I saw a 60 year old lady in the Pain Clinic with all over body pain, including pain in the neck, hip, leg, shoulders and lower back.
On examination, she had a number of trigger points on her back. There was also a reduction on internal and external rotation, and flexion and extension of her hip joints. Both hip joints were painful on palpation.
In the first instance, she was not keen on taking medication and opted for a course of 6 acupuncture treatments. She had these at 1-2 weekly intervals. At the end of her acupuncture treatment, she found that her sleep had improved and her pain had improved.
She had previously been taking Amitriptyline 25 mg nocte and she decided to stop this. However, after approximately one month, she found the pain was starting to return and she decided to go for a medication option. She was started on Gabapentin 300 mg three times a day. This was titrated up to 500 mg three times a day but unfortunately, she got a number of adverse effects including tiredness, feeling dizzy and with a lack of energy. The dose was therefore reduced back down to 400 mg three times a day.
Two months later, she found that her pain was worsening once again and was not keen to increase the dosage of medication. The next step was to perform injections of local anaesthetic and steroid into the trigger points. This was done on an outpatient basis using aseptic technique with gloves, gown and Chlorhexidine. A total of 20 trigger points in the back, neck and shoulders were injected with approximately 1 ml of solution to a total of 20 mls of 0.5% Bupivacaine, local anaesthetic and 80 mg of Depo-Medrone steroid.
She was reviewed 2 months later following this and she reported that she had a great benefit with the wet needling, with a dramatic reduction in her pain scores. She was now only taking Gabapentin 300 mg at night which she had arranged for herself. We agreed to discharge her from the clinic and see her again should her symptoms return.