Pain Medicine News: “Progress, If No Breakthroughs, In Chronic Post-op Pain”
Pain Medicine News is a very good monthly newspaper that focuses on breakthroughs in the science and treatment of chronic pain. Unlike medical journals, which can be difficult and expensive for patients to understand and access, this newspaper does a good job of summarizing the findings and making them available for free. Although some of the articles are clearly focused at doctors (like articles about medical coding), many of these articles should be as interesting for my patients as they are for me.
The most recent issue highlights advances in the issue of chronic pain after surgery: Pain Medicine News – Progress, If No Breakthroughs, In Chronic Post-op Pain. This is a very common problem, especially after spine (“Failed Back Surgery Syndrome”), chest (“Post-Thoracotomy Pain”), or hernia surgery. “Persistent pain in the area of surgery was reported by 40.4% of the patients” in one study described in the article. That’s a lot.
This article summarizes the various factors that go into the development of chronic pain after surgery, from psychological factors to neuroanatomy. There is also some mention of techniques being recommended to reduce the risk of this occurring, with prophylactic medication. I often make such recommendations to my own patients before they have scheduled surgery.
Post-Surgical Pain Treatments
Despite preventative efforts, in my experience it is still not uncommon for pain to persist beyond the time expected for surgical recovery. Often, surgery irritates or damages nerves. In some cases, I am able to pinpoint those nerves and treat them directly. Unlike most pain doctors, I have training in the use of ultrasound to find such nerve problems – often I can directly see a small nerve trapped in the surgical scarring. In other cases, I use non-narcotic medications that target nerve pain specifically. In the case of spine surgery, there is likely a combination of persistent inflammation, nerve irritation, and scar tissue development. The biggest advance for this kind of post-surgical pain is spinal cord stimulation, which for many patients yields large pain reduction.