Naturepulse™ Therapy in Failed Back Surgery Syndrome (FBSS)

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INTRODUCTION

Failed back surgery syndrome, (FBSS), is a secondary, persistent or recurrent chronic pain after one or more surgical procedures to the lumbosacral spine. Commonly it is referred  to as FBSS, like a persistent fixed pain, often localized to the lower limbs, sciatica, caused by an insufficient functioning of the spine. The phenomenon manifests itself in a variety of cases affecting upto 50% of surgical procedures for herniated discs.

CLINICAL HISTORY

A 53-year-old woman came to our attention with recurring lumbosacral pain, from obvious spinal origin, that radiated from the spine to the inferior limbs, mostly to the right one. The patient reported having had a discectomy, approximately two years before the present algological visit was performed. She was under a rehabilitation programme for a year post operatively, because she had serious functional restriction in moving and ambulation. The secondary consequence of these serious painful symptoms, in the lumbosacral spine and the lower limbs, severely limited autonomy, quality of life and emotional wellbeing of the patient. The pain was not relieved with conventional analgesic treatments. The level of pain intensity was equal to a VAS score of 7, at rest, in the visual analogical scale, from 0=no pain to 10= insupportable pain. Characteristically the pain was chronic, continuous, dormant, dull, burdening, but with acute episodes which correlated to physical activity.

TREATMENT

The conservative treatment via analgesics in patients with FBSS is currently difficult and a possible challenge with methodologies and drugs at the disposal of doctors. The therapeutic approach must be multidisciplinary and aimed at the interruption of the mechanisms responsible for the chronic pain. In this case light opioid was prescribed to the patient, Tramadol, 100mg every eight hours, in slow release tablets, an antiepileptic, Gabapentin, in doses up to 2400 mg/day, and a tricyclic antidepressant, 10mg in the evening.

After being informed and with prior agreement, we suggested to the patient to undergo two complete treatments Naturepulse™  the following month, including 20 sessions of approximately 20 minutes each, 5 days a week, administered in a clinic. The therapy was made up of 3 components to stimulate the relevant area, performed in sequence and called "decontracting", "antiphlogistic", and "microcircle". The positive surface electrodes (red) were positioned at the level,corresponding to the root of the , L5-S1, while the negative ones (black) were placed about 10-15 cm away, to enclose an area of at least equal to the area in pain on the surface. The patient was required to indicate to the examiner the threshold level of stimulation, when the feeling of the paresthesia was pleasant and relaxing. When it was felt a reduction in the intensity of the impulse occured, after a few minutes at the beginning of the procedure, the level of stimulation was increased, until the patient stated that she had reached the previous level of feeling. 

OUTCOME

The patient was carefully observed for the whole period of treatment, 30 days, recording in the case folder the change in VAS score (T0-T1). It was considered a therapeutic success and a reliable decrease in this parameter by at least 50% at follow-up. We recorded in the case folder the final base serum values (T0-T1) of the VEGF, according to the method reported above. We used a 5 point scale, from the first visit, evaluating the muscular strength and the range of movement (ROM), to recommend again at the end of the therapeutic sessions electroanalgesis (T0-T1). We questioned further the patient about the main factors affecting the quality of life, repeating the detailed analysis at T0 and T1. These were the quality of sleep in terms of hours of sleep at night, the level of mood, assessing the grade of satisfaction relative to the treatment. All the functional levels observed had significant improvement, in 1 month.

CONCLUSIONS

The clinical case reported above shows an effective and safe new treatment method, Naturepulse™, allowing us to achieve positive results, analgesia and functional rehabilitation in difficult cases known as failed back surgery syndrome (FBSS).

 

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