In Search of the Best Pain Clinic in L A: Working With Other Specialists, Part 2

By | January 23, 2013

If physical therapy is the attempt to physically overcome disabilities, occupational therapy is the  attempt to work around the disabilities that cannot be directly overcome.  Here a woman with weakness of her right hand uses a tool to overcome this disability.

If physical therapy is the attempt to physically overcome disabilities, occupational therapy is the attempt to work around the disabilities that cannot be directly overcome. Here a woman with weakness of her right hand uses a tool to overcome this disability.

In our continuing saga of Madame X and her right forearm and hand pain, I told the patient and the hand surgeon that while the distal radius and the carpus need to be stabilized I would recommend that the surgery be as quick and limited as possible to minimize any further nerve damage. I told her that felt that this might be early complex regional pain syndrome (CRPS) and that a diagnostic stellate ganglion block should be done at the Burbank offices of Schlesinger Pain Centers as soon as possible to confirm the diagnosis. Since her current pain medication was ineffective, I started the patient on moderate doses of gabapentin. I also gave her a referral to occupational therapy, which surprised her since she was no longer working and didn’t understand the difference between occupational therapy (OT) and physical therapy (PT). I explained to her that although her right was not her dominant hand, she had told me that she was still having trouble with many activities of daily living (ADL) and that since there was a high likelihood that the hand would never be completely normal she needed help learning how to work around her disabilities. Finally I told her that if all of the above measures proved ineffective I would recommend a trial of spinal cord stimulation (SCS), but not until after all of the hand surgery had been completed.


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