Journal of Clinical Monitoring and Computing

, Volume 30, Issue 6, pp 845–848 | Cite as

Electroencephalographic evoked pain response is suppressed by spinal cord stimulation in complex regional pain syndrome: a case report

  • Nicholas Hylands-White
  • Rui V. Duarte
  • Paul Beeson
  • Stephen D. Mayhew
  • Jon H. Raphael
Original Research


Pain is a subjective response that limits assessment. The purpose of this case report was to explore how the objectivity of the electroencephalographic response to thermal stimuli would be affected by concurrent spinal cord stimulation. A patient had been implanted with a spinal cord stimulator for the management of complex regional pain syndrome of both hands for 8 years. Following ethical approval and written informed consent we induced thermal stimuli using the Medoc PATHWAY Pain & Sensory Evaluation System on the right hand of the patient with the spinal cord stimulator switched off and with the spinal cord stimulator switched on. The patient reported a clinically significant reduction in thermal induced pain using the numerical rating scale (71.4 % reduction) with spinal cord stimulator switched on. Analysis of electroencephalogram recordings indicated the occurrence of contact heat evoked potentials (N2–P2) with spinal cord stimulator off, but not with spinal cord stimulator on. This case report suggests that thermal pain can be reduced in complex regional pain syndrome patients with the use of spinal cord stimulation and offers objective validation of the reported outcomes with this treatment.


Complex regional pain syndrome Contact heat evoked potentials Electroencephalography (EEG) Spinal cord stimulation 



The authors received no financial support for the research, authorship, and/or publication of this article.

Compliance with ethical standards

Conflicts of interest

The authors declare no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.


  1. 1.
    Kemler MA, Barendse GA, van Kleef M, de Vet HC, Rijks CP, Furnée CA, van den Wildenberg FA. Spinal cord stimulation in patients with chronic reflex sympathetic dystrophy. N Engl J Med. 2000;343:618–24.CrossRefPubMedGoogle Scholar
  2. 2.
    Gong W, Johanek LM, Sluka KA. Spinal cord stimulation reduces mechanical hyperalgesia and restores physical activity levels in animals with noninflammatory muscle pain in a frequency-dependent manner. Anesth Analg. 2014;119:186–95.CrossRefPubMedGoogle Scholar
  3. 3.
    Sato KL, King EW, Johanek LM, Sluka KA. Spinal cord stimulation reduces hypersensitivity through activation of opioid receptors in a frequency-dependent manner. Eur J Pain. 2013;17:551–61.CrossRefPubMedGoogle Scholar
  4. 4.
    Sato KL, Johanek LM, Sanada LS, Sluka KA. Spinal cord stimulation reduces mechanical hyperalgesia and glial cell activation in animals with neuropathic pain. Anesth Analg. 2014;118:464–72.CrossRefPubMedPubMedCentralGoogle Scholar
  5. 5.
    Kemler MA, Reulen JP, Barendse GA, van Kleef M, de Vet HC, van den Wildenberg FA. Impact of spinal cord stimulation on sensory characteristics in complex regional pain syndrome type I: a randomized trial. Anesthesiology. 2001;95:72–80.CrossRefPubMedGoogle Scholar
  6. 6.
    Harden RN, Bruehl S, Stanton-Hicks M, Wilson PR. Proposed new diagnostic criteria for complex regional pain syndrome. Pain Med. 2007;8:326–31.CrossRefPubMedGoogle Scholar
  7. 7.
    Chen A, Niddam D, Arendt-Nielsen L. Contact heat evoked potentials as a valid means to study nociceptive pathways in human subjects. Neurosci Lett. 2001;316:79–82.CrossRefPubMedGoogle Scholar
  8. 8.
    Pralong E, Pollo C, Bloch J, Villemure JG, Daniel RT, Tétreault MH, Debatisse D. Recording of ventral posterior lateral thalamus neuron response to contact heat evoked potential in patient with neurogenic pain. Neurosci Lett. 2004;367:332–5.CrossRefPubMedGoogle Scholar
  9. 9.
    Mayhew SD, Hylands-White N, Porcaro C, Derbyshire SW, Bagshaw AP. Intrinsic variability in the human response to pain is assembled from multiple, dynamic brain processes. Neuroimage. 2013;75:68–78.CrossRefPubMedGoogle Scholar

Copyright information

© Springer Science+Business Media New York 2015

Authors and Affiliations

  • Nicholas Hylands-White
    • 1
  • Rui V. Duarte
    • 2
  • Paul Beeson
    • 3
  • Stephen D. Mayhew
    • 4
  • Jon H. Raphael
    • 1
    • 5
  1. 1.Faculty of HealthBirmingham City UniversityBirminghamUK
  2. 2.Department of Public Health, Epidemiology and BiostatisticsUniversity of BirminghamBirminghamUK
  3. 3.School of HealthUniversity of NorthamptonNorthamptonUK
  4. 4.BUIC, School of PsychologyUniversity of BirminghamBirminghamUK
  5. 5.Department of Pain ManagementRussells Hall HospitalDudleyUK

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