We report a case of a woman with disuse syndrome who had a history of depression and was suspected to have central sensitization syndrome.
The woman was 55-year-old housewife. Because she had difficulty moving her body and felt weak, she called for emergency medical care. She was then admitted to the hospital for treatment of acute prerenal renal failure and electrolyte abnormalities including K, Mg, and P. She has had numbness in both lower limbs and distal to the wrist joint for 2-3 years. The numbness increased distally from the knee joints, and sensation in the plantar feet was lost. Her medical history includes a diagnosis of cervical spondylosis. She had depression, psychomotor seizures, and anxiety disorder, and had been attending our department of psychiatry. Her Barthel Index (BI) score was 60 points. She complained of Numeric Rating Scale (NRS) 5 pain at rest and pain after walking about 5 meters. The pain appeared on the contralateral side after slight tactile pressure stimulation, suggesting the possibility of central sensitization syndrome. The following patient reported outcomes (PROMs) were collected; Central Sensitization inventory (CSI) 39 points, Pain Catastrophizing Scale (PCS) 42 points, Tampa Scale for Kinesiophobia-11 (TSK-11) 33 points, Pain Self-Efficacy Questionnaire (PSEQ)-28 points, and Hospital Anxiety and Depression Scale (HADS)-29 points. The results of QST suggested that temporal pain summation (TPS) was increased and conditioned pain modulation (CPM) was not functioning. Therefore, the patient was given graded exposure, including instruction in self-touching and walking practice, starting with short distances.
After 10 days of intervention, the patient began to show a positive attitude toward rehabilitation, and received positive comments regarding increased activity. The PROMs ultimately resulted in the following scores; CSI 24 points, PCS 39 points, TSK-11 24 points, PSEQ 32 points, and HADS 13 points. BI was 90 points. After 30 days, she was discharged home and transferred to an outpatient rehabilitation facility.
The use of graded exposure, low intensity and high frequency exercise therapy, starting with self-touching and short distance walking, led to an increase in walking distance. In addition, cognitive-behavioral therapy and exercise therapy improved the patients' mental health and depressive state, and they became more positive, and even voluntarily participated in the rehabilitation program.
Although it is anticipated that the selection of treatment programs and load setting may be difficult due to the coexistence of multiple diseases, it may be beneficial to develop a management plan based on an understanding of a person characteristics using the PROMs.
Disuse syndrome
Depression
