20-year-old male with chronic low back pain leading to adverse affect changes sees full physical and emotional recovery
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Dr. Shannon Leon Functional Neurology, United States
Presentation
Patient presents to our clinic with chronic low back pain that is not relieved in any position. He has received three cortisone injections in the past year with little pain relief. An MRI lumbar study with impressions of “disc desiccation at the L4-L5 and L5-S1 levels. A central disc protrusion and mild diffuse disc bulge at L4-L5...without significant spinal stenosis or foraminal stenosis.” The chronicity of his condition has lead to self-described anxiety. Clinical examination highlights reveal hypermetric saccades leftward, low tone of left cerebellar musculature, right eye accommodation in neutral, and resting nystagmus beating up-right.
Intervention
To defeat the patient’s propensity for uninhibited oculomotor burst activity we engaged him with antagonist up-left saccades and up-left Brock string; and for appendicular and spinal input to cerebellar para-vermal and vermal regions we enacted multiplanar joint kinesthesis of left extremities and manual high-velocity low-impact adjustments to the lumbo-sacral spinal segments.
Outcome
This patient was “amazed” to find immediate relief after such subtle therapies, and within seven treatments spanning fewer than two months he was able to return to weighted squat exercises. Perhaps more empowering is that he quickly regained emotional stability, thus signaling probability that he will adapt to future stressors without detrimental emotional spillover.
Perspective
Pain is an emotional sense perception that requires breaching the membrane threshold of the anterior cingulate nucleus, and the gatekeeper to that threshold is the conglomerate frontal lobe. Further, the fronto-pontine-cerebellar projections descend to the spinal cord to enact purposeful movement and to avoid tissue derangement. It is our view that this patient had primary lesions in his frontal lobe leading to uninhibited anterior cingulate activation, hence sensitized pain and emotionality, and poorly coordinated lumbo-sacral intrinsic control. And so, following summative activity from spinal joint afferents and frontal projections this patient was quickly able to reach a central integrative state that adequately perceived nociceptive input without anxiety provocation and to coordinate fluid spinal motion with appropriate spurt and shunt stabilizing activity.
Keywords:
Low Back Pain,
Affect,
emotional regulation,
Pain,
Pain syndrome
Conference:
International Symposium on Clinical Neuroscience, Orlando, United States, 24 May - 26 May, 2019.
Presentation Type:
Poster Presentation
Topic:
Clinical Neuroscience
Citation:
Leon
S and
Langhough
J
(2019). 20-year-old male with chronic low back pain leading to adverse affect changes sees full physical and emotional recovery.
Front. Neurol.
Conference Abstract:
International Symposium on Clinical Neuroscience.
doi: 10.3389/conf.fneur.2019.62.00018
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Received:
30 Mar 2019;
Published Online:
27 Sep 2019.
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Correspondence:
Dr. Jason Langhough, Dr. Shannon Leon Functional Neurology, Woodbury, Minnesota, 11797, United States, j.langhough@gmail.com