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Pain Ther. 2019 Dec;8(2):281-284. doi: 10.1007/s40122-019-00136-5. Epub 2019 Aug 20.

A Case Study of Combined Perception-Based and Perception-Free Spinal Cord Stimulator Therapy for the Management of Persistent Pain after a Total Knee Arthroplasty.

Author information

1
Department of Anesthesia, Critical Care, and Pain Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA. iurits@bidmc.harvard.edu.
2
Department of Anesthesia, Critical Care, and Pain Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA.
3
Valley Anesthesiology and Pain Consultants, Envision Physician Services, Phoenix, AZ, USA.
4
Department of Anesthesiology, University of Arizona College of Medicine, Phoenix, Phoenix, AZ, USA.
5
Department of Anesthesiology, Creighton University School of Medicine, Omaha, NE, USA.
6
Department of Anesthesiology, Louisiana State University Health Sciences Center, New Orleans, LA, USA.

Abstract

INTRODUCTION:

Total knee arthroplasty (TKA) is an effective treatment modality for severe osteoarthritis of the knee. Causes of pain following TKA are poorly understood; however, patient-specific biology and various neuropathic underlying mechanisms such as neuroma formation and complex regional pain syndrome (CRPS) have been suggested. Our case demonstrated the successful treatment of CRPS in the knee with the use of combination therapy in spinal cord stimulator.

CASE:

We present a 71-year-old Caucasian non-Hispanic male who presented with chronic left knee pain after undergoing a total knee arthroplasty (TKA) 18 months prior. Following his TKA, he reported doing well in the acute post-operative period but began to develop progressively worsening left knee pain at approximately the third post-operative week. He underwent a successful spinal cord stimulator (SCS) trial and subsequent implantation of two 16-contact Boston Scientific leads with a Boston Scientific Spectra WaveWriterTM SCS system. Upon first post-procedural follow-up, and moreover at his 6-month follow-up, the patient reported complete resolution of his symptoms.

DISCUSSION:

The development of persistent pain following TKA is a significant complication that is often challenging to treat. Our case demonstrated the successful treatment of CRPS in the knee with the use of combination therapy in spinal cord stimulator therapy. We anticipate that more data will continue to emerge to assess for the safety and efficacy of combination therapy.

KEYWORDS:

Combination therapy; Complex regional pain syndrome; Neuromodulation; Spinal cord stimulator; Total knee arthroplasty

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