Natalie’s problems began after working long hours to the point of exhaustion on a home reconstruction project in 2000. She developed burning tingling and numbness the dorsum of the left hand especially over the second finger. She thought at first that this was caused from exposure to fiberglass but this persisted more than a month. In 2013 with extreme job stress she developed a burning tingling, numbness and redness in the same area of the hand with swelling. Ultimately blisters appeared and a diagnosis of shingles was made. She was treated with acyclovir and steroids and the problem resolved after a period of weeks. In December 2015 after returning from a vacation in Aruba same swelling burning tingling and numbness developed in the left hand especially in the dorsum and first and second fingers. There is exquisite allodynia over the surface of the hand and fingers and touching her second fingertip causes a shooting electrical pain. She treated this with multiple modalities including and in her scalene block using ketamine as well as EMLA and ketamine cream. More recently she began to use Lyrica to help control pain. This was ultimately diagnosed as RSD. Her symptoms have recently begun to spread up the arm towards the shoulder.

The current finding is that a person must be off ketamine for at least 3 to 6 months before a normal response to scrambler therapy is possible. Natalie wanted to begin therapy as soon as possible even though it was only 3 months since her last exposure to ketamine. She weaned herself off the Lyrica she had been taking and began treatment. Her response to therapy was positive but progress was slow and grudging. It took 20 treatments to bring the spontaneous and allodynia pain to 0 in all but the second fingertip. This finger had been the one on which ketamine cream at most often been used. We elected to suspend therapy and allow number of months to go by and then to resume therapy presumably a more rapid and robust response to scrambler therapy will occur once she has been off the Ketamine cream for the recommended period of time.

 

 
Posted by info@pccofid.com at 10/26/2018 9:23:00 PM