Severe neuropathic pain due to Lyme disease. Inside Lyme Podcast

Hello, and welcome to another Inside Lyme Podcast. I am your host Dr. Daniel Cameron. In this episode, I will be discussing the case of a 36-year-old man with severe neuropathic pain due to Lyme disease.

I first read about this case in the journal Neuromodulation by Karri and colleagues.

A 36-year-old man suffered with a chronic pain syndrome associated with post-treatment Lyme disease syndrome (PTLDS). [1] PTLDS is a complication of Lyme disease. Individuals with PTLDS remain ill with pain, cognitive impairment, and fatigue and find it difficult to function.

The patient described severe neuropathic pain in both feet and categorized the pain at a level 10 out of 10 despite treatment with methadone 5 mg every 4 hours as needed. The doctors assumed that the tick-borne infection had resolved and elected not to treat with antibiotics.

Instead, they treated the patient’s symptoms. The pain remained severe despite trials of gabapentin, duloxetine, bupropion and narcotics. “The patient was unhappy with associated adverse effects, especially drowsiness and recurrent constipation,” the authors wrote. [1]

Surgical treatments for pain due to Lyme disease

Two surgical procedures were performed, which improved the patient’s pain. First, the man had a spinal cord stimulator surgically placed in the Dorsal Root Ganglion to mask the pain signals before they reach the brain. The pain dropped to a level 3 out of 10.

A spinal cord stimulator alone does not come cheap. “The Journal of Neurosurgery: Spine published an article estimating the cost per patient of spinal cord stimulator implantation at $32,882 for Medicare patients and $57,896 for Blue Cross Blue Shield, with annual maintenance reaching $5,071 to $21,390,” wrote Laura Dyrda in Becker’s spine review. [2]

The doctors then surgically placed a pulse generator in the right paraspinal-flank area. The patient reported the pain dropping to level 0-2. Narcotics were rarely needed and the man was able to return to work as a health-care provider.

The authors stressed the need for novel approaches to pain management for patients with pain due to Lyme disease.

Some of the following questions are addressed in the podcast:

1. Have you seen severe pain in Lyme disease?
2. What types of pain have you seen in Lyme disease?
3. What is the treatment for Lyme disease pain?
4. What is Post Treatment Lyme disease Syndrome (PTLDS)?
5. What are the symptoms of PTLDS?
6. What is controversial about PTLDS?
7. What are your concerns with a surgical approach to Lyme disease pain?
8. Would additional antibiotics have helped resolve the Lyme disease pain?

Thanks for listening to another Inside Lyme Podcast. You can read more about these cases in my show notes and on my website @DanielCameronMD.com. As always, it is your likes, comments, reviews, and shares that help spread the word about Lyme disease. Until next time on Inside Lyme.

Please remember that the advice given is general and not intended as specific advice as to any particular patient. If you require specific advice, then please seek that advice from an experienced professional.