A Case of Severe Nerve Pain

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A patient came to me in terrible pain, crying with frustration. She had recovered from a lumpectomy and removal of 26 lymph nodes, and suffered lymphedema in her left arm.   At some point during the surgery they had temporarily implanted a defibrillator. The 3-inch longitudinal scar just below the clavicle hurt more than anything from the surgery or cancer treatment. She reported severe nerve pain starting at the scar and traveling or appearing down her arm for the past two years, to such as degree that she could barely sleep, was uncomfortable all of the time and at the end of her tolerance.

She had seen many doctors and they had all suggested gabapentin, but she didn’t want to take medication. She saw an acupuncturist for 6 months and had little if any improvement. Finally out of desperation she began taking gabapentin, 900mg/day in divided doses.   This helped, however the pain was still relatively severe.

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It is interesting how we humans are so predisposed to follow patterns, paths that are already laid out. My first thought was to associate the pain in the scar and the nerve pain – of course, when they implanted the defib device they injured the nerve. Or perhaps there was some scarring internally that was affecting the nerve. Seemed clear enough.

I had her stand up and took a look at her. Her entire left shoulder was dropped and forward, sitting a good 3-4 inches below the other. It was clear she was guarding, and this had become ingrained in her body.   Miraculously she had little to no neck or back pain.

So I started working on the area of the thoracic outlet where she complained of severe pain, convinced that this was the source. Week after week I tried, trying to loosen scar tissue, working the path of the nerve, hopeful to get some improvement. By the third week my intelligence finally kicked in, overriding the deeply ingrained human brain patterns of the search for relationships and for complexity.

As medical practitioners I think many of us find ourselves overcomplicating, not only because it is so important not to miss red flags, but because our brains thrive on complicated medical scenarios – like good detectives.

I stepped back for a moment. The bones and muscles of her shoulder were so out of place, this alone could easily be the source of the problem. So I started to focus simply on re-aligning her shoulder.

After one visit she reported less pain. I knew then it was the most basic of medicine she needed.

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Every weekly visit I attempted to put her bones and muscles back in place. I had her stand and hold them in place, so she could remember what it felt like. I gave her simple exercises to do at home, and a command for her to look at herself in the mirror every morning to make sure she was holding herself straight.   In fact a command that every opportunity she got – walking down the street in shop windows, or in mirrors in shops – she was to scrutinize her posture and alignment and put herself back in place every time.   It was a question of muscle memory, I told her, and that she needed to retrain her body to hold itself properly.  By week two she dropped her medication to half, then week four she stopped it completely.

By week six the pain was gone.

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