A 33 year old gentleman was seen in the Pain Clinic today. A year earlier, he was working as a builder and fell from a roof, approximately 40 feet. He sustained multiple injuries, particularly to the left side of his chest and ended up in an Intensive Care Unit for 2 weeks. His injuries included puncturing his lung, fracturing 5 ribs and having blood clots in and around the substance of the lung.
He complained of an average pain score of 10/10 and the pain was constant. He had tried Paracetamol, Ibuprofen, Diclofenac, Co-codamol and Co-dydramol which were of no help.
On presentation at the Pain Clinic, on examination it was noted that on the left side of his body, below the line of the nipple on the left, both anteriorally and posteriorally, there was marked pain from light touch (allodynia) and extreme pain from a painful stimulus (hyperalgesia). Chest drain scars were also noted. The patient was also complaining of severe electric shock-like pains throughout the chest and a diagnosis of neuropathic pain, secondary to trauma was made, particularly affecting the inter-costal nerves on the left side of the chest from T5-T12.
The gentleman was started on a Gabapentin titration pack, followed by a course of Gabapentin 600 mg t.d.s. He found that the pain subsided dramatically with this. He is due to continue on the Gabapentin for approximately 3-4 weeks. After this time, the plan is to gently reduce his dose and hopefully stop it.