Spinal cord stimulation for atypical anterior chest wall complex regional pain syndrome: illustrative case

Complex regional pain syndrome (CRPS) most commonly affects distal extremities; atypical truncal presentations may be underrecognized and can mimic cardiopulmonary pathology.

A 27-year-old male developed chronic, severe anterior chest wall pain characterized by marked tactile allodynia, episodic erythema, and environmental trigger sensitivity. An extensive multidisciplinary evaluation excluded cardiopulmonary, gastrointestinal, dermatological, infectious, and structural etiologies. The clinical phenotype met Budapest criteria for CRPS type I, including disproportionate pain, symptoms across multiple domains, and objective signs on examination, without an alternative diagnosis better explaining the presentation. Symptoms were refractory to multimodal therapy, prompting a spinal cord stimulation (SCS) trial followed by permanent implantation after significant trial benefit. The patient experienced sustained analgesia and functional improvement at 3, 12, and 24 months, with only minor stimulation-related limitations.

This case demonstrates that CRPS may present in an atypical anterior chest wall distribution. Explicit Budapes criteria documentation and a reproducible exclusionary workup strengthen diagnostic confidence. SCS may provide durable relief for refractory atypical CRPS phenotypes. https://thejns.org/doi/10.3171/CASE26152.