Spinal cord stimulation for injured soldiers with complex regional pain syndrome.

pinal cord stimulation (SCS) therapy enhances pain relief over a long-term period, decreases the need for opioid analgesics, improves quality of life, increases the rate of return to work, and manages pain economically. These benefi ts make SCS therapy a viable treatment option for seriously injured soldiers with complex regional pain syndrome (CRPS). The United States has recently been faced with an increasing demand for medical-related services to treat the ever-rising number of soldiers wounded in combat. Approximately 21,000, or roughly 2% of deployed military personnel, have been wounded since the start of the wars in Afghanistan and Iraq. 1 Sixty-fi ve percent of combat injures account for wounds from improvised explosive devices, land mines, and shrapnel. 1 Some of those wounds are peripheral nerve injuries that lead to a number of different pain syndromes. In a case study of soldiers who fought in Operation Iraqi Freedom, the most common pain syndromes after blast injuries were CRPS Type II and phantom limb pain. 2 In 1994, the International Association for the Study of Pain (IASP) renamed refl ex sympathetic dystrophy (RSD) as CRPS Type I and the condition known as causalgia was renamed CRPS Type II. 3 According to the IASP, CRPS Type I has the following clinical fi ndings: regional pain, abnormal sudomotor activity, skin color and sensory changes, abnormality of temperature, and edema. CRPS Type II has all the clinical fi ndings of CRPS Type I, and also includes peripheral