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: