A 45-year-old woman with complex regional pain syndrome (CRPS) type I of the right upper limb has allodynia, trophic changes, and vasomotor instability that has not responded to 6 months of oral medication. The MOST evidence-based interventional treatment at this stage is:
- A Spinal cord stimulation (SCS) of the cervical or upper thoracic cord ✓
- B Intravenous ketamine infusion at sub-anaesthetic doses
- C Surgical sympathectomy of the stellate ganglion
- D Radiofrequency ablation of C5-C6 medial branch nerves
Explanation
Spinal cord stimulation (SCS) is the most evidence-based interventional treatment for refractory CRPS, supported by RCT data (Kemler et al. NEJM 2000) demonstrating superior pain relief and quality of life improvement compared to physical therapy alone at 1 year. SCS delivers low-amplitude electrical current to the dorsal columns, modulating pain signals through gate-control and central sensitisation mechanisms. Sub-anaesthetic ketamine may provide short-term relief but lacks durable long-term evidence for CRPS. Surgical sympathectomy has unpredictable outcomes with risk of post-sympathectomy neuralgia. Radiofrequency ablation targets medial branch nerves (facet pain) and is not indicated for CRPS.
Reference: Morgan & Mikhail's Clinical Anesthesiology, 6th ed.
High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP
Written and medically reviewed by the StethoPrep medical team.