Anne-Sophie Foghsgaard had originally suffered from a perforated appendix which was subsequently removed. The laparotomy wound was left open before being closed in her home country of Denmark. This was a few years previous to her first appointment with Dr Platt.

Anne-Sophie was referred to Dr Mike Platt, (Pain Specialist at St Marys Hospital, Imperial College Trust, London UK) by Gastroenterologist who could find no reason for her widespread CRPS (Complex Regional Pain Syndrome) of the Abdomen. When Dr Platt first saw Anne-Sophie as an outpatient he noted that she had "a widespread area of allodynia in the abdominal region, particularly epigastric, extending down to the right illiac fossa". The pain was constant and exacerbated by her clothes or after eating. Dr Platt performed RF (radio frequency) therapy to the right Ileoinguinal nerve and trigger points. Dr Platt noted that this therapy offered "some relief" but that additional use of Lignocaine patches was required. Also, the relief was short lived and not particularly marked.

Dr Platt performed Pulsed RF ablation to the greater splanchnic nerve, again offering some improvement but the patient still required an indwelling epidural as an inpatient to gain even moderate pain relief.

Despite the prescription of various drugs including, Pregabalin, Sodium Valproate, Amitriptylline & Lidocaine 5% patches, Anne-Sophie’s pain relief was only moderate.

Dr Platt performed PENS therapy on Anne-Sophie, a minimally invasive diagnostic therapy, which enables the physician to determine whether a patient is likely to benefit from an implanted stimulation device, although for some patients it may also provide ongoing pain management, thereby avoiding the need for more invasive therapies, with their attendant risks. There are also patients for whom an implanted device is not appropriate and in these cases PENS therapy offers an alternative where other less invasive or pharmacological modalities have failed.To ensure sufficient coverage of the areas of greatest pain, the region of pain was first mapped out and then the points where the probes were to be placed were marked. A 100mm probe was inserted at a depth of approximately 5mm and PENS therapy commenced on "Program C" - an automated algorithym which alternates the frequencies at low voltage for a period of 25 minutes. Although Anne-Sophie could feel a "pulsating" sensation, she felt no pain throughout the procedure. After 25 minutes the probe was removed and the process repeated on the other side of her abdomen.

In the days after treatment Anne-Sophie reported very positive results with VAS scores significantly reduced. At one month Anne-Sophie e-mailed to say - "All is fine. Outer stomach doing super well-, inner getting quite sore but that had nothing to do with you zapping of outer tummy. Sounds strange but I also think the scar tissue bulge has gone down".

Allodynia of the abdomen treated with PENS Therapy

PERCUTANEOUS ELECTRICAL NERVE STIMULATION (PENS) THERAPY FOR REFRACTORY PRIMARY HEADACHE DISORDERS

Trigemino-Cervical Neuropathic Pain Relieved by Serially Repeated Peripheral Nerve Field Stimulation

Dr Michael Vagg presents PENS at INS Perth

Susan Daniels