Pain doctor stumped, saying maybe my nerves are different location 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

Post Edited (upjo) : 4/6/2015 6:27:37 PM (GMT-6)

Hi, I have tried 3 pain doctors, they don't offer anything more other than only these injections, which don't work for me, so I am thinking its not much help with another doctor who would want to do the same thing. I have asked them if there is another way to find the pain problem, and they are clueless and have nothing else to offer.

My pain resulted from a lap kidney surgery. It fixed intermittent pains in the back from kidney but gave me permanant constant pain in the abdomen, close to one of the laparscopic holes.

I have had, ultrasound, ct scan, and MRI. It all came clean, except ultrasound and MRI did reveal something odd in my abdominal wall area where I have pain, but its inconclusive and nothing definitive according to my all clueless doctors and specialists who think its probably consistent with somebody who had surgery. But this surgery is why Im having pain.

I have thought about referred pain, But if it was referred pain from elsewhere, then touching my pain area wouldn't affect the pain in anyway. But it does cause me more of same pain, not much if I press on pain area, but a lot when I lift my skin, or squeeze it between fingers, so it's probably something wrong where fascia or the muscle layers is. So that's I feel this is the problematic area. The guy Ive been getting physiotherapy from is very experienced, so Im thinking maybe now since I have narrowed it down and have a clue or so about my pain, he will be able to help me somewhat( Before for a long time, I was clueless where pain was coming from)

I have tried so many different types of creams, I don't feel much affect to pain, and the cremes honestly make it more uncomfortable for me.

Thanks for replying. Sometimes you only get diagnosis with surgery, so it's my only best hope now.

I know what your saying about removing all that, but what about plastic surgeons who do Abdominoplasty (Tummy Tuck), and remove extra fat, muscles, skin etc, I obviously dont have any cosmetic problem, but isn't this like the same idea, except I won't be getting cut for extra fat in the tissues, but for the chronic pain??? Usually these people don't get any chronic issues, maybe odd temporary numbness etc, I will take that over this pain any day??? Theres a chance I might not get any new problems, and If I do, maybe it won't be as bad. But even if does get worse, maybe I would be able to get it fixed unlike this freaking present pain.

Im sure it might be hard to find someone, but if this is what I have to try, im sure I will find someone. Im in Canada so I have provincial insurance, Im sure I will be coverd for surgery.

Also when you say exploratory lap, isn't this same what I'm talking about? Like if the surgeon can visually see something obvious wrong , or odd, and fix it, but if nothing catches his eye, then just cut that whole darn area out lol where I have maximum tendeness and where pain is radiating from. As I write this, I honestly just want to take the knife myself lol

hi alcie. ive had a major surgery that left me with similar symptoms on the right side of my chest wall. the cause for me is scar tissue. the skin has scarred/stuck to my ribs. the skin can be moved, but it pinches. an if you try to pick it up...forget about it! but remember this is on my chest wall where there is no fat left to pick up. i would ask the doc if maybe you have scar tissue causing all this. sounds exactly like my right chest, and if i reach or turn wrong, omg. can feel like a ripping, burning pain. good luck. i hope you get it figured out and fixed.

Like Cindy said, I too wonder if your pain might be due to adhesions (excessive scar tissue) within your abdomen. This is not an uncommon occurrence after abdominal surgery. And can be quite painful. If so, more surgery could actually worsen the problem, by causing more adhesions. These adhesions can not only involve the abdominal wall, but also the internal organs. Although, they probably would have seen some evidence of this on MRI/CT (perhaps the "something odd" you mention was noted on your scans is the beginnings of such adhesions).

You can certainly consult with a surgeon. But I think that you'd be hard pressed to find one willing to remove a segment of tissue, such as you describe, when the definite cause of your pain is still essentially unknown.

Skeye

I have to agree with rocckyd....... our bodies are bizarre.

You have received some great advise from our fellow posters above and after reading them all there is nothing to add.

I am sorry that you are having to experience these issues and don't have a clear end to the road. Remember that doctors are practicing which is why they call it a Practice!

Having a idopathic disorder, which means they don't know the cause. I have a few of those keep your faith!

Blessings

hoopshouba said...
hi alcie. ive had a major surgery that left me with similar symptoms on the right side of my chest wall. the cause for me is scar tissue. the skin has scarred/stuck to my ribs. the skin can be moved, but it pinches. an if you try to pick it up...forget about it! but remember this is on my chest wall where there is no fat left to pick up. i would ask the doc if maybe you have scar tissue causing all this. sounds exactly like my right chest, and if i reach or turn wrong, omg. can feel like a ripping, burning pain. good luck. i hope you get it figured out and fixed.

Did you figure out scar tissue after surgery or was there another more definitive way to diagnose this?

My problem also goes little bit upto the chest wall. My skin picking is very painful but I just noticed it seems to increase as I move to right towards my my flank area, if I pick/fold skin there its less fat there but a lot more painful to pick, I feel 100% this is the cause of my pain, maybe this is where most scar tissue is Its little bit to the side, maybe I should try to get ultrasound in this area because its definitely not normal.