgery 57 (ONS Suppl 3):ONS-404,2005

Funding: None