Novel Treatment of pain arising from contact with a North Queensland Stinging Tree

A 24 year old male who three days earlier had disregarded posted warning signs and had gone bush bashing in an area known for its Stinging Trees and had come into contact with a leafy bush and immediately felt pain that over the next 20 minutes became increasingly intense with the pain described as burning and unbearable and localised to his lower right arm and right lower leg. (The areas that weren’t covered by clothing). Despite the pain he reported that there were no changes to his skin.

Locals advised him to apply hot wax and to peel it off after it had hardened. He was able to obtain some wax 12 hours after the initial incident. This procedure provided no pain relief.

Some 12 hours later he applied multiple doses of a steroid cream; this also has no effect on his pain.

At 3.5 days he presented to a retired General Practitioner who had specialised in the treatment of chronic benign pain syndromes. There were no physical signs, other than a slight tachycardia and mild sweating and in particular there were no observable skin changes on presentation. His pain was worsened by temperature change, air flow and light stroking. However the patient complained of severe burning pain that was not diminishing and an evolving severe itching sensation involving the right lower leg and right lower arm. The pain was similar to that described by those in the early stages of Herpes Zoster.

A provisional diagnosis was made, following an internet search, of Stinging Tree envenomation.

Treatment

Acupuncture with deep needling ( Xie technique) was performed at Li11, Li4 on the ipsilateral upper arm and hand plus ipsilateral GB 34 and Liv3 on the lower leg and foot. Following the onset of the desired Acupuncture induced sensation at the needle sites, best described as a deep dull ache, the patient experienced complete relief of pain and itch. The needles were retained for 30 minutes with intermittent manual stimulation. The pain and itch re-occurred within 10 minutes of the needles being withdrawn.

An hour later the same Acupuncture treatment was given and the pain and itch were again immediately ablated. Following the second 30 minute treatment the patient had good relief of pain but was still complaining of a severe itching sensation. The patient was able to sleep that night and the following morning was far less distressed and complaining of itch rather than pain.

A third acupuncture session was provided (on the second day of treatment) and a liberal application of a Capsaicinoid – Nictotinate substance (Finalgon Cream by Boehringer Ingelheim) was applied to the itchy areas post acupuncture. Several hours later another application of Finalgon was applied. After several hours the patient reported complete pain relief and his itch had markedly subsided.

The following day (third day of treatment) another application of Finalgon cream was applied and the mild residual itch completely resolved after several hours. Over the next week there was no re-occurrence of pain or itch.

Discussion

Pain arising from Australia's Stinging Trees has a comprehensive literature with multiple references and scientific citations easily found via a Google search for the term "North Queensland Stinging Trees". These papers commonly reference severe pain that lasts from weeks to months.

The acupuncture treatment given was specifically designed to provide acute pain relief. The techniques of needle insertion and manual stimulation were taught to the medical practitioner at the Nanking School of Traditional Chinese Medicine (1978). The most probable mechanisms include the release of spinal encephalins and perhaps the release of endorphins from higher centres. The practitioner had treated many early Herpes Zoster patients both in China and in Australia, but had never encountered a Stinging Tree envenomation patient, hence the selection of points and method of stimulation was chosen on empirical grounds.

Capsacinoids are well known for their effect on substance P and there is some literature that supports the use of them in the treatment of itch. The combination of Acupuncture and Capasaicin was a commonly used treatment in the author’s pain clinic for the relief of selected chronic benign pain syndromes.

Medical literature that involves isolated case studies of novel treatments is frequently worthless and does little to advance medical science. Hence it is with some reluctance that I have written this case study. However the dramatic relief afforded to this patient and the abundant literature that points to spontaneous remission over several days being unlikely plus the likelihood of the practitioner being able to get the opportunity to see and treat more Stinging Tree Envenomation patients is in all likelihood zero, I have taken the risk of publishing this account.

I would be interested to hear if other practitioners have had or have similar results using the techniques described above. Please email: [email protected] and tell me your story.