Neuropathic Pain Due to Avulsion of C -C Nerve Roots: A Successful Integrative Approach by 5 7 Acupuncture, Trigger Point Injection and Hypnosis

Neuropathic pain is one of the major challenges in clinical practice, the pharmacological treatment of which is far below the expectations. We report on a case with persistent shoulder and arm pain following avulsion of C5-C7 nerve roots despite pharmacological therapy (oxycodone 20 mg and pregabalin 225 mg daily, plus ketorolac 10 mg as needed). The clinical examination disclosed the co-occurrence of myofascial trigger-points, suggesting a twofold origin of pain and the need for treating both of them. Therefore, the patient was submitted to 10 sessions of acupuncture plus trigger point injection with lidocaine and steroids, followed by three sessions of hypnosis. At 12 months follow-up the patient reported a relevant decrease of pain (VAS decrease from 7 plus frequent paroxysm at 10 to 4 plus 1-2 paroxysm/month at 7) that allowed him to withdraw the pharmacological therapy. Our results, though based on a single case, suggest the potential benefits of hypnosis in neuropathic pain and the need of a careful differential diagnosis of pain mechanisms actually involved, in order to properly guide an integrative approach.