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Post-surgical pain

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  • Post-surgical pain

    In December of '12 they anesthetized me at 7:30 AM and I wakened at 3:30 AM the next day. I didn't feel too good.

    Because I was a good candidate for endoscopy, the surgery was done with the aid of a robot and instead of opening my chest, five entryways served their purposes. The artery was repaired and I was sent home very soon. I spent the next month sleeping in my recliner.

    I'm convinced that the consequent tenderness and numbness I still sense would be worse had I not worked on them with my own version of manual care and movement. When a rehab program was offered I wasn't available and instead I have dragged myself through the processes of aerobic and anaerobic conditioning I know would be best. I've found it takes a while.

    Today there's a discussion begun here that addresses the issue of post-surgical pain directly.

    We should all join in.
    Barrett L. Dorko

  • #2
    Six months in I continue to sense spots as tender and numb.

    I'm convinced that without knowing what I know and doing what I do this would be a larger problem, but that remains in the realm of speculation.
    Barrett L. Dorko


    • #3
      Anybody else here with thoughts about post-surgical pain?
      Barrett L. Dorko


      • #4
        Only personal experience. Once, when it "should have" hurt (but didn't) and once where it did (for no good reason).

        The first time, I didn't know the procedure was meant to run a significant risk of chronic pain till after the fact (wouldn't have mattered anyway; it was critical surgery). I recall taking a lot of Fentanyl whilst in hospital (lovely drug), but after discharge, no other pain meds. I still have sensory 'black spots' from where the thoracotomy was performed but no pain.

        The second time was for ACL surgery - which didn't hurt at all when I woke up, but seems to hurt now (6 months after the fact).

        What's funny is that all the best practice treatment protocols (yes, all the phase I-IV stuff that you're suppose to do) haven't done a nearly as much for pain control & confidence as just going hell for leather on the stationary bike for 4 repeats of 20 seconds (That's 1 minutes 20 for the mathematically challenged).

        The nervous system's a funny thing - it doesn't seem to much care I spent a lot of $$$ for my CEU and best practice algorithms. :/
        Last edited by Dan84; 28-05-2013, 07:29 PM.
        Tactile Raconteur


        • #5
          Only 11 turned up – 3 of those were other speakers, two were friends and another 2 were only interested in medicolegal issues and pain. I guess the surgical world, for many reasons, are not ready or do not want to confront the problem. Or perhaps it was just me? --David Butler from the blogpost linked to above
          I recently approached a couple of spinal surgeons about doing pre-operative education for patients undergoing spinal surgery based on the research done by Adriaan Louw. One of the surgeons was concerned about how it would get reimbursed and the other one didn't show up for a meeting we had scheduled at his office. He hasn't responded to a subsequent email, either.

          This is going to be a very tough nut to crack I think because surgeons are so territorial when it comes to the patients they decide to perform a surgical procedure on.
          John Ware, PT
          Fellow of the American Academy of Orthopedic Manual Physical Therapists
          "Nothing can bring a man peace but the triumph of principles." -R.W. Emerson
          “If names be not correct, language is not in accordance with the truth of things. If language be not in accordance with the truth of things, affairs cannot
          be carried on to success.” -The Analects of Confucius, Book 13, Verse 3


          • #6
            My right tibia fracture site hurts everyday (hyperalgesia to mechanal stimulus). The screw through my medial malleolus can be seen and palpated. Running and jumping activities let me know i've been put back together. The skin over top of the screw is sensitive (allodynia) to touch and the site will ache on random occasions (I do not blame weather...AIGs is my best explanation). I dream of the leg breaking on occasion. I feel and hear the fracture occur then wake up pain free.
            "The views expressed here are my own and do not reflect the views of my employer."


            • #7
              I can't help but think that given a little time I could help both of those with pain here.

              But I don't really know for sure.
              Barrett L. Dorko


              • #8
                Having spent time in theatres over the last 30+ years with the surgeons who refer patients to me, I wonder if some post operative pain is due to what appears to me to be rough handling during the proceedures.

                I was lucky enough to be taught orthopaedics at the British School of Osteopathy by Professor Anthony Andreasen who qualified in the 1930s,and sometimes discussed my concerns with him.

                He said that he was trained to handle the internal structures as gently as possible so as to avoid bruising,as this was thought to compromise post op recovery and increase the risk of infection. He said that this was less of a priority nowadays due to the availablity of antibiotics and post op physiological support.

                He also said that the inside of the body was "private" and was not designed to be "mauled about".

                Post op patients do worry about this and sometimes assume that something has gone wrong, despite the reassurances offered by medical and nursing staff.


                The post-op brain


                Patients who have undergone surgery may develop a condition known as postoperative cognitive decline that involves problems with memory, concentration, and attention. Researchers are trying to determine what causes this condition and how to protect patients. Whether the impairment persists remains controversial, with some studies suggesting a link between surgery and long-term mental declines and other studies finding no connection. Researchers long suspected that anesthetics, which can damage brain cells, triggered cognitive problems. But the main suspect now is inflammation sparked by the physical trauma of surgery. Researchers are now investigating several ways of protecting the brain, including activating natural inflammation-suppressing mechanisms and beefing up patients' cognitive abilities before surgery.
                Update 02/06/2017
                Last edited by Jo Bowyer; 02-06-2017, 08:09 AM.
                Jo Bowyer
                Chartered Physiotherapist Registered Osteopath.
                "Out beyond ideas of wrongdoing and rightdoing,there is a field. I'll meet you there." Rumi


                • #9
                  I have been treating a patient with CRPS for about the last 6 months - a work comp injury that resulted in the classic amount of mis-management, suggestions of the patient "faking it", and non-effective procedures before achieving "maximum medical benefit" and being thrown to the wolves.

                  She underwent a thoracic thoracotomy before coming to see me, symptoms became worse after surgery with classic redness, swelling, dystonia, and contracture. Allodynia to touch and unable to wear certain clothes due the the pain they provoke. I have wrote several letters and made phone calls regarding my concerns over the last few months but never get responses back. I'm currently going through some graded motor imagery with her which has resulted in some meaningful pain reduction, but not much improvement in function of the arm. She has had several follow up appointments with other orthopedic surgeons who have all told her she has "frozen shoulder" despite her complaints of pain spreading into the face as well as many of the largely apparent above mentioned symptoms. Almost every one of them tell her to "push it until you can't stand it" in order to get better.

                  It's very unfortunate. Things types of cases require multidisciplinary management, and people have to be on the same page. That requires communication amongst all healthcare professionals and a willingness to accept that nobody holds the silver bullet treatment. I'm afraid that David Butler's surgical sadness is likely to be commonplace for a while longer before it begins to improve.
                  Ryan Appell DPT


                  • #10
                    I wonder about adequate and immediate post-surgical analgesia and its relationship with ongoing pain (or not). PCAs are fine if the patient is competent and aware enough to use it at all; I knew of someone who did not use the PCA post-TKA because he was too sleepy and as a result, he had to go onto opioids for four months to control pain.

                    Sometimes I think post-surgical pain can be iatrogenic but it is very difficult to ascertain. I have no personal experience of post-surgical pain as I have never had any complex surgery, apart from an SCC dug out of my arm about 18 years ago and no pain at all afterwards.



                    • #11

                      I realize I should know, but what does "PCA" stand for? I assume it's one of those pain relievers the patient controls. "Patient Controlled Analgesia"?

                      Of course, I'm pretty sure that "SCC" is one of those animals you've got down there.
                      Barrett L. Dorko


                      • #12
                        Couldn't agree more, Nari - though in my case, 3 hits of fentynyl = fall asleep = bliss.

                        (Now that I think about it, that was a very important effect)

                        I'm not sure exactly how they positioned me during the surgery, but I did feel as if my shoulder had been dislocated for the next few months. Seeing I was still alive, it didn't seem like much to complain about.
                        Tactile Raconteur


                        • #13
                          I didn't want to mention it, but I was massively bruised in an area that remains numb.

                          The surgeon didn't know what to make of it and said he'd never seen such a thing before.
                          Barrett L. Dorko


                          • #14

                            PCA is indeed what you thought it was, and SCC is squamous cell carcinoma - a rather cranky skin cancer. However, after that length of time, all looks good.

                            It just goes to show that with regard to pain, no one size fits all. Highly individual responses are the norm, but lots of medicos and others don't appreciate that fact as much as they might.
                            The bloke who had his TKA has had "hip" pain on and off ever since on the same side. He reckons the positioning for all their carpentry ruined his previously symptom-free hip.