Question: If A Painful Area Is Surgically Excised Will The Pain Stop?
Answer: Well, again, I think when we think about excising a painful area, maybe a classic example would be an appendectomy again. Certainly we've got an inflamed appendix, we know that it's causing the pain, that we can cut it out and take that away.
It turns out it's not quite that simple for many things. For instance, cutting a nerve may actually cause ongoing pain because it really depends on the duration of the pain and the type of pain. For instance, if you had a foot that was crushed in a horrible auto accident or an industrial accident, you might develop a pain syndrome that ultimately went on to cause amputation of that extremity. Well, oftentimes those patients will develop what we call phantom pain, or stump pain, where they continue to have pain in those areas that even though they don't have a foot anymore, they feel it in their foot. And so these things are very vexing for those of us that treat pain, and I think we try to resist cutting these areas out.
Indeed, if you think about it, many current pain syndromes that are, for instance, the aftermath of cancer pain treatments, like a thoracotomy where they cut your chest open to remove a lung tumor, for instance. Almost half of the patients that have that operation have some ongoing pain, and in a small percentage it's quite significant. So herein we have surgery-causing pain. Same thing can happen after a mastectomy for breast cancer, or for a number of other syndromes that we see clinically.
So I think this whole concept of cutting things out can be a good thing in certain instances. Again, the appendectomy issue or a bowel obstruction, where you've got to bypass it, or even a bypass graft for your heart, where you're trying to make blood vessels work better, and supply blood better. But I think using it for some of these pain syndromes is really not the best idea in most cases.