help with nerve pain

[kimberleyathome]

Hi, I am a student physio and I know a little about the uses of electrophysical agents in pain management. I have a friend whose father who is suffering after an operation he had which resulted in damaged to a nerve. He is complaining of pain down one leg and he is taking pain killers to manage this. I don’t know a great deal about his medical history, only that he has had multiple operations because of cancer. His doctor told him and his family that the only thing they can do for the pain related to the damaged nerve is medication but I was wondering whether TENS could be useful? Would it be worth while visiting a physio to try this, and perhaps purchasing an at-home device? Or is there anything else someone can suggest? Any advice would be greatly appreciated (honestly not a student question, concerned friend question).

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[roycar]

it would definitely be worth giving it a go. even if it helps only a little at least its somethin. he should see someone for a trial to see if there's any benefit.

[bhalla.ravneet]

Be more specific , cancer of what ? is it cured ?

is the pain starting from back ?
course of the pain ?
continuous or intermittent ?

tens would do the job, you could give pulsed ust if the pain is sciatica arsing from lumbar vertebrae, Nerve compression or disc prolapse.
usually this kind of pain is from former or latter

also try neural mobilisation - sciatic nerve..

bless

[gcoe]

Hi Kimberly

Yes probably finding out a bit more about the cause of the pain - although from what you describe it sounds like he developed neuropathic pain or causalgia (CRPS2).

the TENS may help but it probably is best if your friend's dad has been assessed by a multidisciplinary team. For example standard pain killers are not always the best medications for neuropathic pain. Drugs such as Neuroleptics and tricyclics given in the appropriate dosage for chronic pain often have a role on modulating the central nervous system. So he should be seen by a pain team: pain specialist + psychologist + physio - that is if he hasn't been seen already. Given his history of cancer it might be quite complex who is treating him. You could ask if he has been seen and what type of medications were given.

Kinberly the educator in me thinks that while your role here is more the concerned friend it is a great opportunity for you to find out more about this type of pain management and what you as a physio might be able to do. (Sorry I can't help it!). Here is a bit of reading you could do:

Assessment of neuropathic pain -- Callin and Bennett 8 (6): 210 -- Continuing Education in Anaesthesia, Critical Care & Pain

It is a recent guideline for the assessment of neuropathic pain.

And here is a Cochrane review on TENS for chronic pain:

http://www.mrw.interscience.wiley.co...222/frame.html

You should be able to get these through your institution but if you get stuck send me your email and I will forward them to you.

[kimberleyathome]

Thanks guys, I appreciate the advice. Sorry I can't give more detail, it’s a sensitive topic with my friend and her family, and I don't want to make it any harder by prying into their business. I was just hoping that I might be able to recommend something that might bring him some relief from the pain. I’ll let them know what you guys think.

Thanks again,
Kimberley

[kimberleyathome]

Thanks for the information. I've had a look at the articles you suggested, it really is difficult looking at TENS as a treatment because there is so much conflicting evidence out there. Nevertheless, I'll tell him about it, and I will definitely recommend seeing a pain team. I know there are a lot of sceptics out there about EPA's, but in this case I can't really see the harm in giving it a go (unless the cancer becomes a contraindication for its use). You are a true educator, even on the holidays you've got me reading journal articles lol Thank you though, it has been useful.
Kimberley