In 2011, Deborah Finbow’s hand was bitten by an agitated dog. The wound was treated by her local emergency department, and she was sent home with antibiotics to prevent infection. However, after the wound had healed, Finbow began to experience very painful inflammation not in her hand, but in her left foot. Her foot would periodically swell, become discoloured, and burn and tingle with incessant pain. The symptoms worsened with each bout of inflammation. She was diagnosed with osteomyelitis, a bone infection.
Despite a surgical intervention in March 2012 to relieve the now severe inflammation, the pain would not diminish. It was determined that the infection had also damaged the nerve in her foot which was now causing the unbearable pain. This time, she was diagnosed with Complex Regional Pain Syndrome (CRPS).
A married mother of four from Collingwood, Ont., Finbow could no longer put any pressure on her foot and relied on a walker and a cane to stand and get around – if she could find the motivation to get out and do anything. She couldn’t stay warm, even in summer, because her body assumed the same temperature as her foot and leg: ice cold.
“Chronic pain takes everything out of you,” she says. “The pain and discomfort was so intense that I just wanted to stay home in bed and sleep.”
Doctors didn’t think there was anything they could do for her. She was told to get a wheelchair and do her best to manage the pain. But one physician thought it might be worthwhile to see if any of the specialists at Toronto Western Hospital’s Krembil Neuroscience Centre could help.
Finbow was first referred to Dr. Anuj Bhatia, an anesthesiologist and pain specialist to determine whether other pain medications might alleviate her CRPS. It was the first time in a year that Finbow felt any hope her condition might improve. Unfortunately the medication wasn’t effective, leaving Finbow sluggish, groggy, and unable to participate in family life.
It was time to consider a final alternative: surgery. Finbow was referred to Dr. Mohammed F. Shamji, a neurosurgeon who specializes in minimally-invasive and complex spine surgery as well as neuromodulation for neuropathic pain in hands and feet. Conditions caused by neuropathic pain – damage to a complex sensory system responsible for how we perceive things like touch and temperature – often have symptoms of amplifying normal sensations to the point of unrelenting discomfort. Patients can feel very hot or very cold, “pins and needles” sensations, numbness, and itching; much like what Finbow was experiencing.
Shamji is trying to organize a program at Toronto Western Hospital especially for treating patients with neurostimulation, a surgically implanted device about the size of a stopwatch in the epidural space around the spine that delivers a controlled electrical signal to the spinal cord. The electrical impulses deliver a tingling sensation to the brain while also blocking pain signals that the patient experiences, essentially overriding the pain sensation. The patient is taught how to operate a remote control that can change the intensity and patterns of stimulation at any time, adjusting them for different activities such as sleeping or walking.
Although the technology has existed for a few decades, it is not as well-known as a treatment option for patients with severe, chronic pain.
“Neuorstimulation is not for everyone. Some patients don’t receive any benefit from the device and others aren’t comfortable with the tingling sensation it generates,” explains Shamji. “However, we are working on a system to get the right patients to our program so they can be evaluated and treated quickly since this technology is underutilized, but can be extremely efficient in enhancing the quality of life for these patients.”
Finbow was assessed as a candidate for such a procedure, in her case called a spinal cord stimulator, but she was advised that it might only lessen her pain by 50 per cent. She decided to go ahead with the surgery.
The procedure more than exceeded Finbow’s expectations. Just two weeks after the surgery, with her stimulator properly programmed, Finbow no longer felt any pain and could not only put weight on her foot, but also walk around unassisted. She is now getting back to the activities she thought were lost to her forever such as travelling and riding a bike.
“This whole ordeal started the year I turned 50,” she says. “Thanks to Dr. Shamji, Dr. Bhatia and their whole team, I feel like I’m restarting my 50s and resuming the life I had.”