Difficult neck pain case
forum post
Hi. I have a difficult case of neck pain that I have been treating for the last several weeks (8 sessions). My patient is in his 40's and has had neck pain for many years. About 2 or 3 years ago, he had surgery to fuse C4 to C6 vertabrae and has some metal implants in his neck as a result. He said that the surgery did nothing to help his condition and, in fact, has made things worse. He now gets severe right sided headaches and pain/numbness down his right arm in addition to the neck and upper back pain. He has tried physical therapy, massage therapy, chiropractic, and prolotherapy, and has stated that these have all, in the best cases, done nothing, and, in the worse cases, made his pain worse. This is his second time trying acupuncture. He said he tried acupuncture for 3 sessions before, but the practitioner did some stretching and adjustments to his neck, which made the pain worse. Other than the nexk pain, my patient doesn't appear to be in bad physical health. He does have some digestive/heartburn issues and some anxiety due to work and pain. I have diagnosed him primarily with blood stasis with some liver qi stagnation and stomach heat.
In the 8 sessions of acupuncture, I've tried to be somewhat conservative given that my patient has been adversely affected by overly aggressive treatment. I have done about 6 sessions of local needling in the huatojiaji points of C4, C5, C6 as well as typical neck pain and blood moving points like luo zhen, LI4, SI3, UB60, GB39, UB17. I also needle some ashi points in the upper back/neck area. I do not use electro stim, given the metal he has in his neck region. I've also done tui na, cupping (very light pressure), and gua sha (very light pressure). A couple of times when he was in acute pain with a headache, I tried using more distal points and some Tung's points around LU10, which seemed to work for a few hours, but the pain returned at the same or increased level. It seems at times that he has very mild temporary relief, but overall, his general pain level is about the same and I am at a loss as to whether I can even help him or not given his past surgery and everything else he's tried. He has stated that he wants to give acupuncture at least 10 sessions, so I have about 2 sessions left to make a difference.
Has anyone encountered a similar case and have any insights? Would herbal therapy be helpful?
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Comments / Discussions:
comment by "ChadD" (acupuncturist)
on Mar 2012
Well there are times where after surgery and particularly with more rigid implants that all people will get is small amounts of relief. I've actually had patients improve to a point (say stay pain free for a couple weeks) only to have it continually return without treatment every couple to few weeks. A few actually went back in had the implants removed (not everyone/every case can do this and not many doctors will even entertain this idea -- and I'm not recommending it) - but then with treatment they were better. Obviously the best time for treatment is -before- surgery except in cases of acute trauma. All that said just to place expectations appropriately.
Now, on to what you are doing. First, I would be cautious about confusing "aggressive" treatments with "proper" treatment given the case. Forget immediately about others things people have tried as it will only add tension to your treatments and bias you against your better judgement. Light cupping and/or guasha will do nothing for this person, nor will light tuina. Cupping is very well tolerated and extremely effective so using what works well for this is very appropriate. The tuina you have to a little careful with but generally what you are trying to is loosen above and below where the fusion is. This is the only way to make some movement. Generally the cupping should be focused on the upper back huatuos and SI areas and the tuina would be the base of the skull down C1-C3 and then C7-T7 - for the skull massage directly behind the scm as well as near the huatuo points.
Needle wise, you are more or less doing the right things. I think SI 3 w/UB 62 (yang qiao mai) is probably better than with UB 60 which is arguably better for low back pain. GV 20, GB 20 and the huatuo of T1, T2 and T7 would be appropriate. And then, of course, pattern specific points. Again the idea physically is to release the tension above and below the fused segments so the pressure can be dissipated.
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comment by "ang67"
on Mar 2012
Hi Chad,
Thanks so much for your suggestions. I didn't really think so much about needling and treating specifically above and below the spinal fusion, but I'm going to try this approach.
Like I said earlier, I do not do e-stim on this patient due to the metal in his vertabrae. However, if I am needling an area that is above or below his implants, do you think e-stim would be safe?
I was also thinking of giving the herbal formula Jiang Huang Wan (Golden Flower's Curcuma Longa formula) a try since he definitely has some blood stasis and apparently some heat, judging from his strong pulse, reddish tongue, and propensity to heartburn. Let me know if you have any thoughts on this.
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comment by "ChadD" (acupuncturist)
on Mar 2012
We prefer tuina over e-stim so I cannot really comment with any authority on using e-stim, except to say that, yes, below the neck would be fine. As for herbal formulas there are a number that would be appropriate for his constitution, a good one for the neck specifically, however, is Te Xiao Jing Zhui Tong Wan.
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comment by "snissle"
on Mar 2012
If the patient got worse after surgery, it's possible that he developed trigger points in some of the neck-related muscles due to the angle / strain of the surgery itself. It's hard to say in the case without more specifics about where exactly the pain is, but scalene TrP could cause pain and numbness down the arm and pain in the upper back.
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comment by "michal"
on Mar 2012
The metal in his neck creates a cold stagnant condition to his neck, try cautiously working with moxa stick on these areas.
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comment by "Maccomphealth" (acupuncturist)
on Mar 2012
Hi
You are treating your client very professionally and with great care "well Done". I have found on some occasions following medical surgery treatments my clients body structure goes out of line.
I am not saying that the answer is a chiropractor but I am saying that by needling the distal points along his trapezius muscle and also the erector spinalus muscles may help the skeletal structure come back into line (releasing the stagnation in the cervical area). A therapy I find very useful in conjunction with acupuncture is
Bowen therapy.
The bowen therapy is light, mild and very effective in loosening the muscles, tendons and ligaments and thus allows the acupuncture meridians to stretch and open, releasing any constrictions that may be there as a result of traumatic muscle contraction.
I find that following the Bowen therapy the needling effect is increased and client gets incredible pain relief.
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