Diagnosing pain— especially chronic or recurrent pain—is a neglected art. However, if certain well-known neurophysiological principles are applied, diagnoses can be made in systematic and logical ways. An example of this can be found in thinking about “glove and stocking” pain.
Treating ‘glove and stocking’ leg pain after failed back surgery
“Glove and stocking” pain is sometimes described as “non-anatomical”, meaning that the pain cannot be explained by existing knowledge of anatomy. In fact, the patient may be suspected of having pain of psychogenic origin or even an agenda of secondary gain. The “psychogenic” part may not be far from the truth in certain cases, but the whole phenomenon is better explained by recognizing that “glove and stocking” pain is mediated primarily by the autonomic nervous system (ANS).
ANS-mediated pain has certain distinctive characteristics. It may have a burning, hot or tingling quality and may be hard for the patient to localize. Sufferers may complain of the pain in an obsessive way—hence accusations of “neurotic” pain. Often, little can be found on physical examination but skin temperature may be altered (either warmer or colder) and subtle changes in moisture and color may be detected. In its most extreme presentation, it is easily recognized as “sympathetic dystrophy”.
Case in Point:
A 40-year-old woman underwent lumbar discectomy for left-leg sciatica. The surgery appeared to be successful with complete relief of leg pain, but after a few weeks another leg pain came on, more diffuse in distribution and different in quality. Physical examination indicated no nerve root signs and over 80 degrees of straight leg raising. MRI of the lumbar spine showed no sign of nerve root compression.
Autonomic response testing indicated an “interference field” (or focus of electrophysiological instability) in the surgical scar. The scar was infiltrated with a few cc’s of procaine ½% followed by an intravenous bolus of the same solution and the leg pain immediately disappeared. After about four days, the pain returned with a slightly greater intensity. Again an interference field was found in the scar and was treated as before. This time the pain relief lasted two weeks and the pain was less intense on relapse. A third treatment resulted in a permanent cure.
Treatment of failed-back-surgery syndrome is one of the most spectacular applications of neural therapy. An interference field in the surgical scar is the most likely cause, with an interference field in the ipsilateral third lumbar sympathetic ganglion the next most common.
Injection of the sympathetic ganglion is equally effective and although technically more difficult than scar injection, can be learned easily and performed in an office setting. (Injection of ganglia in neural therapy does not require the same accuracy as deep injections of anesthesia).
Alternatively, injections can be avoided altogether by treatment with an electrophysical device. The TensCam®, available from Charles Crosby, DO (407-823-9502), is recommended and seems to work as well as injections.
Robert F. Kidd, MD, CM
Already had neural therapy training?
Come to our mid-winter NT retreat in Ontario
Plans for a mid-winter neural therapy retreat are taking shape. If you have taken at least one neural therapy course (from Dr. Klinghardt or me), you are cordially invited to attend. The program will be informal: a few lectures, perhaps some invited guests, some demonstrations, clinic time and opportunities to ask questions. Please contact me if you would like to present a free paper. Or if you or a family member has an intractable medical problem they would like to have checked out, this might be the time and place to do it.
The dates are February 9 and 10, 2007.
The location: Sam Jakes Inn, (www.samjakesinn.com) Merrickville, Ontario, Canada.
Merrickville is a little country town situated by the historic Rideau Canal, about 45 minutes south of Ottawa. During the summer it a lively place, a favorite getaway for tourists and boaters. During the winter it is quiet and not much goes on—a perfect place for a get-away-from-it-all retreat. The inn is cozy and comfortable and the food is excellent.
e-mail: drkidd@neuralt herapy book.com
web: www.neuraltherapyboo k.com