Managing Severe Nerve Pain After Complex Pelvic and Foot Injuries

Explosive neuropathic pain?

Hello, Doctor.
Last August, I had an accidental fall from a height resulting in a complex pelvic fracture and crush fractures in both feet.
The sensation in my left foot is abnormal; it feels like there are two wires underneath my shoe, and the nerve pain is unbearable.
My attending physician said I could stand, but five months later, I am still bedridden, taking three strong painkillers and several neuropathic pain medications daily, yet they are ineffective.
I constantly feel electrical sensations.
I would like to ask the doctor:
1.
The complex pelvic fracture is extremely painful, and I have a severe foreign body sensation that makes it impossible to lie on my stomach.
The doctors say the injury is not too severe, but it has affected my cauda equina.
The doctor mentioned that the injury is at a small location.
Is acupuncture treatment effective? It has been five months, and I still have no sensation in my vagina.
2.
Regarding the nerve pain in my feet due to the crush fractures, is it true that I will have to endure this pain indefinitely? I do core exercises by pressing my feet against the mattress while in bed, but the pain in my left foot is excruciating.
The doctors say I will be able to walk in the future, but it is so painful even while lying in bed.
Is there really a possibility of recovery?
3.
Is hyperbaric oxygen therapy effective? Thank you, Doctor.

Miss Lin, 30~39 year old female. Ask Date: 2023/01/17

Dr. Zhang Junwei reply Neurosurgery

Due to the lack of detailed medical history and examination records, I am unable to provide an answer.
It is recommended to consult a physician in an outpatient setting with the medical records in hand.

Reply Date: 2023/01/17

More Info

Managing severe nerve pain after complex pelvic and foot injuries can be an incredibly challenging experience, especially when the pain persists despite various treatments. Your situation, involving a complex pelvic fracture and crush injuries to both feet, is indeed serious and requires a comprehensive approach to pain management and rehabilitation.

1. Understanding Your Pain: The pain you are experiencing, described as a "shocking" sensation, is likely due to nerve damage or irritation resulting from your injuries. The cauda equina, a bundle of spinal nerves located at the lower end of the spinal cord, can be affected by pelvic injuries, leading to symptoms such as pain, numbness, or loss of function in the lower extremities. This can explain the severe discomfort you are feeling, especially if the injury has impacted the nerve pathways.

2. Acupuncture and Alternative Therapies: Acupuncture may provide some relief for nerve pain. While scientific evidence on its effectiveness varies, many patients report positive outcomes. It is thought to work by stimulating the nervous system and releasing endorphins, which can help alleviate pain. However, it is essential to consult with a qualified practitioner who understands your medical history and current condition.

3. Pain Management Strategies: Given that you are currently on multiple pain medications without satisfactory relief, it may be beneficial to revisit your pain management plan with your healthcare provider. Options may include:
- Adjusting Medications: Sometimes, a combination of medications works better than high doses of a single type. Your doctor might consider adjusting the dosages or trying different classes of medications, such as anticonvulsants (like Lyrica, which you are already taking) or antidepressants that can help with nerve pain.

- Interventional Pain Management: Techniques such as nerve blocks or epidural steroid injections may provide temporary relief and help you engage more effectively in physical therapy.

- Physical Therapy: A tailored physical therapy program can help improve mobility and strength while also addressing pain. Therapists can provide modalities such as TENS (Transcutaneous Electrical Nerve Stimulation), which can help manage pain.

4. Hyperbaric Oxygen Therapy (HBOT): This treatment involves breathing pure oxygen in a pressurized room or chamber. It has been shown to promote healing in certain types of injuries and may help reduce inflammation and improve blood flow to damaged tissues. While some patients report benefits, it is essential to discuss this option with your healthcare provider to determine if it is appropriate for your specific situation.

5. Psychological Support: Chronic pain can take a toll on mental health. Consider seeking support from a psychologist or counselor who specializes in chronic pain management. Cognitive-behavioral therapy (CBT) can be particularly effective in helping patients cope with the emotional aspects of living with chronic pain.

6. Long-term Outlook: Recovery from complex injuries can take time, and while it may feel discouraging, many patients do experience significant improvements over time. Engaging in rehabilitation, maintaining a positive outlook, and actively participating in your recovery plan can make a difference.

In summary, managing severe nerve pain after complex pelvic and foot injuries requires a multifaceted approach. It is crucial to work closely with your healthcare team to explore all available options, including medication adjustments, physical therapy, alternative therapies like acupuncture, and possibly interventional pain management techniques. Remember, recovery is a journey, and seeking support from both medical professionals and mental health resources can be invaluable.

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