Chronic Pain Following Surgery or Trauma

Any trauma or surgery can result in nerve damage causing chronic pain (pain persistent beyond normal recovery time for a given surgery). The most common two mechanisms include nerve damage either by direct nerve injury with previous surgery, or as a result of a nerve being passively caught in the scar tissue as healing process after surgery/trauma/burns takes place. The pain can start soon after surgery or in a delayed fashion. Surgical treatment of these patients consists of the excision of involved nerve, neuroma removal. This can be accomplished either by the removal of the most distal painful nerve stump, or by removal of the involved nerve proximally. The approach is determined by the location of the involved nerve, requisite dissection and availability of surrounding muscle for implantation. Unlike medical pain management which focuses on symptomatic treatments, peripheral nerve surgery treats the cause of the pain.

You should see Dr. Ducic for chronic pain following surgery or trauma, if your symptoms persist:

• After common reasons for prolonged post-operative pain (infection, bleeding, tumor, biomechanical abnormality, and others) are excluded by your initial surgeon
• Despite the medical care prescribed to you by your surgeon or primary care physician
• Despite supportive care, such as activity and work adjustments, physical therapy
• Beyond six months of prescribed medical and conservative care
• If you had surgery for a different, non-nerve related problem that was followed with an acute nerve functional loss (numbness, weakness or pain). With this presentation, timely evaluation and intervention within 6 or the most 12 weeks after the nerve injury is critical. Restoration of nerve function may be significantly reduced if decompression is done after 3 months from neuropathy onset. This is unfortunately often overlooked by many who rather choose physical therapy and “let’s wait and see” approach.

What is often seen in the practice, is that patients with chronic pain (including RSD, CRPS) are left to be treated mainly by pain medications which do not treat the cause of the problem, but the symptoms only. As a patient becomes tolerant and dependent on pain medications, relief provided by drugs becomes less and less effective, leaving these patients to suffer from chronic pain. This is where peripheral nerve surgery has an important role by addressing the damaged nerve, and thus treating cause of the patient’s pain.

If you are not sure about your eligibility for surgery, and if you are not in the Washington, D.C. area, you can send me your records so I can determine if you are a good candidate for treatment. Visit my patient forms page for a downloadable form.

Interactive schematic drawings of the most common examples (see text below drawing for definitions and more information prior to clicking on schematic drawing link with your interest) are:

Groin pain following inguinal hernia repair, c-section or hysterectomy

Knee pain after knee replacement or knee arthroscopy or trauma

Foot & Ankle pain following any orthopedic surgery or trauma

Amputation Stump (Phantom) pain below knee amputation, above knee amputation, mid-foot, upper extremity, toe or finger amputations

Dental and Oral Surgery Nerve Injuries

Breast pain after breast reconstruction or other breast surgery

Trunk pain history of previous surgery

Upper or lower extremity pain following any surgery or trauma

Post-Craniotomy Headache pain previous acoustic neuroma or other cranial surgery

Post-Herpetic Neuralgia following shingles

You should also know:

What is actually done during nerve excision surgery?

Usually under general anesthesia, an incision through skin, overlying the anatomical location of the neuroma, is made and deepened through anatomical planes. Sometimes, that incision is made proximal to the actual neuroma site in order to have a better implantation site so a neuroma does not recur. If extremity surgery is done, unless contraindicated, a tourniquet is applied proximal to the operative site to provide bloodless field. In this case, blood loss is nearly none, completely eliminating any need for blood transfusions. Once the nerve/neuroma is identified, using proper microsurgical instruments and techniques, excision is performed. When a neuroma involves a sensory nerve, which is most often is the case, numbness/paresthesia distally in the involved nerve’s distribution can be expected post-operatively. Implantation of the proximal stump of the nerve into muscle is carefully done to minimize its chance of recurrence.

Surgery: In-patient or outpatient, its duration, recovery?

Most, if not all of the above treatments are done on an outpatient basis, unless your pre-existing medical condition would warrant admission. It takes in average one hour to perform the surgery.

Dressings are removed, on average, in one week. While sutures are removed about three weeks after surgery.

Ambulation, in general, depending on your personal level of discomfort, is permitted right after surgery. Some patients prefer to use crutches during immediate post-operative period.

Recovery varies but it usually takes about two-three weeks, which certainly can vary depending on several variables (type of professional work done, age, co-morbidities, etc).