This 48-year-old woman with known schwannomatosis since age 40 presented with pain in the right anterior thigh and groin. She reported that the pain felt the exact same in quality and location as when she was found to have schwannomas on her left obturator nerve in 2014. In the last year, the episodes of stabbing pain had increased in frequency, and occurred 5-6 times a day with some episodes lasting hours. The pain was worse with lying on her right side, and alleviated with putting more weight on her left side when sitting. She denied any numbness or tingling. She did report some weakness of her right leg, but was able to ambulate without any assistance and has not had any recent falls. She denied any saddle anesthesia or urinary or fecal incontinence. In 2014, she underwent left cryoablation of the schwannoma with significant ongoing relief.
The tumor in the right quadriceps muscle appeared deep, with a second tumor more medial and proximal tumor and less distinct. (Figure 1) Gabapentin at effective doses made her feel overly sedated and "foggy-minded." She had inadequate benefit from buproprion and nortriptyline prescribed for depression, low-dose naltrexone, celocoxib, or ketorolac. A diagnostic right obturator nerve block with bupivacaine and steroids gave partial relief but also motor paralysis for 24 hours, so she was not considered a good candidate for ablation. Prior to a trial of spinal cord stimulation, she was referred for Scrambler Therapy.
Electrodes were placed vertically 2 cm above and below the area of the pain on the quadriceps area, and diagonally across the L1 (medially) and L2 (laterally) dermatomes. (Figure 2) She was treated with five 35-minute sessions of scrambler therapy, with the stimulation increased every 5-8 minutes to tolerance. Her pain rapidly resolved and has stayed low for over 3 weeks. (Figure 3) She was able to resume normal activities like driving, cooking, and even skiing. If the pain returns, more sessions can be scheduled as “booster”sessions take fewer sessions, and last longer each time.(6)
Full written permission was obtained to use her story and photographs, and Johns Hopkins does not require IRB approval for three or fewer patient cases.