Pain doctor stumped, saying maybe my nerves are in different place to other people?
 

Hey, I visited one of my pain doctors for a lidocaine injrction in my abdomen on right side for my chronic pain of 1 year duration after lap surgery. My area of where pain spreads is small and horizontally across to one of laparscopic holes, its almost like if you put 2 fingers together horizontally just below my right chest side, thats how much the area of pain is, but it does cause lots of discomfort. If I pick/fold my skin in that area with fingers, it gets more tender and painful, thats how I narrowed down the area of problem and its in my abdominal wall.

To date, I have had almost 7 procedures of lidocaine injections, intercostal nerve blocks, rectus sheath blocks, TAP blocks, (all of these have been injections in my abdomen- not spine) to cover that area nerves but none have provided any relief, not even temporary. After all the blocks, my side feels normal( except the usual pain), it's almost like the injections didn't happen, I get no feel of numbness, or reduced sensitivity, inside or outside on the surface.

Today, I again had one more lidocaine injection with another doctor, same result. I finally asked him, this is my problem area( the pain gets worse if I hold my skin here), if all other doctors and you with all these injections and nerve blocks have tried to numb the nerves, why does my pain not get any better, or why don't I feel any different after the blocks, his answer was I am baffled, maybe your nerves are in different place to other people. Or maybe your problem is somewhere else.

But both of these don't make sense when even light pulling of my skin in that area intensifies the same dull achy pain( so obviously that's where my nerves are, and the pain is affected in this area), so the problem can't be elsewhere.

I can only think maybe my nerves are insensitive to lidocaine, or whatever local anesthetic they've used, and I need to try with alcohol, phenol ( unlikely I know). Or the local anesthetic is not reaching the nerves, (which also doesn't make sense after so many injections).

I asked him if I get surgery, will they be able to see the nerves or do anything about it, he said I don't know.

I am thinking at the very least if they can't see anything surgically, can't they just completely cut and remove the whole of that small area( skin, fascia, muscles) and just reattach the severed ends? Wouldn't this ensure that whereever the problem area or nerve is, its taken out?

I am wondering if anyone has anything to suggest. I am done with pain managment and going to try surgery, but just not sure if I should get the opinion of general surgeon or will prepheral nerve surgion have better idea. Thanks

I had pain after my first surgery that might have been neurological to begin with. My story is that with many investigations, antibiotics, and finally another surgery, I now have small fiber neuropathy that is everywhere.

I am not saying you are like me. But I had two surgeons tell me after my appendectomy that a mass was causing my pain and the pain would go away after surgery.

At the time, my truncal pain was awful. Now, this neuropathy makes it seem like a walk in the park. I am very sorry for your pain and all the procedures.

Generally, the physician thinks you have what they treat. I could go on and on about my story.

Have you tried going to a physical therapist that does scar tissue release with laser? Thisightus be less invasive before surgery.

As an aside, the blocks and injections are very expensive and are set up in an assembly line. Some pain docs make 5K for 5 minutes of work. I had a pain doc recently tell me he could do a wait and see block on me.

I have sfn, so no way will this help. My Neurologist just frowned and told me that he would not support a block for me.

Hope you get relief soon.

Did anyone tell you if this could be adhesions or did you have a scan to compare before and after surgery?

From everything I have read here and elsewhere, it is standard procedure for many pain doctors to put patients through blocks before they will advance to prescribing pain meds. The injections make them a lot of money and seldom if ever work on neuropathy pain. I have no idea why this is so prevalent considering that the statistics on the failure rate are out there. It seems unconscionable, wasting money and delaying effective relief.
I know absolutely nothing about surgery, but I would try very hard to avoid it unless it was a clear cut path to relief. So many come here with neuropathies caused by surgery.

remember that doctors, are making big bucks when they are giving any kind of treatment, any kind. As soon as you enter the office, they could give you whatever procedure, injections and they charge your insurance for it.

I started going to a very experienced physiotherapist about a month or so ago. He has told me to give him few sessions to work on before I decide what to do next. So I am planning maybe another six sessions before deciding to go surgery route( which does seem likely at the moment).

I have read that adhesions don't show up on any tests. Plus they are more likely to affect organs, but my pain is very superficial, I csn pick my skin and it hurts the same pain, so maybe it is external scar tissue, it was hinted by my physiotherapist. But then that would hurt you with moving, bending etc, my pain is not like that, its constant, and usually stays the same, unless I pick my skin and massage it between fingers, then it hurts more but feels good in a way also.

My CT scan came clean, US and MRI hinted some abnormality in the anterior abdominall wall( saying hypoechoic area, contrast enhancement) but this always got ignored by all doctors I saw, either because they don't know what all this means , or they just said I had surgery so it is normal for that area to be abnormal but shouldn't cause pain.

To Susanne: Im from Canada so I dont really have to pay anything, but Im sure its the same thing here doctors making money from injections and billing the province insurance plan. But the problem is even after so many injections, all of them including my gps refuse to give any pain killers. I am 26, maybe that's why.
I hate thinking about surgery after it is what caused me this problem, but I can't see any option. I can't even get any opiates to help in the mean time. I really hate the system here.