PGY-2 Resident Montefiore Physical Medicine and Rehabilitation east meadow, New York, United States
Case Diagnosis: Chronic neuromuscular syndrome secondary to ciguatera poisoning
Case Description: A 42-year-old female complains of fatigue, weakness, myalgia, severe migraine, asymmetric facial pain, and dizziness that began after consuming fish during her vacation. Physical exam demonstrated hypertonicity, hyperesthesia, tender-points, vertigo, and loss of balance. Pain treatment included multidisciplinary management, medications, and other interventions (i.e., botulinum injections, nerve block), and among the interventions osteopathic manipulation proved to lead to the most efficacious outcomes in functionality and pain relief. OMT done on face, cranium, suboccipital, cervical and thoracic regions with regular follow-up resulted in significant pain relief (pain scale from 8/10 to 4/10).
Discussions: Long-term management in affected patients experiencing pain syndrome and neuromuscular symptoms using a wide net of therapeutic modalities can lead to significant positive outcomes in ciguatera patients. The patient in this study managed to have her neurological impairment and pain significantly reduced from multiple therapies to a point where she managed to regain most of her function back. This case study is unique in that the patient with a rare condition experienced the most significant pain relief from OMT out of all the other modalities.
Conclusions: Chronic pain syndrome in ciguatera patients can be managed with multiple modalities depending on the presentation – including OMT, nerve stimulation, nerve blocks, Botox injections, dry needling, and medications. In conjunction with other therapies, OMT has the potential to produce significant relief and function restoration in ciguatera patients like the patient in this case study.
