"Kathy" is a 50-year-old woman who more than five years ago developed severe pain in her foot and lower leg following fractures to her leg bones. She was diagnosed with Reflex Sympathetic Dystrophy, now called Complex Regional Pain Syndrome. This is a very severe and poorly understood pain syndrome that generally follows some damage to an area of the body. The painful area is very sensitive to even light touch. The skin changes color and may become warmer or colder than the opposite side of the body. The pain may also travel to the other side of the body and in very severe cases involve the whole body. 

It's important to realize that the cause of your pain may have been diagnosed without considering muscles as a potential source. You may have undergone MRIs, CT scans, x-rays, and nerve conduction tests that suggest various diagnoses for your pain. Sometimes these diagnoses are based solely on the imaging reports. Without a thorough physical examination of your muscles, you could end up with an incorrect diagnosis and a barrage of treatments and medications. Pain relief, if you get any at all, will often be minimal and last a short term.

To further confuse the issue, you may correctly receive a diagnosis of herniated disc, degenerative disc disease, arthritis, spondylolisthesis, spondylosis, facet arthropathy, rotator cuff tear, impingement syndrome, and neuropathy. But just because you have these diagnoses, that does not mean they are the source of your pain, even though the treatments you have received for these conditions may have even given you a modicum of relief.

Kathy's pain and sensitivity to touch was so bad that she could not wear socks or a closed shoe. She received all of the commonly used treatments and medication including sympathetic nerve blocks, saphenous neurolysis, spinal cord stimulation, and intravenous Ketamine. The Ketamine diminished foot pain that had developed in her non-injured foot, but it didn't affect the original injured area. Kathy became severely depressed after living with her debilitating pain for more than five years.

When she finally came to see me in consultation I was able to identify four muscles using the Muscle Pain Detection Device (MPDD). I injected the identified muscles over the course of two weeks, followed by three days of targeted physical therapy after each muscle that was injected. By the time her treatment was completed, Kathy had greater than 95% relief of all of her symptoms. This was a woman who, because of her pain and sensitivity, had not been able to wear socks or closed toe shoes for five and a half years prior to seeing me. She is now more than three months post treatment with almost no pain. Her only discomfort occurs when she experiences light touch over the surgery scar site in her lower leg.

This is an extraordinary example of a diagnosis being made without examining the muscles, thereby overlooking a treatable cause of severe pain. In this case, a patient who had trouble getting through her daily life is now functioning fully and even playing golf.

December 3, 2009 - 12:25pm — Posted by Dr. Norman Marcus