Successful treatment for patient with paralysis and nerve pain for 18 years

According to information from the hospital, Mr. NVT (56 years old, residing in Ho Chi Minh City) came to the Chronic Pain Clinic - Department of Neurosurgery, University of Medicine and Pharmacy Hospital, Ho Chi Minh City (UMPH), with pain, numbness and stiffness in the entire right shoulder, arm and hand. Mr. T. said that the pain was persistent and increasingly severe since the traffic accident 18 years ago.

Traffic accident, right arm paralyzed

Previously, after a traffic accident, Mr. T. was completely paralyzed in his right arm, and initially had to depend on his family for all his daily activities and eating. After that, he tried hard to practice and was able to move with his left hand. However, after only 5-6 months, the pain appeared with numbness and stiffness in the entire shoulder, arm down to the hand, the pain appeared continuously with increasing intensity and frequency. Mr. T. went to many places for examination and treatment using many different methods. Initially, the pain decreased but became more and more severe, the patient had to increase the dose of painkillers to the maximum allowable level.

Người bệnh đang được giảm dần liều thuốc giảm đau, tiếp tục tái khám định kỳ — The patient is gradually reducing the dose of pain medication and continues to have regular check-ups.

In May 2021, Mr. T. came to the Chronic Pain Clinic - Department of Neurosurgery, University of Medicine and Pharmacy Hospital, Ho Chi Minh City, in a state of severe pain with a pain score of 9/10. Doctors diagnosed the patient with chronic nerve pain due to sequelae of right brachial plexus injury and quickly consulted with experienced specialists from Singapore and Thailand.

After consultation, the patient was prescribed spinal cord stimulation (SCS) to treat pain. This method requires multiple steps to evaluate the patient's response to the stimulation electrode.

After the experimental electrode placement surgery, the patient responded with over 50% pain relief. Doctors then placed permanent electrodes in the epidural space of the neck to control pain and stiffness. The surgery ended successfully, and in the first year, the patient responded well to treatment, no longer having to endure the "bone-piercing pain" as before, with an average pain score of 4-5 on a scale of 10.

However, as the disease progressed, the pain became increasingly difficult to control. Doctors continued to consult and control the patient's pain with morphine, rTMS, Scrambler... but there was no response.

Applying new techniques , effective pain treatment

To treat the patient, in December 2023, doctors from the Department of Neurosurgery at University of Medicine and Pharmacy Hospital, Ho Chi Minh City decided to implement the "DREZotomy" technique to relieve pain.

Associate Professor, Doctor, Doctor Nguyen Minh Anh, Head of the Department of Neurosurgery, said that "DREZotomy" is a technique that removes pain transmission connections at the level of the dorsal horn of the spinal cord, where it enters the sensory nerve roots, changing the spinal reflex arc to reduce pain and reduce spasticity. This is a difficult technique, requiring experience, precision and combined with intraoperative electrophysiological monitoring (IOM: Intraoperative monitoring). This technique is effective in treating and controlling neuropathic pain and spasticity when other treatments have failed, such as: Pain after brachial plexus injury, post-herpetic neuralgia, spinal cord injury, cancer pain, etc.

After receiving specific advice from the doctor, the patient was consulted by a multidisciplinary team and had the necessary tests performed. With the cooperation of many teams, the surgery went smoothly in 2.5 hours. The patient was stabilized post-operatively and discharged after 2 days.

MSc. Do Trong Phuoc, Department of Neurosurgery, University of Medicine and Pharmacy Hospital, Ho Chi Minh City, said that immediately after surgery, the patient's pain was reduced by 70-80%, the pain score was 3/10 points and there was almost no more cramp in the arm, only pain at the surgical site. At the first follow-up visit 1 month after surgery, the postoperative condition was stable, the surgical wound was dry, healed well and there was almost no more cramp in the arm, the patient's sleep improved significantly. The patient's spirit was increasingly optimistic, he ate well and gained 2 kg.

Currently, 3 months after the DREZotomy surgery, Mr. T. is gradually reducing the dose of pain medication and continues to have regular check-ups so that the doctor can monitor and evaluate the effectiveness of the treatment.

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