During my last visit to the pain clinic a plan to manage my pain during surgery and post-surgery – if that day ever comes – was laid out for me. There was some discussion in earlier sessions about how difficult they believe it could be to manage my pain down the road because of the high level of pain medications I’m currently taking. That’s also a part of the reason they haven’t increased my pain medications to treat the excessive pain I feel now. Imagine being on such a high level of pain medications that anesthetics might not effectively manage your pain during surgery and then after having your abdomen sliced open there is nothing you can take to relieve the pain. Can you imagine that? I don’t want to.

The pain specialist’s plan for surgical pain management is modular. In the sense that the anesthesiologist can do parts of it or all of it. However, there is one point she feels they should not bypass: an anesthetic review. What this would involve is sending me for a consultation at the Anesthesiology Clinic ahead of surgery. The reason for this is that patients usually meet the anesthesiologist minutes before surgery, but because I am a “complicated case” it would be beneficial for me to go to the Anesthesiology Clinic for a review of my current pain management treatment and its effectiveness to have them create a clear plan for my specific needs. In short, they are going to have a hell of a time helping me cope with pain during and after surgery.

The rest of the plan is where there is room for adjustment. Which recommendations the anesthesiologist uses will depend on the type of cut the surgeon decides to make to do the surgery. According to the pain specialist, if the surgeon chooses to do the resection through a horizontal cut in my lower abdomen I should have a large dose of Gabapentin – about 1200mg – before the start of surgery. This should help to prevent a big pain flare up. I would then have opioids during surgery followed by a Dilaudid button or a Patient-Controlled Analgesia (PCA) post-surgery to manage the pain.

But if the surgeon opts to make a long vertical cut in my abdomen things change. The recommendation is for me to have an epidural to deliver freezing and opioid medications to numb the pain because this is the more painful way to do this surgery. The epidural must be inserted before surgery starts and the catheter would be left in post-surgery to give me pain medications instead of giving me a button/PCA. And in either case (i.e. whichever way they choose to cut) I would most likely get some ketamine and lidocaine during surgery to prevent “low effectiveness” of the opioid medications during and after surgery.

None of this appeals to me. Not just because of the high level of pain anticipated or the long scar I will undoubtedly be left with, but because she told me that I won’t be able to eat or drink for a few days after surgery. Apparently, after having parts of your guts removed your body needs time to relearn a few things, like how to digest food.

But the point of writing about all this is that surgery appears farther away than we all thought. I will be returning to the pain clinic on Friday. It’s time to explore more invasive pain management methods because some days the pain medications barely do their job. We will make a decision about what to do now in light of the delay. I might have steroid injections called Caudal Epidural Steroid Injections that are a “combination of a steroid and a local anesthetic that is delivered to your lower back to treat chronic back and lower extremity pain”. Or I might have nerve blocks known as Ganglion Impar Blocks that “treat chronic, neuropathic perineal pain from visceral and/or sympathetic pain syndromes”.

We discussed these procedures briefly a few months ago to educate me about what is available if I don’t have surgery. They are a temporary patch and I was told that they may not work for me because of the complicated nature of my pain. Regardless, I think the time to try them has arrived because I need more pain relief. So, needles here I come…

Green Day – Give Me Novacaine