Charu Singh, a 50 year old doctor, who is an anaesthesiologist as well as a pain and palliative care physician, presented 10 months ago with pain in her right buttock along with shooting pain in her right leg since 1 year. It was associated with pins and needles sensation (tingling) in her right leg along with severe cramps. The pain had become very severe lately and she could barely walk more than 50 feet. She also needed support while walking as she had developed weakness in her right leg and foot. Despite taking 4 to 5 medications for pain, she had no relief. Clinical examination was suggestive of a prolapsed intervertebral disc (slipped disc) at L4 L5 which was probably compressing the nerve to her right foot resulting in pain, tingling sensation and some weakness as well. The findings of her MRI spine, however, was ambiguous and was not correlating with the clinical picture. She was advised surgery but as she was getting conflicting advice regarding surgery from various spine surgeons, she decided to go with conservative treatment. She now started to look for non-surgical options and alternate therapies for relief of pain. She was referred to me by a mutual colleague.
After taking a detailed history followed by clinical examination and review of her MRI, I decided to start her on dry needling of her back and right leg along with neuromodulation drugs. The aim was to relieve pain, decrease weakness of her leg and improve her functionality. Each session which lasted half an hour involved inserting 70-80 fine needles into her back and leg. Since the needles are very thin, it does not require any local anaesthetic prior to its insertion. Moreover, unlike analgesic drugs, it has hardly any adverse effect on various organs of the body. She was highly motivated to undergo the dry needling therapy and she tolerated the sessions well without any major discomfort. At the end of 6 sessions which she underwent over the next few weeks, her pain score decreased considerably to minimal levels, the tingling and cramps in her leg also subsided and the muscle power in her foot improved. Now she is able to walk up to ½ km without much pain and without assistance and she has resumed her professional career as a pain and palliative care physician. She is still coming for follow up once in 3 months. Her pain relief and levels of functionality is sustained. She has also started regular exercises which has further sustained her improvement.
Listen in to what this doctor has to say………..
During the current public health pandemic of Covid 19, people are very hesitant in venturing out and issues like pain management is really on the back burner. They would rather tolerate pain than visit a hospital and contract Covid. Moreover, at the height of each Covid wave, most routine operations were cancelled as the priority of all hospitals was to take care of Covid patients. Operations and procedures for pain management were, thus, not possible during the ongoing pandemic and these patients had to resort to teleconsultations for pain management.
Steroid injections are usually given to treat a variety of musculoskeletal pain conditions be it shoulder pain, knee pain or back pain. However, there is a controversy regarding the use of steroid injections during the Covid 19 pandemic. Although steroids are being given as a treatment option for patients with moderate to severe Covid, it is an immunosuppressive drug and, therefore, could result in higher incidence of adverse events if patients were to contract Covid after getting steroid injections. Also, it must be kept in mind that steroids, if given before vaccination, could decrease the efficacy of vaccine as steroids can alter the entire process involved in the generation of adaptive immunity following vaccination.
Keeping these issues in mind, administering steroid injections for pain management was not considered in this patient and I focused on modalities like dry needling along with medication to give her relief of her symptoms.