I met Jacek in the hospital in Wrocław. I was brought there by my friends – I had had an accident on my bike and broke my knee. Jacek had already been there for 2 weeks. He was a construction site manager and one day he went to inspect one of the sites he supervised. While walking on the roof of a building, he fell 11 meters down an improperly secured elevator shaft and landed on shopping carts. Miraculously, he survived. What he had to go through since that day, is impossible to fathom. It is enough to read the certificate from the Social Insurance Fund to understand how much he has suffered so far, and what he still struggles with on a daily basis, including the burning and ripping pain in his paralysed hand (9 out of 10 on the VAS scale) that can occur 4 to 5 times every hour. And it has been like this for the last 12 years! I just want to say that I admire Jacek for his perseverance, strength, and attitude to life. He is a real fighter and always keeps it cool despite constant suffering and pain.
Patient: Jacek Sznajder, born 5 Nov. 1970, place of residence: Mirków, ul. Kościuszki 20.
On 8 August 2008, the patient fell from nearly 11 meters and sustained an injury: multiple organ and structural trauma (fracture of the left mandible, right scapula, and ribs I˂II˂VII, VIII, IX˂XII on the left side, fracture of the styloid process of the right ulnar bone, concussion, post-traumatic right brachial plexus palsy). An attempt was made at reconstructing the brachial plexus in a clinic in Paris (29 Oct. 2008), and a sural nerve transplant was performed. Since the accident, the intensity of pain kept increasing, from tingling to shooting pain. Mr. Sznajder was under the care of prof. Wordliczek due to his neuropathic pain. The opioids he was prescribed (tramadol and fentanyl) proved to be ineffective, as did paracetamol, lidocaine, and ketoprofen. Mr. Sznajder had flaccid paralysis of the right arm with pain that could not be resolved through any pharmacological methods. Transcutaneous electrical nerve stimulation (TENS) was applied with only minor temporary improvement. In 2010, a supraspinal electrode was implanted (an 8-contact electrode, from C4/C5 down). A spinal cord stimulator was implanted over the left wing of the ilium. Due to a lack of any pain-relieving effect, the electrode was repositioned by way of two-sided fenestration C6/C7 – to the right side up to half the height of the body of C4. Lyrica 300 mg/day and Amitriptyline were prescribed, however, the analgesic effect was negligent.
Severe, ripping and burning pain in the right hand (9 out of 10 VAS) and forearm (5 out of 10 VAS) persisted.
On 14 September 2012, one 8-contact supradural electrode was implanted above the precentral gyrus using the craniotomy and neuronavigation method, following electrophysiological verification for MEPs. The electrodes were connected to the Synergy stimulator taken out from the subcostal area and implanted in the left subclavian region. Minor pain relief was observed.
Diagnosis: patient following multiple structural trauma and nerve roots reconstruction (C6, C7, C8, and T1) in 2008. Flaccid paralysis of the right arm. One 8-contact supradural electrode was implanted above the precentral gyrus using the craniotomy and neuronavigation method. The electrode was connected to the Synergy stimulator in the left subclavian region.
Neuropathic pain persists. The patient takes Lyrica 300 mg/day (high costs of treatment). The patient underwent all currently available analgesic therapies. He cannot function normally without powerful analgesics, which he needs to take on a regular basis. The condition is not likely to improve, and additional side effects of the analgesic treatment may develop over time.
The patient continues to be on a pension until 2023.