Disclosures: Yonghoon Lee, DO: Nothing to disclose

Case Description: 55-year-old female developed right upper extremity chronic neuropathic pain after spinal infarction at level C6-T2 due to cardiac arrest event during a sedated cervical transforaminal epidural spinal injection.

Setting: Outpatient rehabilitation clinic

Patient: The patient developed right upper extremity weakness along with allodynia and paresthesia in the right scapula radiating down to her medial side of the arm and forearm. She also presented with decreased pin prick sensation in the left upper extremity. She was diagnosed with Brown Sequard syndrome. The patient was referred for a trial of acupuncture for the management of chronic pain. Patient failed conventional management including therapy and medical management.

Assessment/Results: Initial acupuncture treatment included percutaneous wrist needling which was not effective. On a subsequent encounter auricular points and distal hand points were used which improved the pain significantly up to 2 weeks after each treatment. All acupuncture treatment was combined osteopathic manipulative treatment involving counter strain and balanced ligamentous tension of upper trapezius, scapular mobilization while needles were placed. Before the needles were drawn, the patient was asked to actively make arc with her shoulder joint and active range of motion of her neck in all directions.

Discussion: Wrist and ankle needling is a modern shallow percutaneous acupuncture technique which is safer and causes less pain than conventional needling. Auricular acupuncture is suggestive of modulating reticular formation and parasympathetic nervous system. Distal acupuncture points were selected based on the traditional acupuncture channel theory. Soft tissue osteopathic manipulative techniques were combined to provide fine tuned local soft tissue relaxation. Active movement was combined with acupuncture as a way to provide musculoskeletal proprioceptive feedback of the treatment.

Conclusion: Auricular and distal hand acupuncture combined with soft tissue osteopathic manipulation and active range of motion provided satisfactory result for the chronic central neuropathic pain which was difficult to manage.

Level of Evidence: Level V

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PM&R Meeting Abstracts - https://pmrjabstracts.org/abstract/brown-sequard-syndrome-pain-management-with-acupuncture-and-osteopathic-manipulation/