title: The management of intractable pain with adjuvant pulsed electromagnetic field therapy.
abstract: This case describes a 51-year-old woman who reported experiencing severe, constant pain, diffusely located in the region of her right mandible neck (primarily involving the mandible, lower right molars, the neck, the upper back, and the shoulder) during the course of several years. Surgical interventions (root canal, spinal fusion) were performed to address potential sources of pain. Despite these interventions, the patient reported severe pain after both surgeries, which persisted beyond the acute postoperative period. Additional pharmacological interventions and physical therapy were also attempted; nonetheless, the patient reported that pain remained severe and constant for approximately 2 years. On the basis of the patient's poor response to conventional treatments, a novel approach of botulinum toxin (BTX) injections was initiated. When pulsed electromagnetic field therapy was added, the need for BTX injections decreased, with the patient reporting a noticeable decrease in pain intensity and an improvement in quality of life measures. Currently, the patient continues to use pulsed electromagnetic field therapy regularly for pain management, which has allowed her to reduce the use of other interventions and avoid continued use of narcotic medications. Considering the need for multifaceted pain management approaches in the treatment of chronic pain, this case is relevant for wound care practitioners attending to patients with chronic postincisional wound pain because the outcome highlights the utility of a nonpharmacological, complementary pain management intervention for closed, yet persistently painful, postoperative wounds.
authors.affiliation: Jeffrey A. Niezgoda, MD, FACHM, MAPWCA, CHWS, is Associate Professor at the Medical College of Wisconsin, Milwaukee, Wisconsin. Scott T. Hardin, MD, is Medical Director of Rehabilitation Services at the Aurora St. Luke's Medical Center, Milwaukee, Wisconsin. Nicole Kubat, PhD, is an Independent Contract Consultant for Regenesis Biomedical, Inc, Scottsdale, Arizona. Jocelyn Acompanado, PA-C, is a Physician's Assistant in the Department of Rehabilitation Services at the Aurora St. Luke's Medical Center, Milwaukee, Wisconsin.
authors.forename: Jeffrey A
authors.initials: JA
authors.lastname: Niezgoda
authors.forename: Scott T
authors.initials: ST
authors.lastname: Hardin
authors.forename: Nicole
authors.initials: N
authors.lastname: Kubat
authors.forename: Jocelyn
authors.initials: J
authors.lastname: Acompanado
mesh_terms: D000203:Activities of Daily Living; D019274:Botulinum Toxins, Type A / Q000627:therapeutic use; D003131:Combined Modality Therapy; D005260:Female; D006801:Humans; D055909:Magnetic Field Therapy / Q000295:instrumentation / Q000379:methods*; D008875:Middle Aged; D059408:Pain Management; D010148:Intractable Pain / Q000188:drug therapy / Q000628:therapy*; D011788:Quality of Life
chemical_list: D019274:Botulinum Toxins, Type A