T12-L3 midline allodynia; ideas?

[Ligament]

56 y/o F who had mild T12 compression fx 20 years ago.

Has had midline, neuropathic appearing pain along the T12-L3 spinous processes ever since. Allodynic to light touch and vibration in the spine midline. Had good relief for a few weeks after T12-L1 interspinous ligament injection, otherwise ESIs and MBBs in the area have been non effective.

Recent CT, SPECT and MRI all WNL, nothing showing up.

My thought is that it is interspinous ligament entheospathy or neuropathic pain from the medial branches at multiple levels.

I'm thinking a Qutenza patch (jesus I hate obtaining this medication). Ideas?

---

Members don't see this ad.

 

[DODOCSS]

Botox

 

[clubdeac]

Sounds like a good candidate for elavil, pamelor, cymblata, savella, fetzima, lyrica

 

[Ligament]

Thanks guys. Botox sounds like a good thing to try. She's not too interested in oral meds but will run these by her again.

 

[Dr. Ice]

She would pay cash for the Botox?

 

[Ducttape]

Baastrups disease?


Sent from my iPhone using SDN mobile

 

[Ligament]

Baastrups disease?


Sent from my iPhone using SDN mobile

Thats a great idea but I'd think something would show on MR or SPECT? Certainly could Baastrups

 

[Timeoutofmind]

Thats a great idea but I'd think something would show on MR or SPECT? Certainly could Baastrups

Look at the MRI yourself. Have had it missed before and then called on later scans by a different radiologist

 

[BobBarker]

I send all of these female midback pains for PT/dry needling. Probably 90% plus improve. The PT office has good therapeutic energy and they give free t shirts and coozies. That probably helps as much as the needles.

 

[Ligament]

To be clear it is allodynia to very light touch over the exact midline, no significant pressure.

 

[lobelsteve]

Lido, dmso, zostrix.

 

[thecentral09]

What is the ongoing consensus regarding Baastrups. It seems as if I have seen patients with middling pain and MRI evidence of Baastrups, but also patients with only radicular pain without any axial or midline pain with even worse MRI evidence of Baastrups. Do you think it causes pain, if so, do you think it is the main ingredient in many of our patients with axial pain?

 

[bedrock]

56 y/o F who had mild T12 compression fx 20 years ago.

Has had midline, neuropathic appearing pain along the T12-L3 spinous processes ever since. Allodynic to light touch and vibration in the spine midline. Had good relief for a few weeks after T12-L1 interspinous ligament injection, otherwise ESIs and MBBs in the area have been non effective.

Recent CT, SPECT and MRI all WNL, nothing showing up.

My thought is that it is interspinous ligament entheospathy or neuropathic pain from the medial branches at multiple levels.

I'm thinking a Qutenza patch (jesus I hate obtaining this medication). Ideas?

Why not just a lidocaine patch?

 

[Ligament]

Why not just a lidocaine patch?

Great idea but tried and failed long ago.

 

[j4pac]

I've seen Baclofen work twice with an n=2.

 

[Ducttape]

What is the ongoing consensus regarding Baastrups. It seems as if I have seen patients with middling pain and MRI evidence of Baastrups, but also patients with only radicular pain without any axial or midline pain with even worse MRI evidence of Baastrups. Do you think it causes pain, if so, do you think it is the main ingredient in many of our patients with axial pain?

I believe the "proof" of diagnosis of Baastrups is clinical.

radiologic evidence in this case supports but is not inclusive itself in diagnosis. so axial pain with extension, gone with flexion, no radicular symptoms.

 

[Timeoutofmind]

I believe the "proof" of diagnosis of Baastrups is clinical.

radiologic evidence in this case supports but is not inclusive itself in diagnosis. so axial pain with extension, gone with flexion, no radicular symptoms.

I have a lady lined up for interspinous ligament inj later this week. Have not done before...seems easy. Any pearls? What is your usual approach...straight AP direction with the needle in the midline?

 

[lobelsteve]

I've seen Baclofen work twice with an n=2.

100% success rate, no reason not to do this.

 

[Tapspatellas]

I have a lady lined up for interspinous ligament inj later this week. Have not done before...seems easy. Any pearls? What is your usual approach...straight AP direction with the needle in the midline?

I usually contact edge of SP and walk in between the two, gives me a depth check.

 

[melancholy]

Did you get local anesthetic relief of the allodynia w numbing of skin before the interspinous injection? (Or did it hurt worse). Agree w considering Botox. Is there any temp relief w lidocaine cream? How about a compounded topical ketamine? Does pt seem the type to have central sensitization? How about TPI to most medial paraspinals? Even temp relief and change in allodynia in office would be helpful info. Capsaicin cream? If patient has money and is into alternative medicine, could suggest she find someone that does neural prolotherapy (now known as perineural injection therapy).


Sent from my iPhone using SDN mobile

 

[epidural man]

Topical Ketamine.

try capsaicin if Quetenza is difficult to get.

I like the botox injection idea.

I think there is also some evidence for topical TCA.

Does TENS help?

 

[epidural man]

Just for sh$ts and giggles, try an erector spinea plane block bilateral for some pain relief.