55 year young lady has back pain and bilateral foot and leg burning pain from her diabetic neuropathy.
Diagnosis: diabetic neuropathic pain
Treatment: trial spinal cord stimulator. She received >75% foot and leg pain relief. Her back pain improved by less than 50%.
She had spinal cord stimulator implantation.
63-year-young lady with at least 5 years of bilateral lower leg and foot pain due to her long-standing, poorly controlled diabetes mellitus. She describes her pain as burning, searing pain with an occasional ant-crawling sensation. She denies weakness, numbness, or foot ulcer.
Diagnosis: diabetic neuropathy.
Management: Gabapentin, Pregabalin, spinal cord stimulator trial as needed.
55 year young lady 6 years of chronic leg and feet pain for which she takes high dose oxycodone with severe complication of constipation.
She describe the pain as burning, prickling and extremely disagreeable. She denies weakness or numbness.
She had extensive work up including brain, Cervical and chest spine MRI without etiology. She is non-diabetic.
She had non focal examination.
Diagnosis: likely peripheral neuropathy.
Management: Gabapentin and narcotics are ineffective.
Work up with nerve conduction study. She may be a candidate for spinal cord stimulator trial for pain
78 year young man bilateral foot pain worse with walking for 8 years. He does not have back or leg pain with walking. There is no discoloration of his feet with walking. The foot pain takes a long time to resolve - 30 minutes or more once he sits down. He has been to many doctors to no avail. He said it feels like stabbing pain.
He had intact neurological examination and strong pedal pulse.
EMG and nerve conduction study showed evidence for lumbar radiculopathy and peripheral neuropathy.
MRI showed lumbar degenerative disc disease.
Management: pain medication such as Gabapentin to start. He may be a candidate for spinal cord stimulator trial for pain.
66 year young man 5 years of history of burning leg and foot pain consistently. There is not a single moment of comfort. He can not sleep due to his pain. He denies weakness or numbness in his legs and feet. The pain does not improve with narcotics- in fact it gets worse.
He had skin dystrophic change with discoloration and edema in his both feet-worse on right foot. He is not diabetic.
MRI of L-spine and a thorough vascular work up failed to yield clue for his leg pain.
Diagnosis: likely peripheral neuropathy with pain.
Management: EMG/nerve conduction study. Gabapentin to start. He may be a candidate for spinal cord stimulator trial for pain.