I have spent my adult life treating peripheral pain generators in conditions where it is impossible to get the central generators treated (failed backs for example). It dismays me to see people told there is nothing to be done because they have such and such a condition. I am devising a term for them. Nihilists refers to belief in nothing; I’m coining “onehilst” as referring to those who only believe in one thing happening at a time. A onehilist will tell you because you have Fibromyalgia or Peripheral Neuropathy that nothing can be done for you (and in some cases because you have a chronic disease you must be nuts anyway so go away). Below are two cases of nerve entrapment in people with severe pain that received significant benefit from treatment.
Hand Cases
J Hand Surg Eur Vol. 2010 Mar;35(3):228-31. Epub 2009 Dec 9.
Co-existing carpal tunnel syndrome in complex regional pain syndrome after hand trauma.
Koh SM, Moate F, Grinsell D. abstract here
Complex Regional Pain according to them is defined as:
- A syndrome that develops after an initial noxious event
- Spontaneous pain and/or allodynia/hyperalgaesia that is not limited to the territory of a single peripheral nerve and is disproportionate to the inciting event
- Evidence of oedema, skin blood flow abnormality or abnormal sudomotor activity
- The absence of any other condition that would account for the degree of pain and dysfunction (Wong and Wilson, 1997)
They present 4 cases that developed above symptoms 8 weeks after hand surgery. Symptoms were “pain out of proportion to that expected postoperatively, had marked oedema particularly on the
radial[thumb side] side of the hand, hyperhidrosis [increased sweating], increased temperature, loss of finger motion and hyperalgaesia [pain sensitivity].”
They mention positive provocative testing which to my mind would mean a positive tinels signs (shotting down pain or tingling on percussion nerve damage area). All had positive nerve function test results.
Carpal tunnel surgery led to a decrease in pain from 9/10 to 2/10
Foot Case:
Plastic and Reconstructive Surgery:
August 2004 – Volume 114 – Issue 2 – pp 478-483
Chemotherapy-Induced Neuropathy: Treatment by Decompression of Peripheral Nerves
Dellon, A. Lee M.D.; Swier, Patrick M.D.; Maloney, Chris T. Jr. M.D.; Livengood, Melvin S. D.P.M., M.P.H.; Werter, Scott D.P.M. abstract here
Case of foot pain and numbness following chemotherapy that left subject disabled.
Following decompression of her tarsal tunnel syndrome went back to her love of skiing.
I discuss tarsal tunnel under conditions missed in diabetics here:
Surgery For Diabetic Peripheral Neuropathy – Another Option Not Available Here
I’m sure there are lots out there missed – any comments?