(247) Successful interdisciplinary pain management in the treatment of chronic joint pain in a patient with Noonan Syndrome: a case report

Abstract

Noonan Syndrome is a rare genetic disorder that results in the abnormal development of various body parts that can present as short stature, unusual facial features and is most commonly associated with cardiac defects. Chronic joint pain is a clinical finding that is associated with Noonan Syndrome (54% prevalence).1 We present a case of a 51 year-old male with a history of scoliosis status post correction who presented with back, neck and bilateral knee pain. The back and neck pain were described as dull in nature and the knee pain was sharp. The neck and back pain improved with lying down, however, there were no clear alleviating factors for the knee pain. Prior to being evaluated by the chronic pain program, he had been taking hydrocodone/acetaminophen 10/325mg, one to two tablets, four times a day. Without pain medications, the patient’s pain was rated a 90/100 on a visual analog scale (VAS), and decreased to 40/100 on the VAS with opioid medication usage. Prior to participating in an interdisciplinary pain management program, the patient tried land based physical therapy with limited success. Through participation in an interdisciplinary pain management program, which included occupational therapy, physical therapy, biofeedback, pool therapy, feldenkrais, twice weekly medication monitoring and pain psychology, the patient was able to improve his functionality and tolerance to pain. He also learned coping strategies which helped him manage his pain on a more productive basis. This case highlights the importance of using an interdisciplinary approach in the treatment of complex disorders when other treatments have been unsuccessful. (1. Smpokou, P, American Journal Medical Genetics, 2012.) Noonan Syndrome is a rare genetic disorder that results in the abnormal development of various body parts that can present as short stature, unusual facial features and is most commonly associated with cardiac defects. Chronic joint pain is a clinical finding that is associated with Noonan Syndrome (54% prevalence).1 We present a case of a 51 year-old male with a history of scoliosis status post correction who presented with back, neck and bilateral knee pain. The back and neck pain were described as dull in nature and the knee pain was sharp. The neck and back pain improved with lying down, however, there were no clear alleviating factors for the knee pain. Prior to being evaluated by the chronic pain program, he had been taking hydrocodone/acetaminophen 10/325mg, one to two tablets, four times a day. Without pain medications, the patient’s pain was rated a 90/100 on a visual analog scale (VAS), and decreased to 40/100 on the VAS with opioid medication usage. Prior to participating in an interdisciplinary pain management program, the patient tried land based physical therapy with limited success. Through participation in an interdisciplinary pain management program, which included occupational therapy, physical therapy, biofeedback, pool therapy, feldenkrais, twice weekly medication monitoring and pain psychology, the patient was able to improve his functionality and tolerance to pain. He also learned coping strategies which helped him manage his pain on a more productive basis. This case highlights the importance of using an interdisciplinary approach in the treatment of complex disorders when other treatments have been unsuccessful. (1. Smpokou, P, American Journal Medical Genetics, 2012.)