Case Studies

Neck Pain Case Study

Carpal Tunnel Syndrome Case Study

Nicole works in a manufacturing plant where her responsibilities include using an air gun for approximately 7 hours per day. She noticed some discomfort in her right hand that had gradually worsened over time.

Back Pain Case Study

A 30 year old chef developed severe shooting pain in the lumbosacral spine radiating to the posterior aspect of the entire right leg and right foot. The patient suffered with this pain for over a week before he decided to seek medical attention. When he came to our Center his gait showed limping and slowness and his spine was markedly tilted to the left. There was numbness in the lateral aspect of the right leg and the right foot. Lifting his right leg caused his pain to worsen. When the leg was lifted the pain shot down his leg and reached his toes. The motility of his lower back was half the normal range of a healthy back. An MRI demonstrated a large herniated disc compressing the nerve roots.

Paravertebral blocks, pain medication, and physical therapy improved him gradually. Three months after the treatment was begun, his spine was straight and his pain was gone. He was working his regular job. A year after his treatment he remains almost asymptomatic. The pain that remains is mild and requires no medication.

Intractable Migraine Case Studies

CASE #1

A 58-year-old female was seen at the NeuroCenter for the first time in April 2005. Her symptoms included:

• Headache: Throbbing, severe headache that affected occipital, frontal and temporal areas bilaterally. Its intensity ranged between eight and nine on the scale of one to ten and occurred five to six times a month. The headache lasted from a few hours to two days and was not preceded or accompanied by any aura. Associated symptoms included nausea, vomiting, and sensitivity to lights and noise. A constant, moderate, dull, pressure-like headache lingered in between the severe headaches.
• Neck and upper back pain: Moderate to severe pain was located in the cervico-thoracic area and radiated to shoulders, scapular areas, and upper extremities. It was sharp, burning, and constant.
• Low back pain: Moderate to severe pain was located in lumbosacral area and radiated to lower extremities. It was pressure-like, daily, and constant.
• Generalized pains and aches: Moderate, constant burning that was associated with stiffness.
• Wrist pain: Soreness in her wrists and hands with nocturnal paresthesias in all her fingers.
• Insomnia and fatigue

She described her daily life as follows:

“Most of my adult life starting at age 23 I have been in pain. I am always in pain. I never wake up feeling well…. Each day brings a new pain in a part of my body that never hurt before or a pain that is familiar and is always there. My day at work is a struggle, my life at home depressing…. I try my best to fight the constant pain and go on with my daily life but it seems at times I just give into the pain and decide to just go to sleep and forget the day completely.”

This patient was diagnosed with migraines in 1968. She underwent spinal fusions in 1971 and 1999. She underwent cervical spinal fusion in 1995, right shoulder surgery in 1985 and 2001. In 2003 she was diagnosed with fibromyalgia and in 2004 she was diagnosed with carpal tunnel.

Previous Medications taken included, Vioxx, Vicodin, Celexa, Elvavil, Effexor, Inderal LA, Excedrin Migrane, Daypro, and Relafen.

Treatment at our Center:

Procedures: Steroid facet joints injections of cervical and lumbar spine were done in the first month of treatment.

Medications: Initially all medications were discontinued except Elavil. Then she was prescribed Phenelzine (Nardil) 15mg twice a day was added in the second month of treatment.

The patient recorded her improvement herself since the start of her treatment and documented the following:

• Headaches stopped—no migraines at all
• Burning sensation occurred only occasionally
• Better range of motion in her neck with less pain
• Tingling in fingers and hands was gone
• Pain in the arms was gone
• Less difficulty and pain when getting up from a seated position
• Over-all daily aches and pains were less

Mentally she stated that she had a 100% better attitude toward daily life and work. “People tell me I am like a different person talking more and just carrying myself in a more positive way. Getting back into life and enjoying people and my job,” she said. Her improvement has been consistent for the past few years.

CASE #2

A retired 82-year-old man was initially seen for headaches at the NeuroCenter in February 2003. The headaches, located in the left frontal and temporal areas, were severe and received a pain score of ten on the scale of one to ten. They were sharp, lasted for one to two hours, occurred four to six times a day, and were associated with dizziness. A constant dull headache lingered in between them. No tearing or any other local changes were noted. Nor did the pain wake him up from sound sleep.

These headaches began a year earlier when he had suffered an episode of right hemiparesis and aphasia. At that time he was then found to have stenosis of the left carotid artery and a stent was placed. The aphasia cleared quickly but the hemiparesis took several months to disappear. The headaches did not change after his surgery.

This patients medical history included renal cell carcinoma and right nephrectomy, hypertension, and carcinoma of prostate.

This patient had tried numerous medications for the treatment of his headaches. Once he was seen at our Center the patient was prescribed Nadolol which gave the patient 50% improvement for a month. He was then placed on Indomethacin at different doses. This medication eliminated the headaches completely. If the medication was ever discontinued for any reason the headaches returned.

Facial Pain Case Study

Our patient, a fifty year old woman, complained of severe throbbing pain affecting the entire left side of her face. The condition occurred twice a week and lasted for two to three days. The pain was associated with daily severe throbbing pain affecting the left side of her neck and intermittent left sided, pressure-like headaches that occurred once a week and lasted for about two days.

Studies showed irritation of the left cervical nerve roots due to arthritic changes in the spine. MRI of the brain was normal. Patient was diagnosed of inflammation of the cervical nerve roots that were aggravating migraine headaches and atypical facial pain.

Cervical facet joint injections improved the condition about 50%. Adding a betablocker markedly reduced the migraine headaches, but did not relieve the facial pain. The later responded to Oxcarbazepine, which eliminated the pain almost completely.

Intractable Foot Pain Case Study

CASE #1

Our patient was a 60 year old man, with constant severe pain that made him limp. He had undergone several surgeries. He had lots of scars and a bluish discoloration tinged his feet and toes. The sensation in his feet was diminished and there were a couple of superficial ulcerations of the size of a shirt button. The left toe joint lacked any motility. Its joints had been fused. Nerve blocks consisting of anesthetic and cortisone were administered to the arches and affected foot joints. The pain went away. He was referred to a dermatologist for the care of his ulcers. These healed and closed completely. Eight months later, he was feeling good, but had noticed that his pain was beginning to increase again. The procedures were repeated and he has been doing well ever since.

CASE #2

Our patient was a 70 year old woman with severe burning pain in the legs and feet. It was associated with numbness and occasional jabbing pains. She rated her pain as a severe pain (8-9 on a scale of one to ten). Upon examination, she demonstrated decreased ankle reflexes with minimal sensory loss distally in the upper and lower extremities. An electromyogram confirmed the presence of a sensory polyneuropathy. Cymbalta improved her condition to a small degree. For the past 6 years, nerve blocks applied to her foot, three times a year have kept her pain mild, between 1-2 on a scale of one to ten.

Fibromyalgia