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Post-thoracic pain syndrome

Hello, I recently (Jan 20) had a re-coarctation and descending aortic aneurysm repair. Today, six months later, my post-surgery pain is still very strong and does not allow me to do basic things like driving etc. My doctors say that if my condition is still the same after a year I will need to go to a pain clinic. My question is: can anyone reassure me that this pain will eventually go away? If yes, how long could this last?
Best Answer
7721494 tn?1431627964
OK, I misunderstood the situation. Let me give you information in general, and then share thoughts about pain management. Please be patient and read what I have to say.

First, a caveat. This is not a surgery forum and we have limited expertise with your problem. I've witnessed two open chest surgeries in my life, neither of which looked to present an easy road to recovery.

No one here can assure you that your pain problem get better within any time frame. Your surgeons have averages and will report that the "average patient" feels better after a year. There is no average patient -- only statistics. You medical state, including the trauma suffered under surgery, the ability of your body to heal, your genetics, and many other factors, may be very different from those statistics.

Surgical procedures are traumatic events, and destroy muscle, connective tissue, bone, blood vessels, nerves, and other body structures, right down to microstructures like capillary beds and even individual cell walls.

Healing must occurs at all of those levels, from the smallest cell, up to the bones in your chest that have been wired back together.

However, you are not a machine and there are no "replaceable parts". The body never returns to the "original configuration" after trauma because of scarring.

Scar tissue is a connective tissue that replaces injured tissue. The nature of scar tissue differs depending on the original tissue type, and is not identical to that tissue. Just look at the fresh scars on your chest -- do they look like skin?

Scar tissue does the job of closing the wound, but it requires many years for it to return to something close to the original tissue, if ever. Some believe that massage, exercise, or certain supplements help scar tissue return to normal. To some extent this is true.

Thoracic surgery like that you underwent four times is major surgery, destroying layers of all kinds of tissue, excluding organ tissue. Bones, muscles, and sinew must repair themselves, while nerves, blood and lymphatic vessels must reroute themselves. However, nothing ever returns to its original state.

For example, my left thumb got caught up on barbwire fence and required minor surgery in 1964. I still have numbness and tingling on one side of that thumb, with the occasional moments of a sharp stabbing pain. This is all due to the nerve tissue damage experienced 50 years ago. My thumb doesn't require medication or treatment, but it causes discomfort at least once a day. Sometimes that stabbing pain will wake me up, and I'll go ice it before it calms down.

That's just a thumb (half a thumb, really.) I can't imagine what its like to feel how you feel.

If you are OK with the current pain level and want to stick it out, then you can wait to see if it gets better. But it sounds to me that you are not comfortable, and that your pain is unmanaged, meaning it hurts, badly, most of the time.

Treatment of pain usually requires multiple modes of therapy. Physical therapy can be helpful treating skeleto-muscular pain. Interventional pain management can be effective treating pain with procedures aimed at blocking the pain signals traveling to the brain.

Other modalities may help. All modalities must be planned for with medical supervision that prioritizes risk. I imagine that your major area of concern is with that aorta and circulatory system in general, so a treatment plan must respect their limitations.

Simple actions, like massage or stretching can help change scar tissue and promote healing. Exercise is good. But all this must be done under your doctor's supervision. You must pursue healing with patience and prudence.

If you are self medicating with OTC NSADs like ibuprofen, be warned that its use has now been associated with heart disease. Acetaminophen is liver-toxic when taken in doses over 4000mg per day (that's 8 "extra strength" Tylenol capsules). The more we learn about these medications, the more we realize that there is benefit and risk in every substance we put in our bodies.

Unmanaged pain is of concern because it can lead to chronic pain syndrome -- a is disease of the central nervous system that comes with constant pain and other unpleasant symptoms, even after the trauma of your surgery has healed.

But ignoring the chance of chronic pain syndrome, you're uncomfortable now. In my opinion, you need treatment. I don't believe that unnecessary suffering is required in a medical situation, especially given your experience.

If your pain is unmanaged then I suggest you work with your doctors to find a solution to your problem now, and not wait for another 6 months with severe pain.

Don't tough it out -- there is no virtue in this attitude, and don't let a doctor tell you that there is.

Granted, the side effects of opioid pain medication are lousy. Some can be dealt with, and some can't. There is risk of dependence, and in some, addiction. Side effects come from almost every medication -- medical treatment comes with trade offs -- but most side effects can be dealt with by an experienced and caring practitioner.

It's your body and your decision on what you experience. We cannot guarantee happy endings.

I suggest that you do what needs to be done now, and not wait to see what happens in six months. You don't need the pain, the anxiety, or the disruption in your life. I believe that healing occurs more quickly in an environment of managed pain and anxiety. I believe that good health involves feeling comfortable within your body.

But then, I'm just an old sheep doctor, so what do I know about the concerns of modern medicine?

Best wishes.
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7721494 tn?1431627964
Aortic repair is a highly invasive procedure. I imagine you would still have pain.

Your surgeons will know how long pain lasts on average, but not everyone is average.

Your pain is unmanaged, and you are probably under medicated. So, if they won't treat with adequate and appropriate opioid medication, demand that they refer you to pain medicine, now.
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Avatar universal
I am not on any pain medication at the moment. Why is it so important to take any? I understand that it benefits quality of life, but my question is whether there is a more kind of a once and for all solution to my problem.
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Avatar universal
This last surgery was my fourth aortic procedure. I've started at the age of 2 and am now 37. Have had coarctation repair, valve replacement, ascending aneurysm and this recent one. Overall 2 sternotomies and 2 left side thoracotomies. The pain I'm experiencing now though is incomparably more excruciating than anything in the past. I don't mind being in pain as long as I know it will come to an end. That's why this time I'm a bit worried because I came across opinions such as "it could last up to 3 years" and -even worse- "it will never really go away". In general I'm also a little hesitating when it comes to pain meds; I haven't had any as far for any of my previous surgeries -even though I'm extremely sensitive to pain. Knowing that it will eventually withdraw I prefer patience. But, as I said before, this time I'm a little confused with the various opinions on this.
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Avatar universal
Thanks for taking the time to give me such a detailed and clear approach to my problem. It really is confusing as the variety of opinions keep increasing every time one seeks for help.

My idea was always to endure pain, not only as a matter of virtue, but following a theory I came across –and accepted- that the body knows how to fight/deal with pain itself. So, if one “shuts down” this natural mechanism of body’s reaction against pain by taking pain meds then the result is somewhere between slower healing to not complete healing. This theory is a little contrary to what you have stated: “Unmanaged pain is of concern because it can lead to chronic pain syndrome”, which is something I haven’t heard until now. This new thesis impelled me to give your post the “Best Answer award” as it puts me into a new perspective in which I feel that I need to do a little more research so as to see whether I need to review my thoughts on treating pain.

In 2013 I had my 3rd aortic surgery (2nd sternotomy) and after 3 months I really returned to my no-pain past reality. So, till then my tactic in dealing with pain by enduring it was still working perfectly. This time, however, I am facing a degree of pain I haven’t had before and the possibility of “missing a chance” to deal with it the right way, because of misinformation, spurred me on to asking other people who might have had the same or similar experience how they came out of it, if they ever did.

Overall, please accept a great thank you with deep appreciation for your kind help. I will speak with my physicians about all these and hopefully we’ll find a way to deal with my condition.

God bless.  
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Avatar universal
Hello again, I had a phone consultation with my surgeon and his suggestion is that I get intercostal nerve-block injections. The procedure will be completed in 3 sessions starting with 6 injections at the first session (3 on the back from where the nerves originate and 3 on the front where they end). The 2nd & 3rd sessions will consist of 2-3 injections each. The sessions will have a time space of few days to few weeks between them, depending on the effect of each session. Normally after completion of the procedure I should have results from significant pain relief (for a long period of time) to permanent solution of my problem. Do you have any experience on this type of treatment?
Helpful - 0
7721494 tn?1431627964
No my friend, I'm sorry -- It sounds like you're still suffering.

I have no experience with thoracic pain like this. However, I've heard from many people with similar problems.

I think I left my interventional pain book in the car, so I'll look up these procedures later and give you some info.

In the meantime, see what Johns Hopkins and others have to say:

http://www.hopkinsmedicine.org/pain/blaustein_pain_center/pain_procedures/intercostal_blocks.html

http://my.clevelandclinic.org/services/anesthesiology/pain-management/treatments-procedures/intercostal-nerve-block

http://arizonapain.com/pain-center/pain-treatments/intercostal-nerve-block/

(Here's an insurance group that doesn't want to pay for them -- "no medical necessity")

http://mcgs.bcbsfl.com/?doc=Nerve%20Block%20Injections&vm=r

(Here's some bad news...)

http://www.ourhealth.com/conditions/nerve-conditions/intercostal-neuralgia

(Here's a study of post surgical pain in the chest wall, controlled with either nerve blocks or epidural morphine...

http://www.ncbi.nlm.nih.gov/pubmed/9416252

They conclude that the patients hurt no matter which way they try to manage pain -- this may not apply to your problem, but then again, it may.

Finally, what I consider a balanced presentation from multiple practitioners based on their experience:

https://www.healthtap.com/topics/intercostal-nerve-block-technique

This looks to be a difficult decision because of mixed outcomes. Remember, all patients are different.

Keep me informed. I'll be here if you have questions.
Helpful - 0
Avatar universal
Thank you so much. These links are great. At least now I know what I'm looking for. I am still trying to find someone who can do this, but it's not so easy after all... Will keep in touch.
Helpful - 0
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