I FINALLY FOUND SOMEONE WHO UNDERSTOOD THE CHRONIC PAIN I HAD
Surgical procedures are performed with the goal of making us feel better and fixing the cause of a specific problem. Unfortunately, sometimes chronic pain is an unintended consequence of the operation and this pain can occur even if the procedure in question was done correctly. Why would this occur and how could it be remedied? In order to answer this question, we must first recognize the saying that, ‘All pain comes from nerves’. The corollary to this adage is that if one can identify the specific nerve(s) causing the pain and what is wrong with them, perhaps something can be done to improve the pain.
There are many, common surgical procedures which can result in chronic pain. Examples include inguinal (groin) hernia repair, appendectomy, hysterectomy, Caesarian section, vasectomy, and certain types of breast reconstruction. As a cosmetic as well as reconstructive plastic surgeon, I was trained to work from head to toe and hence acquired an intimate understanding of the anatomy of the entire body. As a peripheral nerve surgeon, my specific knowledge of peripheral nerves and how such nerves may be injured, surgically manipulated and repaired has given me an appreciation for defining when nerves have been injured and whether or not they are amenable to surgical treatment.
The nerves that are often injured during the surgical procedures mentioned above are extremely small and can vary in their exact anatomic location. For these reasons, sometimes these nerves are accidentally cut, stretched or burned without the initial operative surgeon realizing that an injury has occurred. In addition, sometimes during the normal wound healing process scar tissue beneath the skin can envelop small nerves and cause compression which, in turn, can lead to chronic pain. Only when this pain does not subside many weeks or months following the initial operative procedure, do clinicians recognize that something has gone awry. Fortunately, certain general principles and compression points exist that allow a peripheral nerve surgeon to determine whether or not a particular nerve may have been injured.
HOW DO I KNOW IF A PINCHED OR INJURED NERVE IS THE CAUSE OF MY PAIN?
During your consultation with Dr. Peled, he will take a thorough history focusing specifically on your pain symptoms. We will discuss all the prior treatments which you have tried in the past, which ones were successful and which ones were unsuccessful and go over any imaging studies or diagnostic tests that you may have had. Dr. Peled will then perform a comprehensive physical examination to elucidate if there are any physical findings that suggest that a pinched nerve could be causing your pain. Oftentimes, a nerve block will be used to confirm whether or a suspected nerve is actually the culprit in your particular case. If the nerve block is successful in significantly reducing or limiting your pain then you may become a candidate for surgery to decompress, repair or remove the injured nerve.
HOW IS THIS TYPE OF SURGICAL PROCEDURE PERFORMED?
Almost universally, surgery to decompress, repair or remove injured nerves can be performed on an outpatient basis. On rare occasions, a 23-hour overnight stay at a hospital may be necessary. There is usually very little in the way of post-operative, confining dressings and/or restrictions and patients are able to eat and drink whatever they like immediately following the procedure. Pain medicine is prescribed for a post-operative discomfort which is usually very well tolerated. Depending on your specific history, the particular type of procedure you have had performed and which nerve or nerves have been addressed in your particular case full recovery can vary. Generally speaking, a procedure is never considered unsuccessful until at least a year has gone by as nerves can often take many months to recover and patients can often see steady improvement for many months following their procedures.
HOW CAN YOU TELL IF A NERVE NEEDS TO BE DECOMPRESSED, REMOVED OR REPAIRED?
This question is one that I get asked quite often and it is a very good question. While there are certain clinical signs and symptoms that suggest whether a nerve has been permanently injured or is simply pinched, there is no way to tell with absolute certainty which is the case. Ultimately, the decision as to what exactly needs to be done is made in the operating room once the nerve or nerves have been exposed and the pathology visualized directly.
WHAT TYPE OF RESULTS CAN I EXPECT FROM SURGERY?
Is not possible to say as a general rule, what your expected recovery will be in terms of pain relief, restored sensation or improved function. The reason for this situation is simply because there are so many variables that ultimately impact the final outcome such as the particular nerve or nerves injured, a patient’s age and other medical problems, the amount of time since the injury occurred, the degree of pressure which has been present and other factors. However, we are able to help most patients who come to see us and have certainly had many patients whose pain has been completely eliminated, whose function has improved significantly and whose sensation has been restored to near-normal. A much more specific and accurate answer to this question can be provided once we know the particulars of your situation which is why it is so important to have a formal consultation and examination with Dr. Peled