Traci’s Story

My name is Traci Patterson.  I’m the Founder and Director of Advanced Pathways Hypnosis, a Keynote and motivational speaker, writer, Delegate with the International Pain Foundation, an Ambassador with the U.S. Pain Foundation, patient advocate, and CRPS survivor.

Who was I prior to my diagnosis with Complex Regional Pain Syndrome (CRPS)?

Prior to my diagnosis with CRPS, I was a healthy, active, mother, wife, healthcare executive (at the top of my professional career), volunteer (with Young Life, Rising Tide and Orangewood Children’s Foundation), mentor, had been on the board for Tustin Eastern Little League, enjoyed softball, kayaking, outdoor activities, baseball, gardening, landscaping, and staying very busy.  I was one of those individuals that was always busy either with our family, volunteering or just helping friends or family.  I just loved to be active and busy.  That all changed after December, 2006 when I stepped over a box in our garage and turned my ankle.  What started out as a simple sprained ankle, triggered dominoes to something that what we could have never imagined. 

How would you define Complex Regional Pain Syndrome?

Complex regional pain syndrome (CRPS), also known as reflex sympathetic dystrophy (RSD), is a long term condition that often worsens with time. It is characterized by severe pain and sensitivity, swelling, and changes in the skin. It may initially affect one limb and then spread throughout the body; 35% of people report symptoms throughout their whole body.

The cause of CRPS is unknown though CRPS is associated with dysregulation of the central nervous system and autonomic nervous system resulting in multiple functional loss, impairment and disability. Precipitating factors include injury and surgery, although there are cases where no injury had occurred at the original site. CRPS is not caused by psychological factors, yet the constant pain and reduced quality of life has been known to cause psychological problems (such as increased depression and anxiety). Although “research does not reveal support for specific personality or psychopathology predictors of the condition,” CRPS is associated with psychosocial effects, including impaired social and occupational function.  It is classified as an amplified musculoskeletal pain syndrome.

Somebody who has chronic pain is living with a daily challenge to cope with pain that does not have a quick fix, sometimes it does not have a cure and the best you can hope for is to get into remission. As a patient you feel like you have to learn how to alter your dreams and bring focus and meaning back to your life.  Patients living in chronic pain also have to cope with others looking at them, not understanding what they are trying to deal with day in and day out, because most people only see a glimpse of what you are going through and to them you look normal.  You are not in a cast, you are not necessarily in the hospital, and you are home on medication dealing with a horrible pain condition that is wreaking havoc on your body.  This is why Chronic Pain, CRPS/RSD and many neurological pain syndromes are also known as ‘Invisible’ pain conditions.   

 How are people’s lives affected by this illness? What changes when they start dealing with this illness?

Your life is altered, your dreams for the future are never going to be exactly as you planned them to be, you have to change your expectations in life because now you are dealing with a condition with chronic pain, and now that you have pain you are not physically able to do things the way you used to.  So it alters your life.  Many will say it’s a matter of learning to live with it, around it and accept the changes that have come to your life.  The career that you had may now be gone.  The many activities that you were involved with, you now cannot continue due to high pain levels and it is very hard for others to understand this.  People that once stood by your side start to disappear as they just don’t understand why you are unable to do what you used to.  Your life as you once knew it changes, and this isn’t even talking about the impact it has on your family.

Why is this illness different from others illnesses?

You have to face this for the rest of your life, unless you are one of the individuals that can get into remission. Some people go to physical therapy for 6 to 8 weeks and then they get better. There is no cure for Complex Regional Pain Syndrome (CRPS). Some people have an injury and they go through their process and the pain; medication, PT, injections, blocks and all of a sudden they graduate and then they’re able to get into remission and get back to their lives (this is not the norm). People like me that don’t respond to normal treatments go through aggressive treatment protocols that can include: heavy medications, injections, PT, regional blocks, lumbar sympathetic blocks, and maybe even Spinal Cord Stimulators.  Yes, I did all of that and had no improvement.  As a matter of fact everything they did to treat me made me worse!  I was told my case was one of the worse my Pain Management doctor had ever seen.  It was very aggressive and extremely volatile.  It started out in my left foot and ankle, moved into my back when they put in a Spinal Cord Stimulator (they stated this had never happened before to previous patients), then I had a build-up of scar tissue on my Dura of the spine that would have paralyzed me, so the final Spinal Cord Stimulator had to be removed.  At this point my Pain Management doctor was giving up!  My CRPS kept trying to ‘mirror’ to my right leg, but we were able to stop it each time.  How was I ever going to get better?  I refused to give up, my life had already been drastically altered, and I had been living life as a Chronic Pain patient on a cocktail of pain meds to just live…  I just knew in my heart that there had to be some answer out there, some hope, some way of getting my CRPS into remission and I refused to give up! 

At this point in my life I knew I had already been to hell and back, my CRPS was moving – getting worse (it was in my left foot/ankle, my entire back and had recently moved into my pelvic region), I knew God had other plans for me and I just had to figure out where that path was going to lead me.

Complex Regional Pain Syndrome Traci’s Case Report

My Name is Traci.  I was 36 years old when I originally sprained my ankle stepping over a box in December, 2006.  That started my journey.  Then a little over a year later I was formally diagnosed with Complex Regional Pain Syndrome (CRPS) in January, 2008. 

I was then referred to a DPM (Doctor of Podiatric Medicine) for assessment. After conservative treatment that included a CAM Boot, Physical Therapy and cortisone shots, the pain continued.

The DPM followed with three (3) surgeries of which several errors were made, including cutting the Tibial Nerves, Lateral Plantar Nerve, Rupturing the Posterior Tibial Tendon, and making the incision in the wrong place. 

I had two (2) surgeries by a top Orthopedic Foot and Ankle Surgeon to reconstruct my Posterior Tibial Tendon, and later he completed a Tarsal Tunnel Release hoping to help with the nerve pain.

During these surgeries, my pain continued to increase disproportionate to what should have been occurring.

In 2008, I was officially diagnosed with CRPS by my Pain Management doctor, and he put together an aggressive treatment plan to try to treat my condition.  Initially, he thought he could get my condition under control within 6 months to a year, and told me this could be one of the most devastating diagnoses of my life.

He started with putting me on a lengthy list of opioid pain medications that included: Methadone, Dilaudid, Ketamine (oral and topical), and more…

In addition to these medications he tried regional blocks with no results, and then we did 13 Lumbar Sympathetic Blocks (the last one shut down my adrenal glands, landing me in the hospital for several days).  Thus, my PM Doc stopped any further blocks and I was then told I had to get a Spinal Cord Stimulator (SCS).  In addition to the Sympathetic Blocks I also received a prescription from my pain management doctor to undergo HBOT.  I did 25-30 sessions of HBOT, which I had heard could help to relieve pain, but did not get relief.  The next step was a SCS trial which was a success. Yet once the real spinal cord stimulator (SCS) was implanted it functioned in-properly and caused swelling every time the battery was charged.  Thus, I had to have a 2nd surgery to change out the SCS Battery. It was at this time that I started to notice some CRPS Pain in my back.  I had continued trouble with the SCS, so the system was removed and replaced (Medtronic to Boston Scientific) – no precautions were taken to make sure the CRPS didn’t move into the back.

Following this surgery, I had full CRPS in my back (my waist to my shoulders).  I was told by the Neurosurgeon this was the first time he had this happen.  I had further issues with the Boston Scientific SCS, which included a build-up of scar tissue on the Dura of my Spine.  Upon further review, it was found in several articles that SCS in rare cases could cause scar tissue on the Dura that would lead to paralysis.  Therefore, my SCS was removed/explanted (2011).

It was at this time that my Pain Management doctor told me, “…after all of this I’m afraid to touch you. There is nothing else I can do at this time.  Therefore, you may have to do your best with pain meds.”

Three weeks following my post-op of the SCS removal, I flew to Frankfurt, Germany, for further treatment.  This was the first of my four trips over to Frankfurt, Germany, for treatment of my CRPS.

The first trip, we started with building up my immune system, Stem Cells (utilizing my own blood), Thymus Cell Extract, Blood Ozone Therapy, Neural Therapy with Ozone, Myers Cocktail IV’s, Lymphatic Massages, Physical Therapy and Detoxing.

On my second trip to Frankfurt, we noticed there was one area where they removed the SCS that was problematic.  Following an ultrasound, they discovered there was something foreign in the incision.  The Medical Director in Germany re-opened this area and found there was some gauze left in my incision from when the SCS was removed.  This was cleaned up, left open to heal, debrided on a daily basis until it closed on its own.

During this trip and my subsequent trips to Germany, I completed the following types of treatments (this is inclusive of the last three trips):

Neural Therapy with Ozone

Ionization

Ozone Therapy

Blood Ozone Therapy

Thymus Cell Therapy

Regional Hyperthermia (3x/day – 5days/week: first CRPS patient in world to be treated with Regional Hyperthermia)

Alpha Lipoic IV’s

Myers Cocktail IV’s

Homeopathic Injections

Regeneris Therapy (RNA Cell Therapy – 4 weeks treatment protocol)

PK Protocol

Physical Therapy and Massage

Bodywork

(Last trip to Germany was August-September, 2013).

 

I still feel that my trips to Germany were important in my over-all treatment process as they were able to shrink the area(s) of my CRPS and decrease my pain levels overall.  Following my last trip, my pain levels remained at a 5 for approximately six weeks and then started to increase again.

I contacted the Medical Director in Germany and it was suggested to do two more rounds of Regeneris or return to Frankfurt for continued treatment.

Between my trips to Germany, I was also treated in Mexico in tandem with the Medical Director from Frankfurt.

In Mexico, he treated me with the following over 3 different stays:

Insulin Potentiated Therapy (IPT – utilizing pain meds)

PK Protocol

Physical Therapy

Chiro

Alpha Lipoic IV’s

Myers Cocktail IV’s

Rife

Acuscope

Neural Therapy with Ozone

Ondamed Biofeedback

HBOT and detox

Regional Hyperthermia

 

These treatments only decreased my pain levels to a 6-7.  My last trip to Mexico was July, 2013.

Following my last trip from Germany I contacted highly regard clinic known for hypnosis for possible treatment.  I had previously done some hypnosis sessions, but was referred there due to their background and being known for Pain Management.  After speaking we set up a time to be seen mid-November, 2013.

I was told that it would be a week long intensive session that would include our time together and homework each evening (i.e. reading, listening to CD’s, etc…).  To me, this was an exciting avenue to go down and I was 100% dedicated to get the most out of everything that was set before.

Day one, I walked in with what I formerly called “Pain Levels”, and now have changed, calling them “Comfort Levels” up in the 8-9 range.  The evening prior they were at a 10+ due to the full day of travel to get from CA to my destination.  Little did I know, although I had hoped and prayed it would be, that my ‘Comfort Levels’ would drop to a ZERO by the end of the week! 

Over the week we used a combination of:

Hypnosis

Imagery / Meditation

Biofeedback

Light/Sound Therapy

“Issue Solution Training”

and learning Self-Hypnosis

 

While working together the first day, it was discovered that I was also dealing with a case of PTSD due to everything that I had dealt with over the years; the treatments; being given medications for anesthesia and not having them work – then listening to the physicians; having my Pain Management doctor tell me that there was nothing more he could do and I would just have to live with the pain;  going through some treatments that were extremely uncomfortable; and negative comments from physicians about the possible outcome of my situation.  This did not surprise me to say the least.

From the first day to the last day I saw progress.

Thursday of our week together, I was scheduled for a massage.  To be honest, I was a bit reluctant and worried walking to that appointment due to the fact that I had not been able to tolerate a massage on my back since 2011 when CRPS had moved into my back.  I knew that my ‘Comfort Level’ had already dropped to a ZERO in my back, but I wasn’t sure if I trusted it enough to do the massage.  I was pleasantly surprised to see how relaxed and comfortable I was during the massage.  I had no pain in my back and I was able to keep my ‘Comfort Level’ at a Zero.  To me this was a test, and it showed me what I had accomplished to that point was holding and would continue to get better.

The other huge thing that they were able to assist me with was a continual spasm or uncontrollable motor deficiency in the little toe on my left foot.  This was in addition to my CRPS, and it was due to a nicked Lateral Plantar Nerve.  I had had many doctors consult with me regarding this, and I was always told that they had never seen anything like it.  They had no idea what to do, etc.  Thus, I had been dealing/living with my little toe being in continual spams since 2007, and in 3 days, we were able to get my little to stop moving!  Wow, this was a mechanical problem and it had stopped.  This was huge!  Talk about bringing a smile to my face. It was intriguing to see how the process of hypnosis could access areas of the brain to stop the continuous signals being sent out.

Yes, it was an intense week of learning, working, and following all of the instructions given me, but to have my ‘Comfort Levels’ drop to ZERO for the first time since 2006 when I sprained my ankle, then was diagnosed with Complex Regional Pain Syndrome (CRPS), it was well worth it.

One of the things that I learned was that every cell has a memory.  It is essential to provide the cells with a new memory other than pain, and when you do this, new memories will take hold as the cells regenerate every 90 days.  Thus, in approximately 90 days after arriving home, new memories should be strong.

When I arrived home I was barraged with questions, because friends and family members immediately noticed a marked difference in my demeanor, a bigger smile on my face, my ability to put weight on my left foot for the first time since 2006, and an overall sense of well-being.  This was after 5 days with of treatment with hypnosis in a multi-therapeutic approach.

Once home and settled, I put myself into a routine that included listening to the CDs of the sessions that I had completed, doing self-hypnosis, and utilizing the tools given to me.  After the first week home, I was no longer utilizing my cane to walk.  I still needed to work on my gait, but this was a big milestone.  During this time, I also met with my Pain Management doctor.  He was used to me going to Germany for treatment and coming back with their protocols, but this time, he had no idea what to expect.  When he entered the exam room, I was sitting there with socks and running shoes on, no cane and long pants that could touch my ankle and medial side of my foot. 

My Pain Management doctor looked at me, pushed back on his stool, and started looking around the room. He was in disbelief at what he was seeing.  He then asked me to take off my left shoe and sock, because he wanted to see if my left little toe was still spasming or doing the rhythmical movement.  When he saw that it was not moving, I had shoes on, my coloration was not off in my foot, and I was feeling great, he was dumbfounded.  He next words were, “I’m being punked. Where are the cameras and how are you doing this?”  I had to laugh.  He wanted to know what I did in my treatments, but since he doesn’t understand what I did, he was skeptical.  Then when I asked him to take me off of my pain medications, he was awestruck.  He hesitated, to say the least, because he wasn’t sure this was going to hold.  As I told him, I am confident in where I am and what I have accomplished.  I have no pain at this time, so I don’t feel that I should continue on pain medications, and I asked again to be titrated off of them.

Week by week, I continued to see progress.  Having the ability to walk my dog at the park with no pain, completely comfortable, completing household chores with no discomfort, babysitting my nephew who was 6 months old with complete confidence, and spending time with my family in activities that I would not have been able to have done previously, these are all the rewards of learning self-hypnosis and following through with what I was taught during my treatment.

Now over 3 years later I continue to be completely pain free and have had the ability to regain my life.  It is important for people living with CRPS and other chronic pain conditions to hear about positive outcomes such as mine.  This is not a one off or something that cannot happen to others.  As a matter of fact I am honored to be able to treat chronic pain patients now with HCT (Hypnosis Combined Therapy).  This protocol is very similar to what helped me get into remission with some exciting changes based upon medical advanced.

I’m now seeing clients on an international basis with outstanding outcomes.

I know for some it is hard to believe, but trust me with everything that I went through with treatments in the United States (Traditional Western Medicine), in Frankfurt, German (Integrative Medicine), Mexico (Integrative Medicine), and then back to the US to be treated by a highly recommended clinic… I think I can say I looked at everything, tried just about everything and found what worked for me.  I have heard from others with CRPS that they have tried hypnosis and it just doesn’t work.  I too tried hypnosis prior to going back to be treated in 2013, my previous treatments with hypnosis didn’t help me – then again they were not well versed in chronic pain and not certified in ‘Pain Management’ either.  When I was referred to the last clinic I was told by everyone that it was the best, that they did things differently, and they do – they work with the biology and physiology of the brain and how it causes Chronic Pain.  It is a completely different way of looking at things, working with Chronic Pain and finding a solution for the pain.  What works for one will not necessarily work for all, but if it is successful for one it is likely going to be successful for many!

Now you have a better understanding of what Complex Regional Pain Syndrome is, how it affects a patient, just a little bit about what we go through and some of the treatments we endure.  I was a fortunate patient in that I was able to get into remission in 2013. 

I was determined to find a treatment somewhere, some way to help me regain my life, and I did it!  I went from not being able to have anything touch the areas where I had CRPS to being able to put a sock on my foot, to wearing a shoe and not being in pain.  I got my life back.

This is why I am so passionate about sharing my story, getting information out about chronic pain, trying to educate as many people as possible on the effects of CRPS/RSD and chronic pain syndromes, and viable treatment options.

Let me ask this question before you read on… if you or a loved one are willing to look at opioid therapy, spinal cord stimulators, pain pumps and other invasive treatments that are only bandaides… why are you not willing to seriously look at other treatments that have worked on other CRPS/RSD and chronic pain patients?  Is it because your doctor(s) are not talking to you about these types of treatments?  Possibly because the pharmaceutical companies are not advertising it or the insurance companies are not pushing it? Yes, I know that many patients, like me, find out about these treatment options after going through the ringer.  But, if this is a way to get your life back, to regain what you lost, and to start fresh… is it not worth taking a serious look at your options?   Please take a serious look at what will really work to help you or your loved one in the long run.   No, not every treatment is right for every patient, but if it is evidence based and non-invasive is it not worth looking into? 

HCT by Traci Patterson is helping chronic patients that have been diagnosed with CRPS/RSD, neuropathic pain, Fibromyalgia, cancer pain, phantom limb pain, PTSD, migraines, etc… to regain their lives on a global basis.  

I have a dynamic background from a perspective that few if any one other Certified Instructor and  Clinical Hypnotist can offer.  My background as a chronic pain patient diagnosed with Complex Regional Pain Syndrome (CRPS), someone that was treated with/utilized hypnosis to get into remission, and is now a practicing hypnotist is rare.  I have patients that contact me on a global basis searching for viable treatment options.   

If you have questions regarding CRPS, my story or would like information on how you or a loved one can find relief from chronic pain please contact me.

 Info@Advancedpathways.com  | http://www.AdvancedPathways.com | 714-717-6633

Outcomes With Hypnosis Combined Therapy by Traci Patterson

Hypnosis Combined Therapy (HCT) by Traci Patterson, CH, CI has proven to be an excellent drug-free, non-invasive, and evidence based treatment protocol that is providing positive outcomes for the patients diagnosed with chronic pain, fibromyalgia, neuropathic pain, chronic migraines, and Complex Regional Pain Syndrome (CRPS) [type 1 and type 2].  Yet it is not limited to these specific diagnosis.

The data in this report is specific to those clients/patients diagnosed with Complex Regional Pain Syndrome (CRPS); type 1 and type 2; that were treated with Hypnosis Combined Therapy (HCT).  The data is based upon all CRPS clients/patients that were seen over a one year period (June, 2015 – June, 2016).

Today, over 1 million people are diagnosed with CRPS (Complex Regional Pain Syndrome) aka RSD (Reflex Sympathetic Dystrophy) worldwide.  While staggering, patients are not being given the options of treatments outside the box that can help them such as Hypnosis Combined Therapy (HCT).  What we have found through research and tried methodology is HCT gives hope and restores chronic pain patients’ lives.

The majority of patients diagnosed with CRPS aka RSD are treated with traditional methods (i.e. NSAIDS, PT, OT, local blocks, regional blocks, lumbar sympathetic blocks, ganglion blocks, pain medications/opioids, spinal cord stimulators and even pain pumps), and most do not see long term or permanent relief.

At Advanced Pathways we are seeing clients/patients that have been diagnosed with CRPS from all over the world.  Those from the United States have been seen at some of the top facilities (Cleveland Clinic, Mayo Clinic, Scripts Medical Center, etc.) and by some of the top physicians including Dr. Chopra prior to coming to our office. These are individuals that have not been able to find relief from other treatment options (listed above), but they are able to dramatically decrease pain levels and regain their lives utilizing HCT.  Many have been able to get into complete remission.

The average starting levels are below:

Pain Level:      9.090909091   (Rated on a scale of 0-10.  10 being the worst pain imaginable.)

Sleep Quality: 7.272727273   (Rated on a scale of 0-10.  10 being the worst.)

Quality of Life:                      (Rated on a scale of 0-10.  10 being the worst.)

HCT Outcome Data – CRPS

 

The average ending levels following, “Week-Long Intensive”, with HCT:

Pain Level:      0.727272727   (Rated on a scale of 0-10.  10 being the worst pain imaginable.)

Sleep Quality: 2.363636364   (Rated on a scale of 0-10.  10 being the worst.)

Quality of Life: 3.363636364   (Rated on a scale of 0-10.  10 being the worst.)

HCT Outcome Data – CRPS 1

 

HCT is a combination of the following modalities:  clinical hypnosis, biofeedback, light/sound therapy, transdermal peptides (when appropriate), working with the limbic system, cell memory, and more.  This combination is evidence based while providing our clients/patients with the best outcomes possible.

We have found that it is critical to look at all aspects of the diagnosis and what the individual is dealing with (i.e. stress, anxiety, depression, insomnia, PTSD).  It is imperative that the individual is able to resolve all of the issues they are dealing with, or have the tools to decrease these in order to regain their lives.

Hypnosis as an adjunct to medicine allows one to decrease pain and enhance healing. Often, a person with chronic pain may feel helpless, lost, and victimized. Hypnosis gives the person greater self-control, which decreases the effects on the autonomic system that activates the fight or flight response. Self-control also decreases the level of stress hormones. Both the reduction in fight or flight, and the decrease in stress hormones, can lead to a significant decrease in pain.[1]

We work with the subconscious mind.  The subconscious mind is not just in the brain or the head. According to research completed by Candace Pert, Ph.D., a research professor in the Department of Physiology and Biophysics at Georgetown University, she states, “The subconscious mind is a part of every cell within the body. Every cell in the body has memory units. Each cell has over 6,000 receptor sites for proteins capable of interacting with signals and converting those signals into intracellular activity. Through molecular division, each cell divides into a daughter cell and the mother cell dies. The daughter cells replace the parent cells; however they still contain the cellular activity or memory of the mother cell. This cell replacement process occurs every three months, except in skeleton cells that divide every six months. With each division and replacement new memories can replace old memories, creating new behaviors from the cellular level.”[2]

Another key area of focus is working with the limbic system and the autonomic systems of the body.  We understand that the human body is made up of four significant vital signs:  heart rate, blood pressure, temperature, and respiratory rate.  Pain was added to this list of vital signs in 2000 by JCAHO.  As with other vital signs, pain impacts a number of functions such as emotions, behavior, long-term memory and olfactory senses. The limbic system influences these same functions.  Understanding how pain interacts in the limbic system and how it operates helps patients break the pain loop and move beyond chronic pain. “When we think the Limbic System responds”[3].

When the limbic system functions abnormally, numerous health problems can occur. Physical problems such as a lack of sleep, too much stress, or chronic pain, exacerbate the problems created by an out-of-balance limbic system. The results are devastating.  In some cases, depending on the external factors, these imbalances can result in post-traumatic stress disorder (PTSD). This is the essence of stress turning into distress.

Hypnosis works well with the limbic system, specifically the Amygdala and the Hypothalamus, to change the stress response. Hypnosis allows a focused concentration and relaxation, resulting in an increase in oxygen throughout the body’s cells. This increase in oxygen has a major influence on decreasing a patient’s autonomic response to stress. Dr. John Rowlingson, the director of the University of Virginia Department of Anesthesiology Pain Management Center, is quoted as saying, “The limbic system might explain why therapies that act primarily in the brain, such as hypnosis, biofeedback, and brain stimulation, work so well to control pain.”

Transdermal peptides mixture of BPC-157, TB-500 and MGF has been proven to break up scar tissue, decrease inflammation, and decrease nerve pain.

Hypnosis Combined Therapy – the research and science of the mind-body connection, knowledge of how brain mechanisms interact, and pulling this together in individualized treatment plans – is what makes it so successful.  Utilizing different techniques through HCT, patients are able to break the chronic pain loop, bypass devastating memories, decrease inflammation, and set a path towards hope and a new life.

If you would like more information on Hypnosis Combined Therapy (HCT) by Traci Patterson, CH, CI please contact Advanced Pathways.

 

 

[1] Temes, Roberta, PhD. (1999). Medical Hypnosis and Introduction and Clinical Guide. New York: Churchill Livingstone.

[2] Pert, Candace B. PhD (1999). Molecules of Emotion. NY: Touchstone Publishing.

[3] Siegel, Ronald D. PsyD, Michael H. Urdang and Douglas R. Johnson M.D. (2002) Back Sense. New York: Broadway Books.

 

Quinolone-Induced Peripheral Neuropathy

Quinolone-induced peripheral neuropathy is a real potential.  Quinolone is a broad spectrum antibiotic that works by interrupting the molecules in bacteria.  The majority of people in the US will know these medications by such names as:  Levofloxacin, Cipro, or Levaquin.  If you have recently taken a medication within this classification and have started suffering with neuropathy I urge you to get in touch with your physician.    

Although this adverse event is considered rare, a 2013 Drug Safety Communication[2] from the US Food and Drug Administration (FDA) cautioned providers to recognize this side effect.  The potential for the development of peripheral neuropathy has been recognized since the mid-1990s.[3,4] It can occur within the first several hours of medication use, and most cases occur during the first week on the quinolone.  The most common initial symptom is paresthesia, which for many patients is the only symptom.  Some people, unfortunately, will also experience substantial pain.  Permanent neuropathy may occur.

Quinolones have many other side effects, and there have been lawsuits in the United States over some of them.  Most clinicians are aware of concerns about tendinopathy with quinolones and the risk for tendon rupture.[5] Tendinitis is most likely to occur in the Achilles tendon, although the hand and shoulder are also commonly involved.  A smaller percentage of affected patients may progress to tendon rupture.  This catastrophic event can occur within hours of commencing treatment and weeks to months after discontinuing the drug.  A black-box warning regarding the risk for tendinitis and tendon rupture was added in 2008.[6]

An important clinical pearl: Risk for tendinopathy is far greater in older patients and those taking concomitant corticosteroids. The risk for tendon rupture (odds ratio, 3.1; 95% confidence interval, 1.5-6.3) and, specifically, rupture of the Achilles tendon (odds ratio, 43.2; 95% confidence interval, 5.5-341.1) is substantially increased in patients taking a quinolone plus steroids.[7] If use of a quinolone and steroids together is warranted, the patient must be informed about this potential and educated to recognize its onset, discontinue the medication immediately if symptoms occur, and notify the prescriber.  Patients should also avoid exercise and use of the affected area at the first sign of tendon pain, swelling, or inflammation.

Other adverse effects of quinolones are important to note.  Central nervous system side effects, such as insomnia, headache, dizziness, and confusion, are common.[8] There is also an increased risk for ventricular arrhythmia secondary to a prolonged QT interval, a side effect most noted with moxifloxacin.[9]

Recent research has investigated the association of quinolones with retinal detachment.  One study[10] found that current, recent, or past use of an oral fluoroquinolone was associated with a 4.5 relative risk for retinal detachment. A more recent study[11] published in JAMA in November 2013 concluded that oral fluoroquinolone use was not associated with increased risk for retinal detachment.  The investigators emphasized that their study’s limited power did not allow them to rule out a less than 3-fold increase in relative risk, but they did note that any differences in absolute risk were likely to be of minor clinical significance.   Therefore, although the jury is out on risk for retinal detachment, that possibility must be kept in mind for a patient taking a quinolone who experiences visual changes.

Is the risk for peripheral neuropathy important to recognize, or any of the other risks?  The recent FDA letter provides a warning that must be taken seriously.  It is quite interesting that Australia has banned the use of Quinolones for the above mentioned reasons, yet we continue to allow their continued use here in the US.

 Any risk with any medication that a patient takes must be taken into account and weighed out accordingly with benefits and reason for it being prescribed.

Ultimately the physician is responsibility to prescribe a safe medication with the fewest side effects possible to their patients.  Yes, this may take a bit more time and knowing what the top medications are for a specific diagnosis but this is what the patients are depending on their doctor for.  They also need to know that ‘statins’ can also lead to neuropathy in rare cases, but it does happen.  (We’ll leave that for another story.)  It is time for the patient(s), their loved ones or care takers to get educated on what is prescribed; the potential side effects and they need to be willing to ask for an alternate medication if they are not comfortable with what they are given.  I am a firm believer that the patient, their loved ones or care taker needs to be an active participant in their care.

If you have neuropathic pain and are seeking a ‘Drug-free’ alternative treatment please contact, Traci, at Advanced Pathways Hypnosis for a FREE consultation. Compassionate pain management is just a step away!

1.714.717.6633    |    Traci@AdvancedPathways.com    |    www.AdvancedPathways.com

 

 

 

 

 

 

References

 

  1. ….
  2. US Food and Drug Administration. FDA Drug Safety Communication: FDA requires label changes to warn of risk for possibly permanent nerve damage from antibacterial fluoroquinolone drugs taken by mouth or by injection. August 15, 2013. http://www.fda.gov/Drugs/DrugSafety/ucm365050.htm Accessed July 30, 2014.
  3. Hedenmalm K, Spigset O. Peripheral sensory disturbances related to treatment with fluoroquinolones. J Antimicrob Chemother. 1996;37:831-837.
  4. Cohen JS. Peripheral neuropathy associated with fluoroquinolones. Ann Pharmacother. 2001;35:1540-1547. Abstract
  5. Lewis T, Cook J. Fluoroquinolones and tendinopathy: a guide for athletes and sports clinicians and a systematic review of the literature. J Athl Train. 2014;49:422-427. Abstract
  6. US Food and Drug Administration. FDA requests boxed warnings on fluoroquinolone antimicrobial drugs. Seeks to strengthen warnings concerning increased risk of tendinitis and tendon rupture. July 8, 2008. http://www.fda.gov/NewsEvents/Newsroom/PressAnnouncements/2008/ucm116919.htm Accessed July 30, 2014.
  7. Giovanni C, Zambon A, Bertu L, et al. Evidence of tendinitis provoked by fluoroquinolone treatment. Drug Saf. 2006;29:889-896. Abstract
  8. Oliphant CM, Green GM. Quinolones: a comprehensive review. Am Fam Physician. 2002;65:455-464. http://www.aafp.org/afp/2002/0201/p455.pdf Accessed July 30, 2014.
  9. Gatifloxacin and moxifloxacin: two new fluoroquinolones. Med Lett Drugs Ther. 2000;42:15-17. Abstract
  10. Etminan M, Forooghian F, Brophy JM, Bird ST, Maberley D. Oral fluoroquinolones and the risk of retinal detachment. JAMA. 2012;307:1414-1419. Abstract
  11. Pasternak B, Svanström H, Melbye M, Hviid A. Association between oral fluoroquinolone use and retinal detachment. JAMA. 2013;310:2184-2190. Abstract

Spinal Cord Stimulators – Adverse Effects and Possible Paralysis

08/10/2014 – Traci Patterson, Owner, Advanced Pathways Hypnosis

In April 2014, the Wall Street Journal published an analysis of adverse events associated with spinal cord stimulators:

 

.When Spine Implants Cause Paralysis, Who Is to Blame?

 

These events were submitted to the FDA or were obtained from medical malpractice law suits. “In many cases, the injuries occurred after patients’ spinal cords were punctured or compressed by the stimulator electrodes….The FDA’s database contains 58 unique reports of paralysis with report or event dates from 2013, compared with 48 in the prior year.” The spinal cord stimulators were made by various companies.

 

“Researchers at Duke University medical center recently found that nearly one in every 100 spinal stimulator patients experienced some degree of spinal cord or spinal nerve root damage, said Shivanand P. Lad, a Duke Neurosurgeon and the study’s lead researcher. The study, based on insurance claim records of 12,300 stimulator patients has been submitted for presentation at an upcoming medical meeting.”

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“A 2011 study based on adverse event reports submitted by device makers found the rate of paralysis or motor weakness in patients implanted with a commonly used type of stimulator was considerably lower, at around 3.8 per 1000, with about 60% of patients eventually experiencing complete or partial recovery.”

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Medtronic updated its product label in February to note “that scar tissue can form around device electrodes and cause nerve damage, including progressive quadriparesis, or gradual weakening of all four limbs.”

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“Medtronic estimates that as many as 50,000 people in the U.S. are implanted with spinal stimulators each year from all device makers.”

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“Stimulators cost between $20,000 and $60,000 each and have estimated global sales of $1.5 billion annually….”

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The FDA “cautions that the agency’s database cannot be used to ascertain comprehensive rates of adverse events because the events are under reported and often contain incomplete or incorrect information.”

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The article describes a man with 40 years of back pain who had a spinal cord stimulator implanted at the University of Texas Southwestern Hospital, Dallas. He complained of numbness in his legs. A blood clot was removed on an urgent basis, but damage was irreversible. He was paralyzed from the waist down and left in a wheelchair.

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Spinal cord stimulators (abbreviated SCS) can cause many more problems that paralysis. They can cause pain, tethering of the cord, scarring of the battery pack that can slide across the back, infection that may cause death, and many other complications. Electrodes may not always be able to be removed and remain permanently scarred into the cord. Deeply troubling is that an MRI can never be done again even if the patient has cancer or stroke.  This information has been reported by various physicians including Dr. Sajben.

 

As a patient that was diagnosed with Complex Regional Pain Syndrome (CRPS) and got to the point of what I called, ‘no return’.  Meaning my pain management doctor and other doctors had nothing more to offer me other than a Spinal Cord Stimulator or that is all they knew to offer me shall we say, so I moved forward with it (having a Spinal Cord Stimulator implanted) back in 2010.  In hind sight I will state that it was the worst mistake that I made in the treatment of my condition and this is why.  This is a look at what I wrote to a physician doing a study on spinal cord stimulators in 2011 after I had a very successful trial!

 

I currently have a Medtronic SCS it was implanted early 2010 and I ended up having swelling in my Lt (affected) foot/ankle every time I would charge the “re-chargeable battery”. No one at Medtronic could figure out the issue. I turned into their “human lab rat”. After several months of this I was told to switch from a rechargeable battery to a non-rechargeable battery. Thus another operation… which I did. After this surgery (I have a paddle with 16 electrodes) all 8 electrodes on the Lt side that used to supply stimulation to my Lt foot/ankle now hit my pelvic area – thus I can no longer utilize these electrodes. And out of the 8 electrodes on the Rt 2 are providing stimulation to my Lt foot and the other 6 are hitting the wrong areas. In addition to this I have had continual instances where I am getting a very sharp pain/ sharp twinge (like a jolt) around where the electrodes area. When this happens if I turn off the SCS the pain immediately stops. I’ve been on a conference call with a Senior Engineer of Medtronic and a local Rep in person with me to do reprogramming… The Engineer only wanted to know if the electrodes were putting out stimulation. He didn’t want to know what the amperage was at before I could feel it or in what part of the body the stimulation was felt. These should have been critical pieces of information. All he wanted to state was that the electrodes were working. As for the Sharp Pain / Sharp Twinges that continue to occur in the electrode area their Senior Engineer has no idea what is causing this. He asked me to run an experiment the next time it happened – I did exactly what he wanted and reported back the findings. I have yet to hear back from Medtronic. They do not want to back up their product and they are not willing to admit that there is a problem. Although I have 2 doctors including a Neurosurgeon that feel there is some type of fault in their product or that it is faulty. Hopefully this gives you some additional information you were seeking. Please feel free to email me if you would like to discuss further. I am continuing my uphill battle with Medtronic.

I have spoken with Medtronic as recently as yesterday and they cannot explain the continual sharp pain/sharp twinge that I continue to get where the paddle that holds the electrodes is placed. The “Patient Relations Rep” that has been assigned to me, (at one point she tried to tell me she was from their “Legal Department” and she was later introduced by a team member as a “Patient Relations Representative”), doesn’t feel this is a big issue. She told me yesterday that this is “just medicine” and sometime they can get it right and other times it just doesn’t work out… The Senior Engineer at their company cannot figure out what the problem is, so he just wants to reset the “INS”. I asked exactly what the “INS” was and the Patient Relations Rep couldn’t answer that question. I have already had my system reset numerous times (too many to count) and reprogrammed numerous times.

The trial was approximately $25,000; the hospital expenses alone and cost for the SCS implant were over $150,000 and the secondary surgery to replace the rechargeable battery with a non-rechargeable battery was approximately $53,000. This is all for a system the now has 2 out of 16 electrodes that hit the correct area, creates an intermittent sharp pain/sharp twinge in the spinal area where the electrodes/paddle is placed, and they aren’t sure how to resolve this issue. But I was told yesterday that their system was working properly by their rep.”

 

Here is what happened after the above referenced correspondence / issues:

 

I did have the Medtronic SCS explanted. Medtronic could NEVER explain why their unit was having issues and I even released it to their lab for processing.

My pain management doctor, neurologist and neurosurgeon all told me they had nothing more to offer me accept to try a different type of SCS, so I was convinced to have a ‘Boston Scientific’ SCS implanted as a replacement. This was the end of 2011.  This particular SCS was only in for a couple of months and I began to have issues with the stimulation that was being delivered. I had their top reps working with me. I also had some other odd sensations happening that I was very aware of. Thus, I had my Neurosurgeon do some searching online to see if there were any write-up on scar tissue build up due to ‘Spinal Cord Stimulators’.  The reason we looked into this area was because I kept loosing signal strength and the ability to control the stimulation. He had never heard of any issues and had never seen any literature on this problem, but he was willing to do the research. I knew I was in trouble when I received a person email back from my Neurosurgeon within 24 hours of my request for information… He found 2 articles in medical journals about scar tissue from Spinal Cord Stimulators causing paralysis in patients. We then did what imaging we could do as no MRI was possible with a SCS. We found that I was within this category after just a few months!

Please keep in mind that the surgery to input the SCS(s) in my back also caused my CRPS to move into my back. This was a huge issue for me. Now on top of that I had to go through yet another surgery to have the SCS removed immediately to prevent paralysis from my waist down.

I was never told about any possibility of build-up of scar tissue around my Dura. I was never told about a possible complication of paralysis. I asked if I needed to be concerned about my CRPS moving into my back with the implant of the SCS and I was told, “NO”… Yet, it happened.

I personally sent in information to the FDA regarding my case with the SCS(s), my Neurosurgeon wrote up a case study on me (with my permission), my Neurologist submitted a report to the FDA regarding my issues with both Medtronic and Boston Scientific and we all tried to do our part to get the information out there.

As a patient, if you have issues like this happen to you, you need to be willing to report it so that others can be aware of it. Otherwise the DME companies (i.e. Medtronic, Boston Scientific, etc…) will not release the information unless they are pressured.

Now you may be saying that this is just one patient and this is just a fluke.  No, it isn’t.  Look at the statistics that are just starting to come out.  The interesting thing is that I have spoken with my own pain management doctor recently about the use of ‘Spinal Cord Stimulators and to inquire about his outlook on them since he went through this with me.  My pain management doctor is also a professor at well-known medical university in Southern Californian in addition to having his own practice.  Our recent conversation has outlaid several things in his opinion.  First of all he feels many pain management doctors and/or surgeons or pushing the spinal cord stimulators as they are, ‘quick and easy’ in their eyes.  He feels that the physicians need to be very selective with the patients and it is the physicians’ responsibility to know the possible outcomes (i.e. side effects of the implantation of a foreign device in your body) and not just the possible complications from a basic surgery.

Where are the five year studies that show benefit?  Even with no complications, how long do they continue to relieve pain?  Electrodes move and/or they malfunction. There is little to no federal investment in medications that relieve pain, but these devices are garnering sales of $1.5 billion annually without showing lasting benefit. This is a very big source or income for pain specialists, but what is the gain for patients?  How can we weigh the pros and cons of this money generating device?

So many of chronic pain patients that have failed to get better after basic therapies and trying just a small regiment of medications are given only one choice by their pain management doctors:  spinal cord stimulator.  One choice.  This is a very big business, but where is the five year data?

This is very unfortunate, because physicians and the manufacturers are giving the patients false hope.  They tell the patients that the Spinal Cord Stimulator will help stop their pain.  They never discuss the fact that the CRPS/RSD can move into the back with the implant or surgery.  They never talk about what happens when they can’t get the coverage with the stimulation that they hoped for.  This means that the patient does not get as much relief as previously thought.  They never talk about the fact that this is not a way to get rid of 100% of the pain.  At best it will knock it down by 40% or maybe a bit more, but the longer you have the SCS in those figures go down due to the build-up of scar tissue.

Yes, there are some success stories out there with the SCS or they would not be utilized, but it is critical for every patient to know all of the information prior to making this decision.

At what point will the physician open up their thinking to allow their patients access to additional options for pain management?  There are different options available now!  The more informed the physicians are the better off their patients will be when it comes to their conditions, their health and their outcomes.

If you would like information of alternative treatments for chronic pain, CRPS/RSD, fibromyalgia, cancer pain, PTSD, stress/anxiety reduction or insomnia please contact Traci at Advanced Pathways Hypnosis.  Call today to set up a FREE consultation:

714.717.6633 | Traci@AdvancedPathways.com   |   http://www.AdvancedPathways.com