A family agrument led to years of misery for Abigail Morris of Shropshire.
Angered by her brother Abigail took out her emotions on a iron box outside the family home. But rather than quell her fury, it turned out a few swift kicks had broken her toe.
Initially just a little sore, Abigail’s foot soon began to swell and become very painful, leading to a visit to hospital. The resulting X-ray showed a small fracture to the fourth toe. The medical advice was clear; it would heal in a few weeks and Abigail would be back to normal. Abigail recalls: “I broke a toe. No big deal I thought. Give it a few weeks and it’ll heal.”
Unfortunately time was no healer. The pain Abigail was feeling began to get worse, and she began to get strange, excruciating new symptoms. The front half of her foot became more swollen, then changed colour to red, blue and purple. The foot also felt ice cold but began to sweat constantly. The toenails also became more brittle and rigid.
Abigail says: “I lay awake at night for weeks, crying, screaming and in unbearable pain. Unfortunately the days were much the same.”
The pain began to get more severe and was constantly changing; sometimes burning, throbbing, tingling or akin to having a red hot knife stabbed into the foot over and over again. Abigail was visiting her local hospital regularly but, increasingly frustrated by lack of progress, began to research her own condition. In time she was diagnosed with Complex Regional Pain Syndrome (CRPS).
CRPS is only poorly understood. Usually occuring after an often minor injury to a limb, the most common symptom is pain which is more severe and long-lasting pain than would be expected after an injury. Problems can occur with nerves, skin, muscles, blood vessels and bone. It is thought to arise as a result of abnormal nerve healing, but the exact reason remains unknown. Doctors define CRPS into two main types. CRPS type 1 is pain which develops without an identifiable injury to any nerves. CRPS type 2 is pain which develops after injury to a major nerve.
Abigail was unable to continue her work as a gardener, a job she loved. The intense pain left her increasingly withdrawn and unable to socialise.
Abgail found the TENS helped and diligently followed the physiotherapy programmes. Unfortunately nothing eliminated the pain so she was placed on codeine-based painkillers and the epilepsy medicine gabapentin to block sensations from her nerves.
Her condition continued to worsen, leading to ‘mirror syndrome’ where the nerves in her other leg replicated what she was feeling in the damaged foot. By this stage Abigail had been on at least one crutch since the accident, but mirror syndrome meant she was left in a wheelchair.
Abigail comments: “I was starting to become desperate. I told people: I don’t have a good leg to stand on.”
In November 2009, Abigail met Professor Raphael at the Russell Hall Hospital Pain Clinic. He recommended Spinal Cord Stimulation as she had exhausted all other non-invasive treatment options with no success, and had suffered from the condition for such a long time.
Spinal cord stimulation (SCS) works in a similar way to TENS, but the electrical pulses are delivered directly into the spinal cord. The electrical signals work to interrupt the pain signals being sent by Abigail’s damaged nerves. People with SCS often report their pain is replaced by a tingling sensation.
Abigail was warned not to expect too much. She says: I was considered an ideal candidate but right up until I went into theatre, a part of me knew there was a chance it wouldn’t work for me, but I had to try.”
Abigail had the neurostimulator turned on the day after the operation to implant it and believes that the device has helped reduce her pain by 90%. Experts usually look for a 40-70% reduction in pain in patients who have undergone SCS.
Abigail is also aware of the limitations of earlier SCS systems. She says: “The main problem with spinal cord stimulation is adjusting the stimulation when you move. When your body position changes the electrodes can move closer to the spinal column and cause a brief increase in voltage. Although this is painless it can be a shock, but the new device is now learning how to adapt to my movements so that I don’t have to change any settings. I now have settings for different body positions, such as walking, standing, sitting and lying in different positions.
Despite being laid off work shortly after surgery due to the economic situation, Abigail has a new job and is keen to get started, something which would’ve been impossible before her implant.
Abigail is once again able to do many things she used to take for granted; walking, doing her own gardening and household chores, and socialising for the first time in years.
Abigail comments: “I am happy and enjoy getting up each day and seeing what else I can do. I have reduced one of my medications by half and am no longer taking painkillers regularly, which has left me feeling awake instead of under water.
“The spinal cord stimulator has resulted in a higher pain reduction for me than I could ever have hoped for. Yes, spinal surgery is frightening, and like any other surgery there are significant risks, but the pain caused by surgery was merely an irritation for me compared to the chronic pain I experienced every day beforehand.
“Everyone at Russell Hall Hospital has been fantastic and the pain team there have been brilliant. They have given me my personality and my life back. Instead of wondering if it is worth getting out of bed, I now wake up in the morning and think what am I going to do today?”
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