RESUMEN
Background: Erythromelalgia, which has primary and secondary presentations, causes heat, pain, and redness in the skin. The condition seems to have an autonomic basis, with vasomotor dysfunction causing dilatation of some blood vessels and constriction of others. No consistently effective treatments have been reported. Anticonvulsant, antidepressant, antihistamine, anti-inflammatory, antihypertensive, analgesic, nutritional, and topical approaches have been tried as were lidocaine infusions, nerve blocks, and thoracic and lumbar sympathectomies. Interosseous membrane stimulation appears to affect the local autonomic milieu in the extremity being treated. This approach was used on a patient with erythromelalgia. Case: A 36-year-old woman with erythromelalgia was treated with interosseous membrane stimulation. Eight treatments were given over a 1-year timeframe at 1-3-month intervals. Results: This patient repeatedly experienced much relief from her burning paresthesias, swelling, diaphoresis, and ruddy discoloration of her extremities for 6-8 hours following each treatment. The intensity of her discomfort subsided gradually over time. Conclusions: Interosseous membrane stimulation is a safe, simple, and effective treatment for erythromelalgia, which is notoriously refractory to treatment. This patient's response to treatment might have been a result of localized derangement of her autonomic nervous system. It is possible that manipulation of the autonomic milieu of an extremity is a significant factor in the mechanism of action of interosseous membrane stimulation.
RESUMEN
Background: Painful peripheral neuropathy is a condition that may be associated with diabetes as well as other causes of neuropathy. Common treatments for the pain include topical application of capsaicin as well as using oral medications, typically gabapentin. The results are variable and rarely provide substantial lasting relief. Cases: This report describes how a simple and easy to perform acupuncture technique-interosseous membrane stimulation-was used to treat painful neuropathy in 3 patients: 1 with painful diabetic neuropathy; 1 with idiopathic painful neuropathy; and 1 with painful neuropathy caused by exposure to Agent Orange while serving in Vietnam. Results: The 3 patients had much relief from the pain associated with their neuropathy for several weeks at a time. With regular treatments, sustained relief was obtained any without the addition of new medication. Conclusions: Interosseous membrane stimulation is safe, simple, and effective for treatment of painful neuropathy. This treatment should be considered for patients who are suffering with painful neuropathy.
RESUMEN
Introduction: There is a need for nonopioid alternatives for treating pain. Acupuncture is one such modality. However, institutional resistance to the use of acupuncture is common in the Veterans Administration. Objective: The goal of this article is to lay out the reasoning for integrating acupuncture within the VA as well as in general practice so as to be able to relieve patients' pain quickly. Conclusions: Among the medical specialties, neurology is particularly suited to lead the way in incorporating acupuncture into daily practice. Aggressive training of physicians of at least basic acupuncture skills should be encouraged. The use of acupuncture as part of pain-control planning should be considered with more of a sense of urgency.
