Mr R. is a 46 year old man who has experienced left lower abdominal pain for 6 months due to an inguinal hernia. He has a very high BMI of 52. He lives on his own after he lost his wife 1 year ago. He is not working and lives on benefits. He used to enjoy playing guitar with a music group but he had to give up because of alcohol and drug abuse. He gave up alcohol but still smokes. He was hesitant to have surgery as he is very anxious about everything related to surgery. He continues to take oramorph for his pain.
He suffered from anxiety and depression for which his GP has started him on citalopram which he used to take only occasionally. He eventually decided to have the surgery under general anaesthesia as the hernia caused a lot of pain and discomfort. The surgeon performed an open hernia repair with a mesh. He was in terrible pain immediately after the surgery, needing a lot of analgesia. Unfortunately his post-surgical recovery was complicated as he developed an infection for which he needed further surgical interventions and required antibiotics. Even though the infection had settled, he still had pain in the left lower abdomen which is different to what he used to have before the surgery. It has changed from a dull ache and discomfort to numbness and a burning sensation which is constantly present. Touching that area made the pain worse. The pain goes into his left groin with intermittent shock like sensation especially when he bends over. His mood and sleep are severely affected because of the pain. He blames himself for all these problems. His GP has referred him to the pain clinic as his pain has worsened with time.
- What are the risk factors you can identify for developing chronic post-surgical pain in this patient?
- How do you define chronic post-surgical pain?
- How do you differentiate whether his pain is visceral or coming from the abdominal wall?
- How do you assess neuropathic pain?
