It was just a moment.
A carefree day, a flying disc, and a twisted ankle. Elizabeth Ruddick was nearly 15, and a twisted ankle was nothing to worry about.
Until it didn't get better.
Her doctors suggested physical therapy, ordered X-rays and then MRIs. "It's just a bad sprain," they said. "A bad ligament, you just need time to heal."
But the pain never went away.
After nine months of hoping for the best, Elizabeth was diagnosed with complex regional pain syndrome (CRPS). Who knew then that it would take six years of failed chronic pain management techniques to finally find relief?
Living with chronic pain
CRPS is a rare condition that doctors are still working to fully understand. What is known is that in greater than 90 percent of CRPS cases, trauma is the cause. What isn't clear is why some traumatic injuries fail to heal without complication.
People with CRPS endure a burning, tingling discomfort. The skin around the injured area may swell and become shiny and thin. Muscles affected by CRPS may become unusable, resulting in tremors or rigidity, and an inability to move the limb as they desire. Chronic pain management becomes a struggle. Searching for relief can take over their lives.
Elizabeth used a protective boot and frequently required crutches to get around during the first nine months of her injury. She and her family tried conventional treatments — lumbar block and physical therapy — to hopefully relieve her symptoms. Nothing was effective for long.
The pain eventually spread to her hands. Her ability to walk slowly diminished. Finally, she was confined within the four walls of her bedroom, only able to leave by wheelchair for doctor's appointments and occasionally to join her family at the dinner table.
Searching for relief
Physical therapy, infusion therapy, hypnotism, behavioral therapy, non-narcotic pain medications, all-natural remedies, ketamine infusions.
Elizabeth tried everything.
She sought the advice of doctors from her home state of Indiana to Florida and North Carolina. Some treatments brought mild relief, while others were completely ineffective.
Through the pain, she and her family never gave up hope that the answer was out there.
After four years searching, she met Dr. Brandon Sutton. He suggested that Elizabeth might benefit from a spinal cord stimulator (SCS), an implantable device that manages the pain signals sent by the nerves. Her previous physicians avoided this type of permanent procedure because of her age.
Dr. Sutton told Elizabeth that because she had chronic CRPS in the lower limbs, she was an ideal candidate for a new type of SCS that stimulates a spinal structure called the dorsal root ganglion (DRG). He explained that for patients with CRPS — a pain which can be underserved by traditional SCS — stimulation of the DRG can provide pain relief when previous treatment options were unsuccessful. After taking the DRG stimulator for a trial run and receiving significantly more relief than with any previous treatment she had tried, Elizabeth decided to get a permanent device.
The implanted device consists of leads — similar in scale to a piece of thick string — that direct the electrical current and a battery pack about the size of a matchbox, but Elizabeth says that it is barely noticeable unless she touches it. She controls how much stimulation she gets with an external handheld controller.
Life after the device
Within a week of the DRG implantation, Elizabeth was able to walk at her twin sister's wedding. Her wheelchair has been parked.
Thanks to DRG, she continues to strengthen her body and increase her stamina with yoga and her favorite activity, swimming.
With only a cane for extra support, she can attend soccer games, visit her sister and go out to lunch with her friends. She isn't "cured" of her pain, but it's significantly reduced and manageable. Her future feels bright again.
"Don't give up; you'll eventually find something that works," Elizabeth advises. "It's been six years since I got injured, and I have been all over the states looking for something. At times they would seem to work, and then they would stop. It's been a very long journey, but eventually, we found something that helps."
This story reflects one person's experience; not everyone will experience the same results. Talk to your doctor about the benefits and risks of your treatment options. St. Jude Medical does not provide medical services or advice as a part of this website.
Brief Summary: Prior to using these devices, please review the User's Manual for a complete listing of indications, contraindications, warnings, precautions, potential adverse events and directions for use.
Indications for Use: Spinal column stimulation via epidural and intra-spinal lead access to the dorsal root ganglion as an aid in the management of moderate to severe chronic intractable* pain of the lower limbs in adult patients with Complex Regional Pain Syndrome (CRPS) types I and II.**
*Study subjects from the ACCURATE clinical study had failed to achieve adequate pain relief from at least two prior pharmacologic treatments from at least two different drug classes and continued their pharmacologic therapy during the clinical study.
**Please note that in 1994, a consensus group of pain medicine experts gathered by the International Association for the Study of Pain (IASP) reviewed diagnostic criteria and agreed to rename reflex sympathetic dystrophy (RSD) and causalgia, as complex regional pain syndrome (CRPS) types I and II, respectively.
Contraindications: Patients who are unable to operate the system, who are poor surgical risks, or who have failed to receive effective pain relief during trial stimulation.
Warnings/Precautions:Diathermy therapy, implanted cardiac systems or other active implantable devices, magnetic resonance imaging (MRI), computed tomography (CT), electrosurgery devices, ultrasonic scanning equipment, therapeutic radiation, explosive or flammable gases, theft detectors and metal screening devices, lead movement, operation of machinery and equipment, pediatric use, pregnancy, and case damage.
Adverse Effects: Painful stimulation, loss of pain relief, surgical risks (e.g., paralysis). Implant Manual must be reviewed for detailed disclosure. Refer to the User's Manual for detailed indications, contraindications, warnings, precautions and potential adverse events.
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