Ask Dr. Javahery: Dealing with Quadriplegic Nerve Pain and More
This is the latest installment of Ask Dr. Javahery! Every month, I answer medical questions from the community on anything from back pain to headaches. And while I can’t give out personalized treatment over the web, I can provide general feedback to help you in your everyday life!
If you have questions that you’d like me to answer in a future column, submit them to my Facebook page or send me an e-mail at DrJ@finnpartners.com.
Seventeen years ago my son Tim had a trampoline accident subluxing C6 over C7. They had to break his neck to release. Long story short, he worked hard to become a high functioning quad. He caths himself, and plays the trombone and has walked in braces. That was a mute point as he could not stand on his own. He has attained his BS in Anthropology and is working on his masters and teaching credentials. The problem is his horrendous nerve pain in his hands. If he reads too long his entire body feels on fire. Two questions:
1- is there anything new to help with nerve pain?
2- is there anything coming to give him more movement and freedom? Tim was a class I gymnast and musician and has always been an honor student. As a parent it is heartbreaking to know the pain never seems to end.
Thank you for your time.
Jolyn: Let me start by congratulating you on raising such a substantial human being. To persevere in light of a cervical spinal cord injury is a testament to the emotional and spiritual health of a person. May we all learn from the strength of people like your son. We should at the very least learn to be more grateful for our health. There is a Persian expression that states “health is a crown worn by the healthy that only the sick can see.” It is to remind us to be grateful. Your son has a crown of emotional and spiritual health.
Now, to try and answer your question. Patients who have had a spinal cord injury can develop either early or late neuropathic pain. It is especially a problem for people with incomplete injuries (and it sounds like Tim has an incomplete injury). There can be many etiologies for the pain including persistent compression, arachnoiditis (scarring of nerve roots), tethered spinal cord (scarring of the spinal cord causing it to stick to the dural sac), cystic myelomalacia (scarring of the spinal cord and cyst formation), deformity of the spine causing compression, and then there is pain associated with the injury without any secondary issues.
Obviously, I can’t tell specifically what is happening to Tim, but I think he should have further imaging including an MRI of the cervical spine and x-rays of the cervical spine (with flexion/extension views). Once you know why he is having the pain, his neurosurgeon can decide if there is an underlying cause that can be fixed or not. If there is a surgical issue with the spine that has to be fixed then that may be an option. Often there is no direct surgical issue. The neuropathic pain is related to sprouting of pain fibers in the spinal cord that are then overly activated. There is treatment for this. Deep brain stimulation (same basic technique used for Parkinson’s but stimulating a different location in the brain) has been effective and epidural motor cortex stimulation also been shown to be effective.
Non-invasive approaches are also being used with some benefit. These include transcranial magnetic stimulation (using H-coils over the motor cortex) and transcranial direct current stimulation. There are also pharmacologic treatments that most pain management specialists can prescribe.
In terms of the future of recovery from spinal cord injury, there are many areas of research for direct regeneration of the spinal cord including stem cells (both embryonic and pluripotent stem cells), scaffolds for neuronal growth, and the use of various medications to reduce inflammation at the time of injury. There are also projects to create exoskeletons controlled by implanted electrodes that help with mobility. These experimental areas are somewhat out of my field of expertise, but there are definitely new technologies coming to help with mobility.
Overall, I agree with your final sentiment that the major issue is controlling his pain because it seems to be the issue that truly affects the quality of his life. He seems to have come to terms with his paralysis and optimized his capabilities. Good luck and I hope this helps.
My mom was having back spasms in June of last year, I took her to the doctor and she had a bacterial infection in her knee. She was operated on and sent home on July 5th, but she was still having back spasms and no one could address the issue. On July 28th, she had a blood clot and 2 heart attacks, of which I was told was a pulmonary embolism. She is now paralyzed from the waist down. She has some mobility in her right leg and both feet and there is blood and pus on her spinal cord. However, due to the pulmonary embolism she is not a candidate for the operation. Is this true?
Andrea: Unfortunately, your mother sounds like she has had a very difficult course both medically and neurologically. I can’t give you specific answers about the decision making in her case since the case is complicated and I don’t have sufficient information. What I can tell you is that there are situations where neurosurgeons will not operate on a patient because the patient is too sick medically for any surgery — especially one as taxing on the body as a major spine operation. It is a difficult decision to make.
It may lead to permanent neurological dysfunction but it may be a better option than proceeding with surgery that could lead to death. If your mother had 2 heart attacks and a pulmonary embolism then she was medically unstable then I can see the possibility that she may not have been a surgical candidate. On the bright side, if she is moving both feet and the proximal right leg at 6 to 7 months out from the event, she has a very good chance of recovering more significant functions. She will continue to improve for up to 2 years. Most of the recovery will be in the first year but she can have recovery of function even beyond that. She needs aggressive physical therapy and rehabilitation. All the best to her in her recovery.
I’m over weight and had an umbilical hernia repair with mesh 4 months ago. What is the best way to lose weight or work out? When is it safe to work out my core muscles without risk of another hernia?
Connie: I wish I could give you an answer regarding your concerns. I am a neurosurgeon and umbilical hernia repairs and the rapidity of the healing process associated with mesh are subjects outside my field of expertise. I would encourage you to speak to your surgeon and once you are cleared to work with a physical therapist, come up with safe exercises to begin the process of strengthening your core and back. Good luck!