• Andreas Goebel, Sarah Lewis, Rhodri Phillip, and Manohar Sharma.
• Walton Centre NHS Foundation Trust, Liverpool, U.K.
• Pain Pract. 2018 Jan 1; 18 (1): 104-108.

BackgroundLimb amputation is sometimes being performed in long-standing complex regional pain syndrome (CRPS), although little evidence is available guiding management decisions, including how CRPS recurrence should be managed.MethodsThis report details the management of a young soldier with CRPS recurrence 2 years after midtibial amputation for CRPS.ResultsConventional spinal cord stimulation did not achieve paraesthetic coverage, or pain relief in the stump, whereas L4 dorsal root ganglion stimulation achieved both coverage and initially modest pain relief, and over time, substantial pain relief.ConclusionsCurrent evidence does not support the use of amputation to improve either pain or function in CRPS. Before a decision is made, in exceptional cases, about referral for amputation, dorsal root ganglion stimulation should be considered as a potentially effective treatment, even where conventional spinal cord stimulator treatment has failed to achieve reliable paraesthetic cover. Furthermore, this treatment may provide pain relief in those patients with CRPS recurrence in the stump after amputation.© 2017 World Institute of Pain.

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