Overcoming Severe Neuropathic Pain with Physical Therapy
Daily activities, e.g., standing, walking, and putting on shoes, are second nature for most people. However, for Mr. Arnav, these everyday tasks were accompanied by severe neuropathic pain. Even the strongest pain medications failed to provide relief.
Abnormal Gait Since Childhood Due to Spondylolisthesis
“Ever since I was young, I walked a bit differently. My back also seemed to have some issues, and my posture wasn’t quite right,” said Mr. Arnav Manish Nambiar as he described the beginning of his long struggle with pain. He had an abnormal gait since childhood, and as he grew older, his friends noticed an unusual curvature in his back, which prompted him to seek medical evaluation, which ultimately led to a diagnosis of spondylolisthesis.
Classification of Spondylolisthesis
Spondylolisthesis can be classified into grades (Grade I–IV) to indicate the severity of the condition.
- Low-grade spondylolisthesis (Grade I and Grade II): This is the most common form of the condition. It is prevalent in adolescents with lower spinal vertebral slippage or in adults due to age-related degeneration. Symptoms are usually mild and are often manageable with non-surgical means.
- High-grade spondylolisthesis (Grade III and Grade IV): These cases often require surgical treatment, particularly when severe pain or other symptoms significantly interfere with daily life.
Initially, Mr. Arnav’s condition was a Grade I spondylolisthesis, and the doctor who treated him at the time advised that physical therapy would be sufficient. However, as time passed, subsequent MRI examinations showed that abnormalities of his lower spine had progressed to Grade III. Most of his pain was in the lower back. Sitting for prolonged periods would trigger significant discomfort, and if he missed his morning exercise routine, the pain would persist throughout the entire day. As the condition increasingly interfered with his daily life, surgery eventually became necessary. Mr. Arnav’s parents were deeply concerned about the risks of spinal surgery. If something went wrong, the consequences would impact the rest of his life.
Postoperative Neuropathic Pain: Even Walking Was Painful.
Dr. Pheeravut Tantisuvanitchkul, a specialist in Physical Medicine and Rehabilitation at MedPark Hospital, recounted his first encounter with Mr. Arnav: “The patient came to us with severe pain in both feet. He described the pain as a burning sensation, similar to electric shocks. He could barely place his feet on the ground and was unable to wear socks or shoes.”
This condition is known as “neuropathic pain,” which occurs when nerves become damaged or inflamed. As a result, the nerves transmit pain signals to the brain instead of normal sensory signals. The pain can progressively worsen and may not resolve on its own. Without proper treatment, the condition can become increasingly severe and may also lead to emotional and psychological effects such as anxiety and depression.
Clinical Symptoms Associated with Neuropathic Pain
Spontaneous pain includes burning sensations, sharp shooting pain, electric shock–like, or pins and needles sensations on the skin.
- Allodynia is a condition in which stimuli that do not normally cause pain, such as cold temperatures, pressure, or light touch, become painful due to high sensitivity to touch.
- Hyperalgesia: An exaggerated pain response to stimuli that would normally cause only mild discomfort. For example, a small pinprick may feel far more painful than expected.
- Hypoalgesia: Reduced sensitivity to pain. For example, a pinprick that would normally cause some pain may barely register at all.
- Dysesthesia: Abnormal sensations often described as creepy or unexpectedly painful.
- Insomnia: Difficulty sleeping, which may be associated with emotional stress from persistent neuropathy.
“At that time, the nerve pain was unbearable. It lasted for days, and I cried throughout the night despite taking the strongest painkillers available,” recalled Mr. Arnav as he described what he went through after surgery. Dr. Pheeravut knew the patient and his family's primary concern was the pain. Therefore, his priority was to help relieve the pain as quickly as possible.
Relieving Pain Through Occupational Therapy
Occupational therapy is a field focusing on helping patients who experience physical, sensory, cognitive, or emotional challenges through therapeutic activities and assistive devices. The goal is to help patients regain independence and return to daily life with greater self-reliance. In Mr. Arnav’s case, therapy began with sensory stimulation exercises, such as gently stroking the skin with a soft sponge and gradually progressing to firmer materials, such as brushes. Although the process was painful initially, continuous therapy helped the nerves and brain relearn that these sensations were normal. Over time, the pain gradually abates.
Peripheral Magnetic Stimulation (PMS)
In addition to occupational therapy, Dr. Peerawut also considered peripheral magnetic stimulation (PMS) as part of Mr. Arnav’s treatment plan. This modality is known to help reduce inflammation and alleviate neuropathic pain. PMS also supports the restoration of impaired nervous system function by promoting neuroplasticity, enabling the nervous system to adapt and reorganize. This process helps correct abnormal sensory processing and restore more normal function, ultimately contributing to the reduction of chronic pain.
Physical Therapy: A Journey of Hope Overcoming Pain
Mr. Arnav shared his experience recovering from neuropathic pain at MedPark Hospital: “I enjoyed hydrotherapy the most. It helped me a lot, especially when the nerve pain was at its worst.” In addition to physical and occupational therapy, MedPark Hospital offers hydrotherapy, which has become an important part of his rehabilitation journey.
“Since birth, he has never walked like other people. But now, for the first time, I saw him walk with balance and stability. It means so much to me because he loves walking and exercising,” said Arnav’s mother, expressing the overwhelming emotions she felt when she saw her son finally able to walk steadily and return to a normal life once again.