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Pain Case Studies by Caroline Grierson
22 cases of pain patients - most are referrals from the California Pain Medicine Center and RSD Institute at UCLA
These are a collection of (edited) insurance reports I have written on pain patients over the past year. Many of them are Workers Comp patients and are part of an authorized pain program that is why I get insurance coverage and so many sessions. They have various diagnoses. I have written information for the neurofeedback practitioners (in parenthesis). I have included in bold the final protocols and the medications they were on when they left neurofeedback. Occasionally, I have included other protocols used throughout our experience together. Most of these reports are done at 10 or 20 week intervals. All of these patients receive peripheral biofeedback (especially RSA training) and neurofeedback in the same session. Some will go on to Interactive Guided Imagery and/or Alpha/Theta. Most leave the program still in pain but have good life skills and due to neurofeedback are much calmer and manage their pain better. Many of them come back for 5 -10 sessions per year if they have a flare of pain symptoms and become deregulated.
2 or 3 recovered Marked with * Recover*
Not all of them were patients from UCLA
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RSD - Rt arm and shoulder - 38 YOF
* Recover* or at least remission
CAUSE - Someone bent wrist back at work, heard a pop, wrist swelled like a ball
Description Program - Spinal Cord Stimulator, Physical Therapy, then Pilates and Yoga, Psychotherapy (done weekly or bi-weekly all the time, as necessary)
MEDICATIONS - Topomax 75 mgs b.i.d., Neurontin 600 mgs b.i.d., Zoloft 100 mgm. Decreasing gradually. Now off Ultram t.i.d. and Vioxx 25 mgs but uses them if there is a flare. Stimulator is turned off.
PROTOCOLS - 21min. T3-T4 10.5 -13.5Hz (2-7Hz), 9 min. FPO 8-11Hz (2-7Hz) (9 sessions of alpha/theta - ***see notes below for her response)
TOTAL SESSIONS - 35
December 1998
(Injured hand at work several years before. Bent wrist back and developed RSD. Was offered a stimulator previously but had refused. Patient was seen for an NF eval in December. Began n/f training for RSD and poor sleep January for 5 or 6 sessions. Had stimulator placed. Did not return until May. Saw me once. Then returned consistently in September 2000. Always reported good results from the training. Good means feeling calmer and better able to manage pain.)
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December 2000
(Patient) has completed 20 sessions of neurofeedback. During this time (past 14 sessions) she has experienced freedom from pain for up to a week. We have also explored alpha theta training. It is often useful for deeper healing of the trauma caused by pain.
During this past 2 weeks she experienced a flare in her right side after lifting something. She was able to manage it with the stimulator and a slight increase in her medications. This was the first time she had used the stimulator in quite some time. The pain is less now but still reminds her that she has RSD. Her family is having to work through the fact that she will always have "special needs" even though I believe she rarely asks for help or imposes her pain on them.
Because of this increase of pain, her neurofeedback training protocols have again changed and are giving her greater relief and insight. (21min. T3-T4 10.5 -13.5Hz (2-7Hz), 9 min.)
We will continue her training through the New Year and will then report her progress and she will discuss with Dr. Prager any future needs she may have for Neurofeedback.
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February 2001
Patient has completed 33 sessions in this series of neurofeedback. She has made significant progress in her abilities to manage her pain and has grown in her family relationships in spite of the pain. She has had some medication changes but, in general, has decreased the doses of the medications and has been able to manage, quite frequently, with the stimulator turned off. There have been occasional flares with trauma (such as her daughter falling on her, etc.) but each time has been manageable. She is planning to accompany her husband on a work related stay out of the city for several months. She will have the ability to return should she need to have medical care.
In the past 8 sessions the training protocols in the neurotherapy sessions have been again changed, with the most significant results yet. (*See notes below about comparison of A/T with FPO2) This inner healing is integrating very nicely with the work of (psychologist).
She has about 8 sessions left. Because this training has been so valuable, she has requested that she be allowed to continue neurofeedback on an as needed basis. She has even requested the possibility of home training. I can make the details of this available to you should it become an option. She will discuss with (doctors) her future needs for neurofeedback. I recommend that, she be given, at the minimum, 10 or 12 sessions per year in case of future flares.
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***Notes from discussion with patient comparing A/T and FPO
Dx: RSD (Reflex Sympathetic Dystrophy) Right arm and shoulder for 8 years. Probable flare to left hip, leg and foot and face in past 6 months.
Rx: Meds, spinal cord stimulator, psychotherapy, marital counseling, physical therapy, Pilates, massage, homeopathy, 30 sessions of peripheral biofeedback, imagery & NF, including Alpha/Theta - the last 7 sessions with T3 -T4 10.5Hz- 13.5Hz (21 min), and last 8 sessions with FPO 8 -11Hz (9 min).
Past 10 weeks stimulator off (with one week exception) and decreasing meds.
(Note: was intrigued with A/T but went to sleep (way too deep) even with the help of Bill Scott)
Comments starting T3 - T4
Once appropriate frequency established (10.5 - 13.5Hz)
Neck hurts less, hands hurt some, better
Focused brain, not confused, although pain still there, it feels great.
Has peppy quality - perhaps new med.
Comments on FPO began with:
Feels totally focused and quiet in the head - enjoyed it
Muscle tension less and better. Liked it. Good for the RSD.
Wonderful, only pain in face and eye, which is minimal.
More relaxed
Better response if T3 - T4 done first.
Insight one week after session 6 of FPO
Was very “inside” at the end of training and didn’t want to go home. At the next session said she had been considering her experience all week.
“It had been very good. It was ‘clicking’ on a pre-conscious level. Whatever these things are - they are becoming more integrated. It is better than A/T - it (FPO) is more me. There is a band in the center of my head where this affects me. If you divide the head into 3 strips - the back is darker, the middle I can access, (It is easier to access the back from the front, than the back from the back), and the front I can verbalize. It’s like I have to go in the light door (front FPO) not the dark door (back or PZ). It seems like there are different paths to get to the same information. It was like ‘forcing’ to go through A/T. It wasn’t that I didn’t like the information, it was the path to it - the road, the wrong hook-up - like a computer connection when there is the wrong part or the wrong cable – don’t know exactly how to say it.
This (FPO) is more important than the training before. This is like my virtual reality. I want to see it and not have to re-experience it and then come to terms with it, evaluate it and process it.
I didn’t want to go so deep with A/T, it was just the wrong deep. This is the right deep.
I have been ruminating in all 3 slices (front, middle and back of the head). It’s like a sandwich.
I’m more mellow because of it. It has turned down my volume. It had a cognitive effect. It permeates my thinking process. I can consciously try to stop and take a step back, literally and figuratively, and take that breath. In the last week things have ‘jelled’.”
Insight 4 days after session 7 of FPO
“ This has validated my sense of self that has been lost with pain. I couldn’t get this or get around it. It was out of the realm of all my experiences. This (pain) is what I need to learn this time. (this life) What’s next? Where do I go from here? Is there more? The door has been flung wide open. FPO takes me back to childhood experiences - being connected or not connected, accepted or not accepted, inside or out. It gets me right there. I’ve always felt that I had access to a bigger part ( or different area) of my brain than most - I can see things that some don’t “.
October 2001 will be returning - Stimulator was poking out of skin and needed to be replaced. Still was not using it at the time. Surgery triggered RSD.
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PAIN MANAGEMENT, MIGRAINES AND FACIAL TICS - 38 YOF
* Recover*
CAUSE - Patient was kicked in the face by a student 2 years previously
MECIATIONS - Ultram prn, Vicodan prn, Allegra, Oxycontin 10mgm3-4 times per day, Vicodan 50 mgm prn X3
PROTOCOLS - T3-T4 11 -14 Hz then10-13 Hz (4-7Hz) for 34 sessions, Alpha/theta for 35 & 36 th session for nightmares, then C4-Pz 10-13Hz (for tics). On Sessions 45 -55 FPO 8-11 Hz (4-7Hz) then 7-10hz in a sandwich (FPO 12 min, T3-T4 12 min, FPO 6 min)
TOTAL SESSIONS 55 sessions before surgery for an anular tear in T3,T4,T5.
August 1999
Referred for biofeedback
March 2000
Patient has completed 20 sessions of Neurofeedback for her pain.
She reports that her facial tic is rare, now, although the aura of the tic can still occur as often as daily under stress. She has experienced no migraines recently, even though work includes much more responsibility for her. As well, she no longer reports double vision.
The intense spasms in her muscles are not entirely helped by neurofeedback but she reports that she is not so emotional about them when they are so intense and she is therefore able to handle the situation better. This calming can last up to 24 hours after the training. The blocks with (doctor) and the Pilates training, in combination with the Oxycontin seem to have been very successful in managing the spasms. She reports more flexibility and more energy since beginning Pilates, as well. Apparently, the monthly staph infections in her sinuses are less frequent and less severe.
It is important for her to continue neurofeedback until she is more stable- it is expected that the tics and migraines will continue to diminish.
July 1,2000
Patient has completed 30 sessions of Neurofeedback for her pain.
During this time her pain has improved, although she still has episodes of severe thoracic pain and muscle spasms which can be controlled only after several days of medication, as prescribed by (doctor). The most significant improvement seems to be in the facial tics and migraines. She has reported only one migraine in the past several months. Any episodes of facial tics have been rare and the severity of the episodes have diminished significantly. In fact, they are mostly the precursor symptoms, now.
In light of the fact that she still experiences episodes of severe pain and muscle spasm, (doctor) has recommended 10 more sessions of neurofeedback. She feels considerable relief with the training.
July 30 2000
Patient has had severe nightmares and woke up screaming awakening her husband and asked to do Alpha/Theta - she had trauma as a kid - anyway, the screaming stopped with 2 sessions and nightmare diminished in severity and frequency. Because the back spasms were so intense, we returned to beta/SMR
Patient has completed 40 sessions of Neurofeedback for her pain. She has made more improvements in that she has had no migraine headaches and one slight aura for the facial tics.
Recently, she has graduated to the Alpha/ Theta portion of the neurofeedback which she finds extremely satisfying and, also, very relaxing. This protocol is designed to address deep healing. When she has a flair in her symptoms, she returns to the SMR training.
She continues to have pain in her upper thoracic area which tends to flair each afternoon, especially while at work. The physical therapy/pilates that she is receiving has been very helpful. Recently, one of the new stretches provided her with a pain- free 24 hours and, although, the pain returned, the stretch can relieve it, somewhat, at times. As well, they have identified a great deal of muscle spasm under her scapula, which will be addressed.
She continues to use her relaxation skills and her new job and is looking forward to an ergonomic chair.
Thoracic Discogram for IDET - Anular tear (disc leaks fluid)
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January 2001
(We started FPO at 8-11Hz, 2-7Hz Inhibit - Loved it - said she was having an "ah ha" experience)
Patient has completed 50 sessions of Neurofeedback for her pain. In the past few months, she has experienced excellent relief during and after the neurofeedback sessions. This has been due to some changes in training protocols. When her back pain increased and she became very anxious and unable to sleep, this calmed her central nervous system and she slept better. On one occasion when she had the severe neck and shoulder spasm, it ceased after the training and she was able to have full flexibility inn her neck again.
Late in the year, she was considered for surgery and although it was scheduled for the first week of this year, it has been delayed. She has managed her pain quite well, with an increase in her dose of p.r.n. medications and her exceptional skill in self-management techniques. However, during the past week, she has experienced a severe change in the back pain - like someone slashing a knife across her muscles about 50 times. This will re-occur with no warning and is completely debilitating. Pain medication will help but the after effects of this severe pain make it very difficult to work or carry on normal activities of daily living. Neurofeedback does not change the pain levels but does keep her sympathetic arousal down. It seems important that the surgery be re-scheduled.
Because of her excellent response to neurofeedback I am requesting that she have 10 more sessions at her disposal in times of severe pain. She is quite conservative in using it.
April 2001
(Patient closed her Workers Comp case and had her surgery in March under her own insurance company. She is in a full body brace but most of her remaining symptoms have been eliminated. She is returning for occasional neurofeedback tune-ups at her own expense.)
October 2001
(Is out of body brace and teaching full time. Has not needed neurofeedback)
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CHRONIC PAIN involving lower back and neck and shoulders - 29YOF
* Recover*
CAUSE - Fell 10 feet, landed on tailbone
MEDICATIONS - Vioxx p.r.n., Benadryl for sleep Others as described below. None by the end training
PROTOCOLS - 15 min each of T4-Fz,T4-Pz @ 9-12Hz(2-7Hz) RSA training and lots of pain counseling and advocacy helped)
TOTAL SESSIONS - 76
(Patient was referred through Workers Comp to me for Biofeedback. 2 years previously she had fallen 10 feet to the ground from the top of the moveable stairs as she closed the door of an airplane prior to takeoff. She had been given extremely good referrals (on paper) getting physical therapy, massage, acupuncture etc. However she was, also, reporting difficulty breathing for which she was given an inhaler with no other testing.)
30 sessions
Patient was evaluated for neurofeedback on November 5,1999. Since then she has completed 31 sessions. During that time I feel she has made excellent progress considering her starting point with me.
Since you last saw her on Jan 13,2000 she has seen me 11 times with a break of one week when I was unavailable for one week due to family matters.
Recently, she has been feeling better due to achieving several good nights sleep. I believe she has taken 2 Ambien at H.S. to achieve this. She reports falling asleep easier and when she awakens approximately every 90 Ð 120 minutes she can fall back asleep within approximately 10 minutes.
Athena has, apparently, also been helped by the pool therapy, although the first pool did not work out. As well, she requested a re-assessment at the physical therapy and is now seeing a chiropractor who seems to be giving her more effective exercises and, I believe, is requesting a belt for her. I have seen good results with the belt for the sacro-iliac joint, if this is the same kind.
By her report, she does not seem to receive pain relief from the Vioxx. I have questioned her several times about the results on the days she has taken it as ordered and the days she has run out. Perhaps, another type of analgesic would be more effective??? I would hope, however, that it wouldn’t be long before she would be able to manage this discomfort with less and less medication. It appears that the neurofeedback is gradually calming her sympathetic overarousal.
She notes that her breathing is often normal now, but still can become labored during a flair of pain. She is getting support for new breathing skills, not only from me but, also, from the pool therapy and the new exercises. She has expressed an interest in learning to swim.
She reports longer pain free (relative) periods now but can still suffer from flairs of pain several times of week, which will limit her activity to watching T.V. She is careful to measure her 'busy' activities such as laundry, shopping, errands, etc. so as to not overdo which is sure to cause a flair. She still feels quite limited but it does appear that her general mood is improving slowly.
As it turns out, I have continued to use several one hour sessions for which I am now billing the code 99199 @$125.00. This still appears to be necessary because of doing the pain workbook exercises mentioned in the last report. She continues to work hard and with this direction and the support of the neurofeedback I believe some progress is being made. She is practicing at home with her tape and also, beginning to use the techniques in her work.
Please consider more biofeedback sessions. It would still benefit her to come once or twice weekly until she stabilizes and is at work full time.
40 sessions
She reports her pain has increased and her breathing appears to be difficult several times a day Ð usually at the same time as her pain is elevated and her anxiety is greatest. What used to work for her pain, such as changing her daily activities, using heat in the form of a shower, etc. have less effect now. She finds driving any distance increases her pain and has therefore decided to cut down on the number of therapies she will attend.
One example of her pain is that there is constant numbness and throbbing in her shoulder, which is distracting, but in spite of this, she is able to work for four hours. Working in the early morning is easier because her pain is less then. As the day progresses, it is increasingly more difficult for her to work because there is more pain in her shoulder, sacro-ileac area and her tailbone. She, also, feels that her workstation contributes to her pain and is very anxious to have the recommendations implemented that were made by the ergonomic evaluation. I believe these included the ability to adjust the height of the monitor and the keyboard to accommodate her need to stand and/or sit, as her pain requires.
One thing that has improved is Athena’s sleep. Whenever she takes the sleeping medication in the dose you recently prescribed she is able to sleep mostly throughout the night and awaken refreshed.
I would like to suggest that Athena be seen by a chiropractor, perhaps as often as, twice per week. One chiropractor with whom I have had professional and personal experience is (______). He has, frequently, worked with Workers Comp patients in their rehabilitation. He recently opened an office at (______)
Another possibility is the option of using an S.S.R.I. One in particular that I have seen to be very effective for myofascial pain is Paxil in the dose of 10mgm for a person of Athena’s size and weight.
I believe Athena can still benefit from biofeedback. She will arrange the number of sessions per week as needed. As of March 23, 2000 the re-imbursement for my sessions can be sent to the above address at Train Your Brain. Thank you for the change.
58th Session
(Patient) has made progress again but has had some significant setbacks along the way. Her progress continues to be very slow. During the past 2 weeks she has reported better mood - not so depressed - and occasional episodes of less pain. This is very good for her but she still has a great deal of anxiety and stress when pain comes up. She consistently follows directions well and an example of this is her dedicated use of ice frequently during the day to help decrease the inflammation.
I believe the transfer to the new chiropractor, (----), has had positive effects. But in his opinion the amount of inflammation in her sacroiliac joint and the imbalance in her hips, causing the referred imbalance in her left shoulder, will require a great deal of time before resolution will occur. The inflammation and imbalance have been allowed to remain untreated for 2 years and habits have been formed by the muscles, which will take time to resolve until pelvic stability has been established. He feels that she may begin to feel some results in about 3 months. For now he has asked her to suspend physical therapy until there is pelvic stability so she can exercise the muscles when they are in balance and out of spasm.
She is still is quite limited in her activities of daily living. Some examples of this are: 1.driving in her car flairs her pain - even the vibration of the motor while the car in idle causes pain and irritation, speed bumps are difficult, putting on the brakes is very painful. 2. Standing or walking for any length of time 3. Sitting for any length of time. 4. Looking down at screen or keyboard. 4. Although she may be better after some days off, more than one or 2 errands after work will flair her pain. 5 using left hand and arm causes painful shoulder, tingling in arm and pain at top of scapula) 6. Working - usually the pain begins to increase after about 2 hours.
Sleep quality is inconsistent. Initially, when she started on the sleeping pill (Ambien) she slept through the night. Now, mostly, it still helps her to fall asleep and remain asleep for about 3-4hours. But then several situations occur: 1. She can fall back to sleep quickly and wake a few more times. 2.Other times she is just restless the rest of the night 3. If she has had bad pain throughout the days she will be awake most of the rest of the night - sometimes tossing and turning with the pain, Also, the bad pain may even affect her ability to fall asleep. 4. On rare occasions she can sleep through the night. She has actually tried for several nights to see if she could do without the sleeping pill without success. Sleep onset is still a problem.
In general, her pain is the lowest upon arising. There are some times, that she wakes with severe night sweats - to the point of having to change her sheets and night clothes. (I have seen this in chronic pain patients but in this situation I might recommend another visit to her gynecologist to adjust the estrogen, which is used to manage polycystic ovarian syndrome)
She reports that the changes in her workstation are not complete and, therefore, so far, there are mixed benefits. The height of the monitor helps for the sitting position and the new keyboard also helps. However the keyboard riser is not installed although it was delivered at the same time as the other equipment. Therefore she is unable to work standing and it has been recommended that she vary her position from sitting to standing every 15 minutes. Her pain increases more quickly because of this, especially because recently there have been more calls and she has no time to get up walk and then sit again. The first ergonomic chair was not useful but there is a trial with new loaner, which seems significantly better. The wheels roll easily. The armrests fit her body as they move in and allow her to rest her arms while she is working. The adjustable features are helpful and the height of the back of the chair is better.
One thing left to report, is the most recent drug reaction to Ultram. Her symptoms appear to match those of about one percent of people who try to use Ultram. I saw her about 20 hours after ingestion and she was still experiencing symptoms, although the Phenergan prescribed at the E.R. was relieving the nausea. Her face was still flushed and burning, her lips were rimmed with dry inflammation, and her pupils were dilated. I believe she is quite sensitive to many pharmacological preparations. In looking through my notes. I see that she reported vomiting approximately 3 nights in a row after beginning Ambien. Then my notes reflect severe nausea, loss of appetite, and occasional vomiting after starting Wygesic. She tried it off and on for a period of about two weeks. It was because of these symptoms that I encouraged her to report to your office and you tried another prescription (Ultram).
Thank you for your consideration in continuing biofeedback.
76th session
Patient is finally pain free and able to work full time with almost no pain. The only thing that can happen occasionally is that her tailbone will be a little sore if she sits too long. She says this is quite tolerable. She currently has no further problems with her shoulder.
I believe the transfer to the new chiropractor, (------), was the catalyst in this change. I appreciate your receptivity in referring her on my recommendation.
From a recent phone call, I surmise that Athena has resumed most activities of daily living and is beginning to socialize again. She is quite pleased to be able to drive long distances (i.e. to help her ailing grandmother) without pain.
I have recommended that she retain the last 4 sessions of neurofeedback out of the last 10 authorized by you. This way, if she should have a sign of the pain returning, she could return for a boost in her parasympathetic functioning to help her body release the stress of the pain.
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Pain - upper back, right side neck, shoulder, left rotator cuff repair 57yof
* Recover*
CAUSE - tripped in office and fell
Description of program - Physical therapy, Neurotherapy, Imagery
Other cond - occasional migraines
Medic - Ibuprofin TID, Ultram prn, Doxepin
Protocols - began with C4-Fz&C4-Pz @ 9-12Hz(2-7Hz) but after migraine changed to T3-T4 12-15hz(8-11Hz) - Lower felt like a migraine.
TOTAL SESSIONS - 25
(Patient) was evaluated for biofeedback/neurofeedback on February 6, 2001 for pain management for persistent myofascial pain of right neck, trapezius and upper back.
She has completed 19 of her 20 sessions. During this time she has attended biofeedback regularly and seems to have incorporated the tools she has been taught into her daily life exceedingly well. Especially, at the office, she has learned to incorporate minibreaks in her work schedule to calm and relax her muscles.
It also, appears that the effects of the neurofeedback are observable in numerous ways. Apparently, the physical therapist can see an improvement in the relaxation of tension in her muscles both during therapy and between sessions. She now reports being able to "push the pain to the back of her mind" or calm it down. She can feel it "go out of her consciousness” when she does her conditioned relaxation. These results are likely due to the calming of the sympathetic nervous system arousal with the neurofeedback training. All of this results in her coping better with the pain. She now realizes that she may always have some residual pain.
(Patient) reports that although the pain remains and she still uses the same descriptive words - burning stabbing, throbbing, hot - the daily intensity is reduced to a +4 or+5 from a +8 or +9.
There are still flares of pain where the intensity reaches +9 or +10 and can stay at this level for approximately one day. These may be decreasing in frequency as well. Perhaps, by 10%.
I recommended that she have approximately 5 more sessions of biofeedback spreading out the time between sessions. (Doctor) ordered this. She has scheduled alternate weeks until the end of May and will save 2 or 3 sessions until after that - either to keep if there is a flare or to schedule monthly.
Patient also has a new physical therapist and she began to improve even more. By the time she completed her biofeedback, she reported the pain as +4 or less all the time. One flare in 2 weeks.)
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RSD left ankle (occasional pain like it in Rt. foot) 63yof
* Recover*
Cause - stepped into a wooden box thro the bottom in garden - didn’t hurt
Other Conditions - Arthritis, Herpes
Medications - Premarin, Lipitor, Zovarex, tried Celebrex - maybe helped
Protocols - C4 12 - 15 Hz (4-7Hz) Initially could only do 15 min. Was very clear about how she felt and how much she needed.
Number of Sessions - 31
Jan 2000
Patient had tried Neurontin and Elavil and had terrific rash. Was offered other drugs and, blocks, with the possibility of stimulator in the future. Refused to do those things and was referred for neurofeedback and Acupuncture.
Participated very actively in texture/temperature training (all RSD patients are given this in Physical Therapy), acupuncture 2-3/week, neurofeedback/peripheral biofeedback/Imagery 2/week, Yoga foot stretches twice daily, massaging of area, especially when pain started.
Gradually weaned off Acupuncture, Neurofeedback until Sept2000, when she said she was well.
October 2001
Patient reports that she is quite well. Still occasionally goes for acupuncture for good measure.
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? Lupus? , Fibromyalgia, Arthritis, Nerve Pain- 25yof
*Improved more than other treatments*
Medic - Neurontin, Baclofen, Norco, Duragesic Patch, Celexa
Protocols - Very, very sensitive - eventually settled on T3-T4@12.5-15.5Hz. (4-7Hz) and 13.5-16.5Hz(4-&Hz) for 3 to 9 minutes each depending on her responses and spread over 11/2 hour session. Peripheral biofeedback, imagery and acupressure included. On session 23 -26 we added 15-18Hz(4-7Hz) near the end of session.
TOTAL SESSIONS - 25 (Plans to return)
(At age 15, patient began to have shooting pains/swelling in joints and variety of symptoms including status epilepticus for several hours. She has been in intense medical care since)
Patient was evaluated for biofeedback /neurofeedback during the week of January 23, 2001. She was then having difficulty driving here (UCLA) from Apple Valley for 2 or 3 sessions per week which is the minimum recommended.
She began her first training on February 2, 2001, had a second one on February 22 and then was able to arrange to stay in town for 3 days per week in the future and has progress rapidly since then. She has just completed 13 sessions.
She is a very receptive student. She practices with the relaxation tapes at home and focuses on her breathing skills frequently throughout the day. Because of EMG training she is now observant of residual muscle tension or bracing against her pain. She is reporting a few less headaches now - probably due to this training around trapezius and masseter muscles. She is very pleased to have some management tools and finds relief when she uses them.
The most satisfying result is that of the neurofeedback. As of session 2 she began to feel more alert, less depressed and as she puts it " my mind feels stronger and I feel bigger than my pain for a change." According to her mother she was more sociable even when the pain increased. Over the past 10 sessions, she has experienced this for as little as one hour after the session to as much as 2 - 3 days. There is still some refinement to be done with the training protocols but it is expected that this effect will continue to accumulate. The last session she also reported changes in her pain. The sharp shooting pain in her joints became less sharp and her electric pain was much less intense. She said it was if she had taken a pain killer - but of course she had not taken anything additional since the previous day.
She currently is experiencing the mood change and pain control for 5 - 6 days. Her mind and vision would be clear. ("Crisp")
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PHANTOM LIMB - RT. ARM - 70yom
CAUSE Tumor
Previous Rxs
4-week in-patient pain program
Morphine Pump
Experimental Drug - SNXIII - Fish Eating Snail
Mindfulness Meditation
Effective Neurofeedback Protocols
14 - 17Hz on SM Strip at right hand -created complete loss of pain that he reported as numbness in arm and hand with exception of Rt. Thumb and forefinger. Good for 2 sessions - could not be duplicated.
T3-T4 8-11Hz(2-7Hz) plus FPO 8-11Hz
Summer 2000
The patient was referred to me in an effort to see if I had better results for his pain management than his previous neurofeedback training had offered. I cannot say for sure.
He expressed an interest in what he and I are doing were doing and based on that information, he chose to continue after the first 10 sessions and to complete his prepaid 20 sessions doing Alpha/Theta. His intentions are images of brain plasticity and with that information he is holding positive images of change within his neurophysiology.
He left with a better understanding of himself and where he fits in his world. Despite his handicap, he has recently booked a trip to England, is talking of learning golf and of gaining new friends. As well, he would like to fish. He is really interested in the newest developments in prosthesis. (The morphine in the pump was discontinued because of severe side effects and no pain relief. Alpha/theta was pleasant but no change in pain.)
January 2001
Patient resumed seeing me for neurofeedback on January 29. He plans to come 3 times per week. The training is 30 minutes long. This week a new protocol (T3-T4,
2-7hz inhibit) is being used and the frequency is gradually being lowered to achieve a greater state of relaxation. So far, the patient has reported no awareness of a change but has not reported more pain than usual. Next week I will continue the same plan.
(Patient returned to the pain clinic because of extreme pain most of the time and depression. He resumed his antidepressant, psychotherapy, Neurotherapy, and was placed in a drug study (pump). As well, he began some energy work (a kind of craniosacral therapy) with encouragement to join a mindfulness meditation group)
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(now at 24 minutes ofT3-T4 8-11Hz, 2-7Hz inhibit) This week patient reports a little change in his pain level - a little less pain for longer periods: maybe a +7 rather than a +8 or +9. To him, this is significant. On Feb 6th he had some pain as he left the office, which receded within the hour and he felt "quite good" for some of the afternoon. On the 8th, he reports still feeling better and that it may be related to the new protocols in the neurofeedback. He has had quite a bit of experience with NF, and so this may actually be the case.
Another expected result of NF is more inner awareness. Certainly, for one reason or another (patient) is recently more aware of tension in his body and the discomfort this causes. This has been discussed in the past but with no particular impact. Now he is interested and is open to suggestions from the Nurse Practitioner and myself.
Relaxation and inner calmness is another expected result but Bernie has not reported any awareness of this as of yet. Because he is starting Craniosacral therapy, he will probably be reporting a variety of changes related to relaxation and tension release.
******
(3rd week) Patient seems to be reporting an improvement in his pain. What he says is that for approximately the last 10 days he finds that his pain is less with frequent flares. Until then, (for the last 5 or so months) it has been at "flare" level all the time. He rates that pain at a "+9 or +10". This lower level of pain is rated at about "+7". As well, he notices that when he goes to bed to cope with the pain, he now can lie on the left side and in a certain position the stump relaxes and the pain relieves. (He is convinced that there is no effect from the drug study and he discounts the amount of effect from the anti depressant but clearly it helps him.)
A great deal of time was spent using EMG biofeedback measurements to demonstrate the amount of tension that can be retained in a muscle even when one assumes one is relaxed. (Patient) was, also, impressed by the power of his mind over the muscle. By just thinking about relaxing the muscle after several practice sessions, he was able to release the tension even with the biofeedback screen covered.
******
(Patient) has had body work and neurofeedback sessions both in the same day. He reports relaxation but no change in his pain patterns after this.
This week I, also, changed the training protocols (FPO2) and after the first session of this, he reported feeling very tired and asked his wife to drive home. After a rest of 20 minutes, he was felt better than usual, the pain remained at about a "6", and was able to go to dinner with friends. The pain flared around 9:30 pm and he went to bed and, after a while, was able to achieve relief lying in his special position.
The second session he felt relaxation but was not exhausted. He did report lessening of the pain during the new protocol and the some return of pain during the section of the training with the old protocol.
The other point to be noted is that (patient) reports "feeling better" overall in the past 10 days. By that, I take him to mean he has better energy and mood. He says that this feeling and the lessening of the pain (often at "6" now) are similar to what he had about 5 months ago.
**********
April 2001
Patient has seen me weekly for the past three weeks and now is going to take a break. He is paying out of pocket as there is no coverage from Medicare. He feels that he will return for "tune ups" because neurofeedback seems to him to have been very helpful in calming his central nervous system and therefore his approach to life and his pain. He is attending some physical therapy and bodywork that is covered by Medicare.
He says that now he has better pain management tools and is coping with the daily pain much better. With the help of the bodywork, he is rarely has neck and shoulder and back pains. They still can reappear with walking. Since, the awareness of these other unrelated (to phantom pain) pains through imagery, bodywork and exercise, he is not quite as miserable with the flares of phantom limb pain.
He has seemed to have had longer and longer periods without severe flares of phantom pain (+10). However he states that only the frequency has lessened, not the severity. The constant pain on the average continues to remain about +5 and +6.
Last week he had no flares but the 2 previous weeks he had a total of 3 flares lasting approximately one to one and one days.
(He still denies any results from drug study. He is still having increases of dosage weekly)
.
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REFLEX SYMPATHETIC DYSTROPHY (RSD) - Rt. Knee - 38 yof
CAUSE - fell at Vons
Spinal cord stimulator, Part of 4 week program including 5 days per week of Neurofeedback, Physical Therapy, Psychotherapy, Medical Management as needed) (took 6.5 weeks to complete)
OTHER CONDITIONS = Genetic Depression, IBS/Colitis, Panic Attacks, Migraines (PMS & Tension) Insomnia, Bruxism, Herpes in left Hand, Nervous breakdown in 1990, Low Thyroid, ITB at 18yrs leading to spleen removal, Hypoglycemia, 2 This, 1 seizure, ADD/Dyslexia/poor reading comprehension)
MEDICATIONS = Celexa 30 mgs AM, Zoloft 150mgm to increase gradually to 300mgm, Baclofen iii T.I.D., Asocol, Thyroid, Zanex 1mgm @ 4pm, 7pm, 9pm, Trazadone qHS, Firoicet for Headache
PROTOCOLS = (after 30 sessions) FPO2 5-8Hz @2-7Hz -10 minutes, T3-T4 5.5Hz @ 2-7Hz -20 minutes (Various responses during the 20 sessions and therefore various protocols i.e. calmed visually for 2 sessions (same protocol as above), then no response, more pain, increase in Has, wanted more of 'that frequency’ (13 -15 hz), Lithium tried, etc) After 40 sessions FPO1-FPO2 2- 5 Hz (2-7Hz) 30 minutes
TOTAL SESSIONS - to date 43
*****
November, 2000
Patient was evaluated for biofeedback/neurofeedback in November 2000 for pain management for CRPS (Complex Regional Pain Syndrome).
January 20,2001
At first, there was a lot for her to assimilate and it is taking some time to choose the neurofeedback protocols best suited to her. As well, there has been some time off for recovery from the surgeries. (Temporary stimulator and permanent stimulator (12/10/00)) She is a dedicated patient and is very interested in the process of neurofeedback.
To date, she has experienced a couple of sessions where she felt extremely calm afterwards, with the result, that she managed her pain and her life better on those days. She is very sensitive to the training and a few sessions left her with too much energy and therefore she was more anxious. It often takes anywhere from 6 to 10 sessions to complete this process of determining the best way to achieve physiological calming.
(Because of the severity of her emotional state she was really unable to contribute much to the choice of protocols. Some protocols lost their effect and have had the opposite effect. Although I originally thought we could manage her mood and affect with NF (especially because of the first 2 session results), she was sent to a psychopharmacologist for medical management)
******
(In December she had a permanent stimulator put in - very disturbed by the process and the small amount of effect compared to her expectations)
She continued to be a dedicated patient and very interested in the process of neurofeedback.
During these last 10 sessions, she has experienced a great deal of emotion regarding the pain and her adjustment to it. Because of this and her basic nature, it took some time to choose the neurofeedback protocols best suited to her. As of session 16, It became clear as to the frequency that gave her the most consistent results. Also, she began a new medication regime on that day or the next, which should be helpful
She is very sensitive to the training (meaning that she has extreme results or no results) but I believe that continued training will give her more physiological stability and she is arranging to come in weekly for 10 sessions, to continue the neurofeedback training. (Finished the program) In general, she has reported a very gradual change in her ability to center herself and stay calmer in the face of stressful events. She is doing her best to work with her conditioned relaxation and diaphragmatic breathing. It will be good for her to have continual reminders in her next 10 sessions to help incorporate these management skills into her daily life. The next step is to incorporate some healing imagery for her pain into the neurofeedback training.
Thank you for the opportunity to work with this very interesting patient.
******
April 2001
Stimulator stopped working
(After program patient saw me for 6 weeks, once per week along with psychotherapy. Recently, father (who pays for this) agreed to pay for NF two times per week for 4 weeks. We had thought to do A/T once per week but, suddenly, getting better results with FPO2 5-8Hz @2-7Hz -10 minutes, T3-T4 5.5Hz @ 2-7Hz -20 minutes. She reports no real pain changes and is very pre-occupied with pain in incision and area of stimulator, as well as, lack of energy and weight gain from drugs. Is getting out to do some of her work, but minimally. Has few friends and isolates herself with her pets for days at a time. Mostly in bed. In late March, the stimulator (one side of the lead broke) malfunctioned and she was completely undone by it. The stress affected her for about 4 weeks, even though the stimulator was repaired in- office 2-3 days later)
October 2001
(Used stimulator at the highest level most of the time and burned out the battery. It was replaced by a more sophisticated model and was set at a lower level so she couldn’t turn it up so high. Patient was very disappointed at the lesser effect. While she was waiting for the replacement, she was in severe pain. New lower n/f filters became available so tried FPO1-FPO2 at 3 - 6 Hz for 20 mints with excellent effect. She felt 60-70% calmer and it lasted until she climbed up her 20 steps when she got home. Have continued with 30 minutes. For past 2 sessions, the effects aren’t so dramatic but family notices her change.
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FAILED BACK SYNDROME -55yom
CAUSE - Injured and disabled since1988 - Fell at work
MEDICATIONS - Soufentanyl and Clonidine in pump, Darvacette prn
Spinal Cord Stimulator and Pump
PROTOCOLS - 15 min. T4-FZ 12-15Hz (2-7Hz) and 15 min.T4-PZ 12-15Hz(2-7Hz) Lower made him nauseated but later added FPO 8-11 Hz (2-7Hz) with no problem. Used FPO each week for 10 -12 weeks in amounts up to 15 minutes.
(10/01/01 FPO 2-15 min 6-9Hz (2-7Hz) 15 min C4-PZ -6-9Hz(2-7Hz)
TOTAL SESSIONS to date: 64
Patient was evaluated for biofeedback/neurofeedback on June 1, 2000 for pain management for Failed Back Syndrome. He has now completed 20 sessions. He has made great improvement over the past few months.
He has recovered from the severe headaches caused by the re-insertion of the stimulator and reports that his leg/knee pain is 25% improved most of the time. If a flare occurs, he is able to use the stimulator to manage the pain and that is very reassuring to him. His mood has improved greatly. I believe this is due to many factors including: the consistent management of leg pain, the neurofeedback, the work with (psychologist), the addition of Paxil 5 mgs, and the reassurance from the pain team's understanding of the pain. Currently, he is making plans to attend classes next semester.
He still has quite a lot of muscle tension in his neck and shoulders, which probably contributes, to his remaining, less severe headaches. I believe Dr. Prager has ordered some physical therapy/massage for this. He is very dedicated to the exercises I have given him and the neck and shoulder spasms seem to be improving
During the early sessions, I encouraged him to look at the different pains he has - back pain/spasm, left leg pain, right leg pain and headaches - separately. In this way it is possible to determine what success has been achieved and where change still needs to be made. He finds that the back pain is quite unbearable at times and he feels that it is getting worse. (Doctor) did a myelogram and now has a plan for replacing the pump catheter in an effort to improve his life quality.
I believe he could benefit from continued biofeedback and would like to request 20 more sessions. A re-evaluation would be done at 10 sessions to determine whether he needs to go on. In the next 10 -20 sessions, I would begin Alpha/Theta training which is used for a deeper healing of long-term trauma. The code 99199 would be used frequently during these sessions as the time required is often a full 60 minutes. He has been oriented to this and is anxious to begin. (Psychologist & doctor) feel that he is a very good candidate to use non-medication techniques and, therefore, concur with this recommendation. I believe the prescription has been faxed to you under separate cover.
********
Patient was evaluated for biofeedback/neurofeedback on June 1, 2000 for pain management for Failed Back Syndrome. He has now completed 30 sessions. He continues to make great improvement.
After the pump was repaired and the Fentanyl was replaced, he had some difficulty adjusting to the drug, experiencing nausea and itching. The neurofeedback seemed help him adjust more quickly, easing the symptoms during training sessions. As the pain has been reduced he has been able to become more aware of the tension he has been holding as he braced against the pain and is working hard to alleviate that response and to continue his diaphragmatic breathing even in pain. He finds he is much more able to manage his pain and stress when doing this and is quite pleased about it.
He is coming to biofeedback less frequently and will probably be done the last 10 sessions by the end of January. He is beginning physical therapy that should complete his rehabilitation. He is planning to attend some classes at college as soon as possible.
I would request that he be able to return to neurofeedback, if necessary, in the future should he have a flare of pain or headaches. Perhaps there could be authorization for 6 to 10 sessions available over one years time. Thank you for your consideration in this.
*****
Patient was evaluated for biofeedback/neurofeedback on June 1, 2000 for pain management for Failed Back Syndrome. He has now completed 40 sessions. He continues to make great improvement.
He continues to have headaches, which I believe could be related to a great deal of tension in his neck and shoulders. They are significantly improved after neurofeedback and some acupressure. I would hope the tension would be addressed in P.T. with exercise and massage/heat.
During these last 10 sessions, he has noticed how much more relaxed he feels after the neurofeedback training. As well, he has begun physical therapy after which he is in great pain for several hours and even until the next day. It seems that EMG biofeedback gives him some insight into how much extra tension he is still putting into his movement and how he pushes harder than is required at the beginning, especially after being disabled for over 10 years. It seems difficult to realize how much patience it takes to grow so slowly. When so much pain is released it would seem that one should be able "to get up and walk". However, Walking, even while he is teaching (at church) for only 20 minutes, gives him severe pain immediately afterwards (and he is in bed for about 24 hours). He is learning skills to gauge his limits and to be patient with them.
In light of this, I believe he would benefit from several more sessions (perhaps 5 or 10) of neurofeedback accompanied by neurofeedback, at least until he is more comfortable with the increased activity in physical therapy. I have spoken with (doctor) about this.
In the past report I requested that he be able to return to neurofeedback, if necessary, in the future should he have a flare of pain or headaches. Perhaps there could be authorization for 6 to 10 sessions available over one years time. Thank you for your consideration in this.
*******
April 2001
Patient was evaluated for biofeedback/neurofeedback on June 1, 2000 for pain management for Failed Back Syndrome. He has now completed 49 of 50 sessions. He continues to make great improvement.
He is doing very well with physical therapy and has used the biofeedback sessions to understand better how to utilize the exercises and where/when he was over exerting. The latter part of each session is now dedicated to relaxation and neurofeedback. He is very much better with the additional drugs in his pump.
One change has been the sudden appearance of frequent, short-lived but extremely intense headaches. These can occur several times a day and will last 15 to 30 minutes. The pain is quite incapacitating. (Doctor does not know what to make of it but last session I reported a BP of 180/98. Wife reports these seem to have begun after last addition of drug but its usual effect is to drop BP. Will keep record and he will see MD in a few weeks). We have looked at the possibility of muscle spasms due to the increased activity for his upper body at Physical Therapy. Although he has made some changes, the frequency of these headaches apparently remains. The long-term daily headaches have subsided.
I believe that (patient) has completed his work with neurofeedback. In the past reports I requested that he be able to return to neurofeedback, if necessary, in the future should he have a flare of pain or headaches. Perhaps there could be authorization for 6 to 10 sessions available over one years time. Thank you for your consideration in this.
October 2001
(Patient came for n/f once or twice over the summer. He was then diagnosed with thyroid cancer and has returned 1-3 times per week before and after surgery and radiation. Imagery was also done. The change in training was quite noticeable to him. After the session with ????????, he felt and acted much calmer.
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RSD - all 4 limbs -35 YOF
CAUSE - fell and broke wrist
2 Spinal Cord Stimulators/Pump/ Probable Brain Stimulator
MEDICATIONS - Morphine and Baclophen in Pump, Celexa, Topomax, Adavan, Elavil, Welbutrin, Compazine, Zofran, Zyprexa, Respiridal
PROTOCOLS - Sept 99 Initially, C4, Then C4-Fz & C4-Pz 9-12Hz(4-7Hz) 15 min each. FZ would calm her and PZ helped hypertonia in arm during session and for a few hours after. May 2000 T4-FZ &T4-Pz 9-12Hz(2-7Hz) 15 min each. Tried some C3 beta (mood) and F3-F4 for anxiety (6-9 gave out of control sensation). Nov 2000 - T3-T4 7-10Hz(2-7Hz) 21 min, FPO 7-10Hz(2-7Hz) 9 min. May 2001 - wants FPO for 30 minutes each session (loves the feeling, very calming, can remember the feeling and use at home. Sept 2001 same protocols)
TOTAL SESSIONS - to date 100
(Patient referred to me in the midst of 4-week program hoping to have better effects from the NF than that of previous practitioner. I was at EEG Spectrum at the time and the advice of Sue. She (an RN) had fallen and broken her wrist in Jan 1999 and had symptoms of RSD but although it was recognized, it wasn’t treated appropriately. By Mid June, she was at California Pain Management Center and RSD Institute. She had lost complete use of right arm and spasms were extremely painful. When I first saw her (September 1999)
She was complaining of burning in low back and right leg and said it felt like her right leg was being pulled up to her ribs. Over the months, RSD spread into left leg and somewhat into left arm. She had frequent Stellate Ganglion Blocks and Lumbar Sympathetic Blocks that relieved some of the pain and the spasms. She was eventually admitted to an in-patient pain program at Daniel Freeman Hospital with no good effects. She was then placed in NPI at UCLA and all meds were withdrawn and replaced.
She was finally able have a slightly normal life at home for several months until more complications appeared. A Morphine/Baclophen pump was inserted with fairly good relief although severe side effects from drugs had to be controlled. At that time (June 2000?) she returned to Neurofeedback 2 - 3 times per week (as well as continuing psychotherapy 2- 3 times per week)
Since then she has had continued complications (stimulator leads breaking, pump catheter twisting and disconnecting and subsequent drug withdrawal - to mention a few) However, she is now resuming her role as a parent with the help of a Nanny and a very, very supportive significant other. She is still in constant pain, frequent but lessening panic attacks and walks with a cane. The hypertonia is significant and is considering a brain stimulator. She is continuing N/F and psych once per week.)
*******
October 1999
Recently, I was authorized to see (patient) for the full month of October for neurofeedback. Initially, I was authorized for 12 sessions. In the face of the severity of her symptoms and the rapid fashion in which this disease (C.R.P.S.) is progressing, I am very grateful to be able to train her with this very powerful technique.
On the first day, she was able to feel relief in the form of more calmness and a decrease in pain from a rating of +9 to +4. She was very relieved emotionally to know there was some help in the form of training her body to lower pain and to relax.
She has continued to experience relief during and after each session. However quickly her disease is progressing, I believe that the neurofeedback is an extremely important adjunct to her care and can, eventually, help slow the progression.
I will report at the end of October.
November 1999
(Patient) was re-evaluated for neurofeedback on 10/28/99 for the diagnosis of Reflex Sympathetic Dystrophy (Complex Regional Pain Syndrome).
For the past 22 sessions, she has been experiencing many exacerbations of her C.R.P.S., throughout which she has bravely carried on in the face of excruciating discomfort and very frightening body changes.
Each time she has completed a neurofeedback training session, she has been able to report an improvement in her symptoms. Even on the first day, she was able to feel relief in the form of more calmness and a decrease in pain from a rating of +9 to +4. Recently, since she has had more muscle spasms in her right arm, it has been observed that the arm will relax from its flexed position to a natural position lying on her abdomen. Also, she has observed that the right wrist now has movement. It is very rewarding to see the tremor in both her arms and legs calm during the session, as well. (Using 15 minutes C4-Fz 9-12 hz, (4-7Hz, 15 minutes C4-pZ 9-12 Hz (4-7Hz)
It is my impression that she will require more training. I know that there are plans to expand treatment program to better assist her recovery. I believe that neurofeedback should continue and, if necessary, I will refer her to a colleague and supervise the training. However, if at all possible, I believe she should continue at this clinic. Please consider, at least, 20 more sessions.
Mid November 1999
As of today, (patient) has completed 32 sessions of neurofeedback on November 12, 1999 for the diagnosis of Reflex Sympathetic Dystrophy (Complex Regional Pain Syndrome). This is an update after 10 more sessions since October 28, 1999.
These past few weeks have been very trying emotionally and physically for (patient). One consistency seems to have been the relief she receives from Neurofeedback. Considering the severity of her symptoms and the rapid rate at which the R.S.D. has advanced, it is pleasing to be able to report this. The neurochemical changes provide mental stillness, physical relaxation and some pain reduction for her. I believe there is some relief here, too, because of the neutral atmosphere provided by the R.N.s during the training and face to face discussions.
If her care is transferred elsewhere, I believe she should continue with daily neurofeedback. Also, I request that, at least initially, I continue to act in a supervisory role as to the protocols used for the neurofeedback training.
June 2000
(Patient) was evaluated for neurofeedback on 09/17/99 for the diagnosis of Reflex Sympathetic Dystrophy (Complex Regional Pain Syndrome). Since then, as you know she has had many medical complications. Recently, she has become stable, thanks to the good care of (doctor & psychologist), and she has been referred back to me for more neurofeedback.
Because she has so much less pain and muscle spasm, I am reviewing the peripheral biofeedback techniques and find that she is very good at them. She reports feeling calmer after each session and is able to report that she is able to sit still for longer periods at home without having to get up and move around. I am, also, considering using a code 99199 for a few sessions where I will be with (patient) for one full hour. (Please see the enclosed letter explaining this.)
Thank you for the authorization for more neurofeedback training. On her first day back she said, "I'd forgotten how good this feels." I will report her progress after 20 sessions.
January 2001
Patient has had a good time over Christmas and the month before. In the past week she has experienced severe hypertonia and (doctor) is checking on functioning of the pump and /or increasing the Baclofen dosage.
Over the past few weeks I have again changed the training protocols for (patient) and she has responded quite well. With these protocols she has reported more relaxation in her right arm and a decrease in the burning and aching in her bones. Each of these results has lasted from 11/2 hours to a full day. As well, today, she was able to experience less agitation.
I believe she would continue to benefit from continued neurofeedback and (doctor and Psychologist) agree.
I will report after 50 sessions.
April 2001
Patient continues to respond to neurofeedback. During these past few months she has had many problems with the pump and stimulator and has been very incapacitated physically and mentally at times. But she continues to bounce back. Her appearance has improved significantly, with a new haircut and lovely clothes. She is doing her best to be more available to her children and take more responsibility for the house.
The new neurofeedback protocols (T3-T4 6-9 Hz, 2-7 Hz, FPO2 5.5- 8.5 Hz). Recently requested 30 minutes of FPO - loved it) give her relief of anxiety for several hours after she leaves. I believe also, that the neuroregulation is beneficial for her improved mental acceptance of her situation.
She attends training once per week and for the time being would like to continue at that rate.
Has had botox injections in Trapezius. Gives her some relief for several weeks.
October 2001
(Patient) has continued with n/f weekly. Has had poor vision most of these past 2 years. was finally seen by a neuro-ophthalmologist and received glasses. Vision much improved. After 5 minutes of training she became severely anxious (her response if n/f training goes too low). The only thing we could figure was that she now could see the screen and was finally getting visual feedback. We continued the training, that day and the next, without glasses. Will re-asses protocols with glasses on next week. Also, Dr.P placed Botox (very experimental) in her Stellate ganglion with incredible effects on her severe dystonia!!!!!
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RSD - 3.5 limbs - 40YOM
CAUSE - Caught in farm equipment
Spinal cord stimulator - 4 week pain program - Neurotherapy, Psychotherapy, Physical therapy, Meds as required, Blocks if necessary.
OTHER CONDITIONS - SX Of severe RSD - Dystonia in left arm (no use), severe anxiety, extreme skin sensitivity, severe migraines, severe hyperhydrosis, and severe fine tremor in left arm and less in rest of body.
MEDICATIONS - Neurontin 600mgm t.i.d., Renetadine (sp?) 300 mgs qHS, Zyprexa 2.5 mgs qHS, Advil iii p.r.n.
PROTOCOLS - 18 min T3-T4 5.5-8.5 Hz (2-7Hz), 12 min FPO (same freq.)
Occasionally, twice per day.
TOTAL SESSIONS - 15
November 2000
(Patient) was evaluated for biofeedback/neurofeedback on November 7, 2000 for pain management for CRPS (Complex Regional Pain Syndrome). He was to be trained for a 20 session package including the assessment, reassessment, tapes and instructions.
He went home after 15 sessions and will be returning in February for another 4-week package, I believe. He was quite pleased with the results of the neurofeedback. The effects he noticed are listed below. Considering the severity of his RSD, these are excellent responses and it would be hoped that he would get more long lasting results as he continued to train. It is possible that he will require training after the next 4-week package. The experience that we have shows that those patients with such advanced RSD will flair with weather changes or stress or too much exercise, etc. and have benefited from continued or intermittent training. Please consider this as an option for the future.
As the training progressed, (patient) observed that the hyperhydrosis lessened by about 80 - 90% and would last up to 2 or 3 days depending on the stress he was under - i.e. exercise. Later, he became aware that the training lessened the spasm in his shoulder and neck and twice terminated his all day headache within about 10 minutes. One of the things that pleased him was the change in the shaking in his right arm. It could visible lessen during the training and remain for several hours. He expressed pleasure in that his anxiety dropped over the three weeks and was less prone to rise as severely with concerns like" flying' and "s
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