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VetVine Client Care
Phantom Scratching - Chiari-like Malformation And Syringohydromyelia
Integrative Care & Pain Management
This clinical case was presented by Deirdre Chiaramonte, DVM, DACVIM, CCRT, CVA in a past webinar on the topic of neuropathic pain:
“Madison,” an 8-year-old spayed female Cavalier King Charles Spaniel, was diagnosed with caudal occiptal malformation syndrome. Since a puppy, she had phantom scratching fits – with the owner reporting four to six fits per day. These fits could be induced by the owner:
Her diagnosis of Chiari-like malformation and syringohydromyelia was based on a combination of factors including her breed, characteristic clinical signs, and supportive MRI findings.
"Madison" was treated with gabapentin (10 mg/kg) and omeprazole (to decrease CSF production). Although she initially showed improvement, she continued to experience multiple daily “phantom scratching” episodes. Other modalities that had been tried included acupuncture, laser therapy, massage, and chiropractic, however these only served to exacerbate her scratching fits and discomfort.
Eventually, pulsed electromagnetic field (PEMF) therapy was introduced into her treatment plan which resulted in a rapid improvement - within 24 hours of starting PEMF therapy, her scratching fits decreased from 4–6 daily to fewer than two, and she appeared markedly more comfortable.
The PEMF treatment plan consisted of 15 minute sessions, every 6 hours for 14 days then tapered to twice daily (every 12 hours). Some pets with chronic neurologic problems / neuropathic pain may seem uncomfortable when first exposed to PEMF therapy - it's been described in humans as a "pins and needles" effect when affected areas are treated. In those cases you can consider reducing the treatment time to 5 minutes for a few sessions, and then slowly ramp back up to normal.
This case illustrates that individual response and tolerance to integrative modalities can vary widely, underscoring the importance of a flexible, patient-centered approach. It should also be noted that PEMF can be combined with some of these other modalities as part of a multimodal approach to pain management.