Chronic Post Surgical Pain


 

CHRONIC POST SURGICAL PAIN

Continuing pain after surgery is a very unfortunate problem.  If further surgery is not indicated, these patients often come to our practice.  The following will try to cover the more common postop pain problems we see.  Please see our section, BACK NECK PAIN AFTER SURGERY.

Continued pain in the affected extremity is not uncommon following TOTAL JOINT procedures and surgeries of the distal extremities to REPAIR FRACTURES of the wrist or ankle. These joints may develop severe Nerve pain or CRPS (see Nerve CRPS Pain section).  Nerve injections or RFA Nerves may be considered.  For postop SHOULDER pain—Suprascapular or Axillary Nerves. Postop KNEE pain—Genicular Nerves x3. Postop HIP pain---Lateral Femoral Cutaneous. Postop ANKLE pain---- we look at 5 nerves---Posterior Tibial, Deep Peroneal, Superficial Peroneal being the most common.           Other options include SCS/DRG and/or PNS.  

Groin pain after a HERNIA repair is common.   We commonly do steroid injections or RFA of the Ilioinguinal and/or Genitofemoral nerves. We can also consider DRG or PNS for this groin pain. 

Continuing thoracic or rib cage or abdominal pain often continues after a THORACOTOMY.  Again, we can do steroid injections or RFA of the intercostal nerves (the nerves running under your ribs).      PNS is also an option.  

After an AMPUTATION of an extremity one can develop two types of chronic pain, NEUROMA pain or PHANTOM pain or both.  The neuromas of the different nerves can have steroid injections or RFA. Phantom pain will often see benefit with sympathetic blocks, such as STELLATES for upper extremity and LUMBAR SYMPATHETIC for lower extremity.  We can also consider SCS/DRG or PNS.  

For chronic pain after ABDOMINAL surgeries we often do steroid blocks of the distal(TAP blocks) or terminal branches(RECTUS SHEATH block) of the intercostal nerves. If you have widespread upper abdominal pain, we may consider Celiac plexus blocks.

Chronic pain after PELVIC surgeries we may block the ilioinguinal, genitofemoral or pudendal nerves depending on where your pain is.  If you have widespread pelvic pain, we may consider Superior Hypogastric Plexus blocks.  PNS may be considered for Abdominal/Pelvic pain. 

Pain after mastectomies, cosmetic breast procedures can cause chronic axillary pain or anterior chest pain. We often do intercostobrachial nerve blocks for the axillay/inner arm pain and consider distal or terminal intercostal nerve blocks for the anterior chest pain.  A PECS blocks is a way to block multiple nerves of the anterior/lateral chest. 

Again, the above are the more common problems we see after surgery.  If you have continuing pain after your surgery, please come in to see us.