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What Causes Severe Pain And Tingling Sensation In Abdomen After A Surgery?
Question: After 20 years of severe pain in my epigastric region i had surgery that found damage and a "rare hernia" caused by the severe vomiting i suffered following shigella infection in Ghana. The hernia was growing into the abdominal muscle and had not gone through it. Further surgery was required to remove the permanent nylon stitch left in due to abnormal and very painful scarring. SInce then "bobbles" have grown around the scar site and spread down through the abdominal area and up over the rib cage, into my breasts and armpits. All are very painful and seem to exacerbate the "underlying"pain left from 20 years of untreated source of pain - the hernia etc. My life is increasingly limited. So far no-one seems able to explain the spread of the "bobbles" and i have been told to accept and manage the pain (with lyrica and limited oxycontin). 5/7 days a week i am totally incapacitated by pain. Things are getting worse. I am otherwise well. I am otherwise very fortunate with a wonderful husband and gorgeous teenage boys. Someone must know about these bobbles - diagnosed as surgical neuromas (palpable and visible on ultrasound, very superficial but not susceptible to biopsy due to their fibrous nature and reluctance towards more surgery. Botox into a "plane" in the epigastric region was not successful and, indeed, made things worse for some time after the procedure. Local int individual "bobbles" helps initially but then seems to "irritate" the bobble injected. Desperate! Dont know where to turn. Surely i'm not the only person to react to surgery this way? I cannot give up - my family need my health and so do i. If you are a bright doctor who likes a challenge please look into my case. I have a nice GP and pain specialist but i need more than ineffectiv management.
Kindest regards to whoever has read this far, XXXXXXX
Kindest regards to whoever has read this far, XXXXXXX
Brief Answer:
Try increase in medication and consider surgical options too
Detailed Answer:
Hello,
I have gone through your question and understand your concerns.
Stump neuroma at the site of injury or surgical scar occurs due to overgrowth of distal end of nerve cut during surgery.
The pain and tingling sensation occurs due to repeated stimulation of nerve bunch or end.
The treatment is difficult.
Medications like pregabalin, gabapentin, amitryptiline, sertraline or carbamazepine can be tried with dose escalation according to response.
Local anesthetic ointment can also be used.
Surgical ablation of nerve with alcohol inj, anesthetic agents can be done.
In epigastric region damage to nerve root arising from spine can also be done.
Surgical therapy of removing the neuroma and burying the nerve ending deep inside to avoid recurrent stimulation can also be tried.
Medications need to be increased if required according to response.
I will recommend to try carbamazepine 200 mg thrice daily and pregabalin 150 mg once night time.
Hope you found the answer helpful.
Do get back to me for further queries.
Regards
Dr N Kumar
Neurologist
Try increase in medication and consider surgical options too
Detailed Answer:
Hello,
I have gone through your question and understand your concerns.
Stump neuroma at the site of injury or surgical scar occurs due to overgrowth of distal end of nerve cut during surgery.
The pain and tingling sensation occurs due to repeated stimulation of nerve bunch or end.
The treatment is difficult.
Medications like pregabalin, gabapentin, amitryptiline, sertraline or carbamazepine can be tried with dose escalation according to response.
Local anesthetic ointment can also be used.
Surgical ablation of nerve with alcohol inj, anesthetic agents can be done.
In epigastric region damage to nerve root arising from spine can also be done.
Surgical therapy of removing the neuroma and burying the nerve ending deep inside to avoid recurrent stimulation can also be tried.
Medications need to be increased if required according to response.
I will recommend to try carbamazepine 200 mg thrice daily and pregabalin 150 mg once night time.
Hope you found the answer helpful.
Do get back to me for further queries.
Regards
Dr N Kumar
Neurologist
Above answer was peer-reviewed by :
Dr. Vaishalee Punj
Thank you.
I currently take 300mg lyrica 4x /day - i believe that's pregabalin and maximum dose. Is that correct?
I forgot to add that i also have use of lignacain patches which provide a little help but are very expensive and give only limited relief.
The number and spread of these "bobbles" and past reaction to surgeries has disuaded surgery. Can you give me more information re "surgical ablation of nerves with alcohol inj, anaethsthetic agents can be done"?
I shall certainly discus your proposed medications with my GP and make another appointment with my specialist.
I am particularly interested to know why the "bobbles" are multiplying and spreading. Many have formed above and around the epigastric scar tissue but the spread reaches around the front of my rib cage, down into the belly area and up to the armpits and new ones continue to form. No-one i've been in contact with so far - including a professor in Sydney - seems able to explain why this is happening. There must be some explaination!
I hope that you'll be able to shed some light on this or direct this query to someone else who might be able to so this.
Kindest regards, XXXXXXX
I currently take 300mg lyrica 4x /day - i believe that's pregabalin and maximum dose. Is that correct?
I forgot to add that i also have use of lignacain patches which provide a little help but are very expensive and give only limited relief.
The number and spread of these "bobbles" and past reaction to surgeries has disuaded surgery. Can you give me more information re "surgical ablation of nerves with alcohol inj, anaethsthetic agents can be done"?
I shall certainly discus your proposed medications with my GP and make another appointment with my specialist.
I am particularly interested to know why the "bobbles" are multiplying and spreading. Many have formed above and around the epigastric scar tissue but the spread reaches around the front of my rib cage, down into the belly area and up to the armpits and new ones continue to form. No-one i've been in contact with so far - including a professor in Sydney - seems able to explain why this is happening. There must be some explaination!
I hope that you'll be able to shed some light on this or direct this query to someone else who might be able to so this.
Kindest regards, XXXXXXX
Brief Answer:
Get consultation by a your pain specialist for surgical options
Detailed Answer:
Hello,
You are definitely taking maximum dose of pregabalin.
Limitation of patches are that they are costly and are to be applied regularly.
Surgical options are many and focus on damaging the nerve causing these pain symptoms.
The neuroma growth will not vanish by surgery until removal of the tissue is planned.
Pain management can be done by damaging nerve root supplying the involved area either at dorsal ganglion, spinal cord.
Injectables medications to damage nerve causing pain are also available.
You can discuss these modalities of treatment with your pain specialist.
I understand you are having not good results from surgery but in view of poor medication response, surgical pain management may be required.
Wishing you good health.
Regards
Dr N Kumar
Get consultation by a your pain specialist for surgical options
Detailed Answer:
Hello,
You are definitely taking maximum dose of pregabalin.
Limitation of patches are that they are costly and are to be applied regularly.
Surgical options are many and focus on damaging the nerve causing these pain symptoms.
The neuroma growth will not vanish by surgery until removal of the tissue is planned.
Pain management can be done by damaging nerve root supplying the involved area either at dorsal ganglion, spinal cord.
Injectables medications to damage nerve causing pain are also available.
You can discuss these modalities of treatment with your pain specialist.
I understand you are having not good results from surgery but in view of poor medication response, surgical pain management may be required.
Wishing you good health.
Regards
Dr N Kumar
Above answer was peer-reviewed by :
Dr. Prasad
Dear Dr XXXXXXX thatk you for your interesting response. I'd still like an explanation as to why these "bobbles" are spreading and multiplying. Each one of them is extremely painful and it seems likely that the problems with the "underlying pain" (explained to me as hyper nerve activity due to the 20 years of undiagnosed hernia) are fuelled by these painful "bobbles" (actually, i am pleased that you are happy to confirm - to the extent that you are able - that these "bobbles" are neuromas as my GP has wobbled on that as there could be no biopsy).
So, why are the neuromas multiplying and spreading?
What can be used to damage root nerve(s) by injectible means?
What would your response be to my doctors' argument that surgery is only likely to make things worse - more surgical neuromas?
Where do you practice and do you perform the type of surgeries you suggest?
I am very tired of being "difficult" (medically not personally!), "challenging", "interesting" etc... I just want to have less pain and able to enjoy life more...
With very kindest regards, XXXXXXX
So, why are the neuromas multiplying and spreading?
What can be used to damage root nerve(s) by injectible means?
What would your response be to my doctors' argument that surgery is only likely to make things worse - more surgical neuromas?
Where do you practice and do you perform the type of surgeries you suggest?
I am very tired of being "difficult" (medically not personally!), "challenging", "interesting" etc... I just want to have less pain and able to enjoy life more...
With very kindest regards, XXXXXXX
Brief Answer:
Consider surgical advice from a neurosurgeon or pain management surgeons
Detailed Answer:
Hello,
Apart from neuroma, the other close diagnosis in a case of surgical site growth is keloid.
Usually keloid is not much painful.
As the neuroma growth is abnormal overgrowth it goes on increasing in some cases.
Surgical removal in most cases leads to improvement but in few it may reoccur.
Injection of alcohol as sclerosant may be used for nerve root ablation. Other surgical procedure for pain management can be discussed by neurosurgeon or pain management surgeons.
I am a neurologist and do not practice surgery.
You should go ahead with surgical procedures as medicines are not of much benefits to you.
Hope you found the answer helpful.
Wishing you good health.
Regards
Dr N Kumar
Neurologist
Consider surgical advice from a neurosurgeon or pain management surgeons
Detailed Answer:
Hello,
Apart from neuroma, the other close diagnosis in a case of surgical site growth is keloid.
Usually keloid is not much painful.
As the neuroma growth is abnormal overgrowth it goes on increasing in some cases.
Surgical removal in most cases leads to improvement but in few it may reoccur.
Injection of alcohol as sclerosant may be used for nerve root ablation. Other surgical procedure for pain management can be discussed by neurosurgeon or pain management surgeons.
I am a neurologist and do not practice surgery.
You should go ahead with surgical procedures as medicines are not of much benefits to you.
Hope you found the answer helpful.
Wishing you good health.
Regards
Dr N Kumar
Neurologist
Above answer was peer-reviewed by :
Dr. Vaishalee Punj
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