The Chronic Pain Solution by James N. Dillard M.D

Author:James N. Dillard M.D. [Dillard, James N.]
Language: eng
Format: epub
ISBN: 978-0-307-48294-5
Publisher: Random House Publishing Group
Published: 2002-03-01T16:00:00+00:00

SURGERY

Say you suffer from hideous, unrelenting pain. No one can tell you where it comes from or why it torments you; or perhaps the source is known but incurable. But one doctor has a idea: an operation that will cut off the pain messages. It’s rarely performed, perhaps experimental. You must agree to surgery on your spinal cord, or even your brain. What do you do?

Sometimes surgery for a painful condition makes obvious sense, as in reconstructing a degenerated arthritic knee. But that kind of surgery doesn’t really address the pain itself. It targets the underlying condition that causes the pain. The next section of this book discusses painful conditions, along with any operations that are appropriate for underlying causes.

But there’s another breed of operation: surgery solely for pain control. The assumption is that the underlying condition can’t be found or can’t be healed; the goal of surgery is to stop the pain message. One of the first procedures of this type was amputation. Desperate people, with equally desperate doctors, simply had their painful arms or legs cut off. Often, the result was phantom limb pain, in which nerve pain comes back with vengeance.

This early experience was instructive. It taught us that pain isn’t located in one particular area of the body; it’s all over your nerves, your brain, and the part that hurts. So surgery to stop pain messages has a pretty poor track record. If you’re going to receive a procedure on your nerves, it will more likely be a deep injection or nerve ablation.

Of the pain-control surgeries that are still being performed, the cordotomy is the most common. It’s most often used for pain that occurs below the neck. In this operation, the bundles of nerves that carry pain and temperature sensations through the spinal cord to the brain are severed. The procedure is usually performed under local anesthesia, so that you can talk to the doctor about what you’re feeling. Often there’s no need to cut open the skin—instead, a needle is inserted just below the ear, and the nerves are killed with radiofrequency heat. But make no mistake: This is a major operation. You’ll be kept immobilized for a day or two in the intensive care unit and then spend several more days in the general ward. After the nerves are severed, you won’t be able to feel pain or temperature below the neck on the affected side of the body; you may even lose total sensation or function where the pain was. In addition to the usual risks of surgery (infection, bleeding, and so on), it’s also possible that you may lose coordination, develop mental dysfunction or mood changes, or lose neurological control of your bowels, bladder, or sexual organs. And when you’re talking about the spinal cord, a surgical slip could be devastating. You should also know that the success rate of cordotomies varies from surgeon to surgeon, and even when the pain disappears, it often makes a return several months later. These factors make cordotomies most appropriate for people whose pain comes from terminal illness.

Download

Copyright Disclaimer:
This site does not store any files on its server. We only index and link to content provided by other sites. Please contact the content providers to delete copyright contents if any and email us, we'll remove relevant links or contents immediately.