NEUROPATHIC PAIN CASE STUDY
Denver Health Medical Center, Denver, CO
History: Patient is a 55-year-old white male who was referred
by a pain clinic for treatment of
peripheral neuropathy. This patient had increasing neuropathic
symptoms for several years.
His current treatment regimen was aspirin, propoxaphine, and
tricyclic. On a scale of 0-10, he described his pain level consistently
at 6-7. He states this level as severe pain unable to perform
activities of walking or standing or work at a computer. He would
use a wheelchair to go shopping because he could not walk or
stand for any duration.
Sleeping was interrupted by severe pain and spasms of his feet
and legs. His medication reduced his pain level; however, it
also reduced his desire and ability to perform his normal activities.
He stated he sometimes remained in bed all day rather than face
another
non-productive day.
Initial
Examination: On his first visit, he was wearing slippers.
Shoes were too painful for him to walk in. He had significant
pain of both feet on motion and palpation.
He was reluctant of me to touch or move his feet for this exam.
He stated his pain level was 6. He was unable to feel the plantar
surface of his feet on ambulation. 5.07 (10 gram) Semmes-Weinstein
monofilament test revealed LOPS (loss of protective sensation)
of toes and plantar metatarsal area of both feet.
Treatment: Forty minute application Anodyne light therapy plantar
surface both feet. After this initial treatment, he stated that
his pain level improved to 4. He was given access to a home Anodyne
light unit with instruction to apply the light therapy daily
to both feet.
Two
Week Visit: His 2-week follow-up revealed a noticeable decrease
in pain level of both feet. He was wearing shoes without pain.
He stated he decreased his pain medication significantly and
began performing many chores and activities he had not attempted
for several months. This was a direct result of pain reduction
and his decrease in pain medication, which reduced his ability
to perform normal his daily activities.
Four
Week Visit: His 4-week appointment was more impressive.
He stated that during his third week of treatment, he had a consistent
dramatic reduction of pain and a gradual improvement of LOPS
of his toes and plantar surface of both feet. His balance and
proprioception improved. He no longer had nocturnal foot and
leg spasms. His pain medication was reduced to only two aspirins
each morning. He pain level remains at a level of 1-3 daily.
He adapted his treatment regimen to 50 minutes every other day.
Daily therapy resulted in hypersensitivity and increased pain
during treatment. He also began to obtain better results when
he placed both pads on the same foot during treatment
Treatment Log
Pain Legend Medication
0 No pain- normal None
1 Slight irritation-easily ignored Aspirin
2 Mild-noticeable discomfort Aspirin
3 Mild-distraction required Aspirin
4 Moderate- walking difficult (limited) Aspirin, Propoxaphine
5 Intense-limited mobility (Limited standing or walking) Aspirin,
Propoxaphine
6 Severe-Unable to walk, stand, difficult to work at computer
Aspirin, Propoxaphine, Tricyclic
7 Severe-Unable to walk, stand or work at computer Aspirin, Propoxaphine,
Tricyclic
8 Extreme-restricted to home (incapacitated) Aspirin, Propoxaphine,
Tricyclic
9 Very extreme- restricted to bed (incapacitated) Aspirin, Propoxaphine,
Tricyclic
10 Intolerable restricted to bed (incapacitated) Aspirin, Methadone,
Tricyclic