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? In a prospective case series, peripheral nerve stimulation (PNS) with surgically placed plate type electrodes connected with an implantable pulse generator reduced allodynic and spontaneous pain in 19 (63%) out of 30 implanted KU-55933 chemical structure patients with CRPS and symptoms in the distribution of 1 major peripheral nerve.80 In a retrospective study with 52 patients (48 CRPS-2 patients and 4 phantom limb patients), 47 patients were implanted after a positive trial stimulation. Of these patients, 43 (91%) had lasting excellent to good success with marked pain reduction and reduction of pain related disability.81 In another retrospective study 41 PNS devices were implanted in 38 patients with pain in a peripheral nerve distribution. Over 60% of patients had significant improvement of their pain of more than 50% following implantation of the peripheral nerve stimulator.82 The technique can only be applied if the pain http://www.selleckchem.com/products/MK-1775.html is in the distribution of a peripheral nerve and is thus less suitable for most CRPS-1 patients. Plexus Brachialis Block.? Somatic nerve block of the plexus brachialis also blocks the efferent sympathetic nerves around it. Theoretically somatic blockade increases the ability to tolerate physical therapy, especially if the shoulder is also affected. In a retrospective case series in 25 patients, of which 17 CRPS patients, improvement in pain and range of motion was found after interscalene block with 30?mL to 40?mL bupivacaine 0.125% injected every other day up to a total of 10 injections. This approach was suggested if sympathetic blockade failed.83 In a small case series of 6 CRPS patients treated with continuous or daily axillary injections with bupivacaine together with physical and occupational therapy, 3 out of 6 patients responded well to this therapy; another patient also responded well initially, but the catheter had to be removed due to infection at the insertion site. The 2 poor responders were chronic CRPS patients.84 Epidural Administration of Drugs.? The epidural administration of opioids and other drugs is increasingly being offered for non-malignant pain. Epidural bupivacaine in high anesthetic doses for 2?days to 3?days followed by epidural CYTH4 infusion of opioids for up to 7?days together with continuous passive motion allowed for recovery of the knee function in patients with CRPS of the knee.85 Epidural clonidine has been demonstrated to give short-term pain relief in chronic CRPS and to be possibly effective in the long term with small VAS reductions from 7.0?��?0.4 to 5.1?��?0.6 (P?