A case of subacute postherpetic neuralgia leading to permanent spinal cord stimulation implantation

Abstract

The patient was a 70-year-old man. He presented to this department with complex regional pain syndrome and muscular weakness secondary to postherpetic neuralgia of the upper limbs. Since continuous epidural block was ineffective, he underwent temporary spinal cord stimulation (t-SCS) for 13 days beginning 40 days after symptom onset. Since pain recurred soon after the leads were removed, a spinal cord stimulator was implanted 60 days after symptom onset. He subsequently continued rehabilitation without the pain worsening. On electrophysiological testing performed after t-SCS, F-waves were absent in the ulnar nerves, but they appeared in month 8 of permanent implantation. The patient likely had a good functional outcome because he continued to undergo rehabilitation along with the urgent device implantation. We believe that permanent implantation should be considered in severe cases with complex regional pain syndrome or motor paralysis that responds to t-SCS but recurs soon after lead removal.