End The Agony Of De-Feet

Peripheral nerve stimulation implant alleviates neuropathy pain.

Charles Thompson began his career in the food service industry at a young age. After dropping out of school, Charles went looking for a job. He found one washing dishes at a New York City restaurant. At one point, Charles went from dishwasher to restaurant manager, but his first love was the kitchen.

“I learned how to cook on the job,” shares Charles, now 61. “I worked as a cook at Rockefeller Center in New York for about 20 years.”

One day, while he was on his way to work in the fall of 1996, Charles was severely injured in a bus accident. The incident altered his future, bringing an end to his career and his life without pain.

“I was going to work at Rockefeller Center,” Charles recounts. “The bus driver was speeding, and I was bounced and tossed around in the back of the bus. A seat cushion came loose, and something hard hit me in my lower back. I couldn’t go back to work because of the injury, so I’m now on disability.”

Unable to work, Charles eventually relocated to his favorite vacation spot in Florida: St. Augustine, where he became heavily involved with his church, Tabernacle Missionary Baptist.

His back injury, however, often interfered with his activities at church and elsewhere.

“The pain was severe,” he reports. “It ran from my back down my left leg, and on a scale of one to 10, it was a seven or eight. In 2019, my primary care doctor sent me to Dr. McGreevy to take a look and see if he could help me.”

During a thorough evaluation that included an MRI review, Dr. McGreevy discovered that Charles’ pain was being caused by a herniated disc in his lumbar spine that was contacting a nearby nerve root. To ease that pain, Dr. McGreevy initially treated Charles with epidural injections and other modalities.

“The injections helped a lot,” Charles confirms. “I wasn’t experiencing any pain, so I was feeling much better. Then, while driving on New Year’s Eve, I was rear-ended. It knocked everything Dr. McGreevy had fixed out of place, and I started feeling pain again.

“This time, the pain went down my leg and into my left foot. I had tingling and numbness in that foot and couldn’t walk for long periods of time because of it. I would do a little walking, but I’d eventually start dragging my left foot because it hurt so bad. It got so bad that I had to use a wheelchair to get around in stores and other places because the injections weren’t doing anything for my foot pain.”

As 2020 moved forward, Charles became increasingly miserable due to the pain in his left foot. He exhausted all conservative measures, including several courses of physical therapy.

Ultimately, Charles turned back to Dr. McGreevy for help.

Dr. McGreevy determined that the cause of Charles’ crippling left foot pain was neuropathy. A condition that affects more than 20 million Americans, neuropathy results from damage to the peripheral nerves that run from the central nervous system – the brain and spinal cord – to the rest of the body. As Charles learned, the most common symptoms are numbness, prickling and tingling in the feet or hands.

Nerve Entrapment

Charles’ peripheral nerve stimulator has him out of the wheelchair and walking again.

There are many potential causes for neuropathy, Dr. McGreevy asserts, including diabetes, vascular problems and trauma. In Charles’ case, Dr. McGreevy performed a diagnostic ultrasound and identified the source as nerve entrapment of the superficial peroneal nerve, which supplies the top surface of the foot.

“This nerve entrapment was mimicking Charles’ low back pain pattern, causing pain down his leg and neuropathy in his foot,” Dr. McGreevy confirms. “Charles had some risk factors for vascular disease as well, so we ran several tests to rule out specific blood flow issues into his lower extremity. Those tests turned out normal.”

Dr. McGreevy elected to perform a diagnostic nerve block to confirm that the pain arose from the superficial peroneal nerve entrapment. Charles received significant pain relief from the nerve block. Nerve blocks are temporary, however, so in an effort to alleviate Charles’ pain over the long term, Dr. McGreevy recommended peripheral nerve stimulation.

 

No Signals, No Sensation

Similar to spinal cord stimulation, peripheral nerve stimulation involves the placement of a small electrode near the nerve targeted for treatment. The electrode is placed underneath the skin within a few millimeters of the nerve.

“When turned on, the electrode delivers pulses of high-frequency electrical stimulation that essentially halts the pain signals in the nerve and prevents the signals from traveling toward the spinal cord and up to the brain,” Dr. McGreevy explains. “If there’re no pain signals, there’s no pain sensation.”

Unlike spinal cord stimulation, peripheral nerve stimulation does not require a battery implanted near the hip. The technology is so sophisticated that the workings of electrical stimulation are inherent within the lead placed inside the leg.

“There is an external, wearable antenna assembly, which is very soft and easy to hide under the clothes,” Dr. McGreevy explains. “This powers the stimulator beneath the skin. It powers the receiver, which is made of a very fine material and is located within the electrode itself.”

The peripheral nerve stimulator is controlled by the patient using a handheld remote. This signals the external antenna assembly to send electrical pulses through the implanted electrode to the targeted peripheral nerve to block pain signals.

“Before the peripheral nerve stimulator is implanted, patients are given a trial run to determine if they will experience significant pain relief with an implanted electrode,” Dr. McGreevy informs. “A stimulator trial is considered successful if patients report at least 50 percent pain relief.

“Charles received greater than 80 percent pain relief and was enthusiastic about finally getting a permanent solution to his pain problem. We proceeded with the implantation and he experienced greater than 80 percent relief from the permanent stimulator as well.”

“It’s Working Great”

Charles’ peripheral nerve stimulator was a huge success.

“It’s working great,” he reports. “Where my pain level used to be a seven or eight, it’s now a two or three, so I can do a lot of things without feeling any pain in my foot. Most importantly, I can walk, so I don’t need to use the wheelchair to get around anymore.

“The overall procedure and being at the surgery center were great, too. I had a wonderful experience. The staff checked on me regularly to see if I needed anything. They treated me well. They were all concerned about how I felt.”
Charles also has good things to say about the neurologist.

“Dr. McGreevy is a phenomenal doctor,” he raves. “He did a wonderful job. He broke down everything for me. He told me step-by-step what’s going to happen and what to look for. And he was encouraging. He told me, I’m going to take care of you. I’m going to take care of your left foot so you’ll be able to walk without severe pain.

“He’s a great doctor, and he got me up and running again. I wouldn’t go anywhere else.”

© FHCN article by Patti DiPanfilo. Photo by Jordan Pysz. mkb
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