Abnormal Pain after ANY Surgery
Any pain that lasts longer than 3 months is addressed at the clinic. A number of different conditions can also present to the pain clinic. Some of them are mentioned below. The idea of referring to these conditions together as a group instead of individually is not because they are rare but because these patients do not know that a pain specialist can help them. They keep going to different doctors till somehow some doctor refers them to us. It is indeed a lack of awareness on the part of patients as well as doctors that leads to this debacle.
Post surgery pains; Any surgery anywhere in the body can lead to neuropathic pains because cut ends of nerves in skin and other tissues can set up a cascade of irritation in the nervous system. This manifests as pain, hypersensitivity to touch and pressure , stiffness swelling etc around the scar. In many patients the body manages to address this problem without intervention . Both the patients and doctors simply assume that this pain is a part of convalescence. It is and it is not. In some patients the body is unable wind down this irritability and these patients are referred to a pain clinic. Invariably the wound would have healed perfectly, and there are no obvious causes or abnormalities that can be detected by any present investigations. This is not because there is no abnormality but because our investigations including MRI, CT , PET scan etc are too crude to pick up functional abnormalities at the cellular level in the nervous system . the patients may even be labeled as being “hyper” to have psychosomatic problems. Obviously this is resented by the patients especially a summary reference to a psychiatrist . These unfortunate patients have a definite physical pain that can be addressed and treated successfully with medications , blocks and IMS. They may then be referred for psychiatric counseling to make them understand that mind may be adding to their physical pain. Some of the surgeries that are associated with post surgey pains are
Back surgery ( FBSs or failed back surgery syndrome incidence of up to 30% in the best of centres across the world) This actually not a failure of the surgery or the surgeon but an exaggerated response of the body to the surgery. The reasons and explanations are too many to be narrated here. But properly and patiently treated it can be eliminated in many patients. The key here is patience both from the patient and the doctor till results can be achieved.
Post hernioplasty pains : There is an incidence of pain in 27% of patients but fortunately only 2-3 % have debilitating pains at 1year. Again with medications , blocks and IMS. They have done very well at Ashirvad.
Post knee replacement pain syndromes : A patient decided to have a knee replacement to get rid of the pain. But in some cases the pain becomes worse or new pains develop which may be unbearable . We also realized this as patients came to us with these problems. Fortunately With medications , blocks and IMS. They have done very well at Ashirvad
Post coronary bypass and post pacemaker pains : here these pains are attributed to the wires or called costochonditis or frozen shoulder. We have achieved considerable success with the combination of with medications , blocks and IMS.
Post mastectomy and after head neck hand and foot surgery pains : The occurrence of these pains are not surprising but rather, expected . After all face hands and fee have the highest density of nerves, and it stands to reason that they get cut in the skin incision and the deeper tissue dissections
In all the above conditions and the pains after other surgeries it is IMS and continuous catheter blocks that play the key role in the reversal of these conditions. Medications provide relief till these two can act. The reversal of pain occurs fairly quickly within a few hours or days but resolution of the whole clinical picture may take up to 3-6 months