Author: Mosae

If you’re living with chronic pain, it may feel like opioids are the only way to find relief, however brief. Surgical nerve repair is a different approach.

For as long as we’ve been able to, humans have used opioids in some form or another to block pain. In the modern era, these include prescription pain relievers, heroin, and synthetic opioids such as fentanyl. While the intention is good—stopping the experience of pain—the side effects of opioids pose a large risk: addiction

The risk of addiction increases the more that opioids are used—especially when they are used to manage chronic pain over a long period of time. According to the Mayo Clinic, “Researchers have found that taking opioid medications for more than a few days increases your risk of long-term use, which increases your risk of addiction.”

According to the American Society of Anesthesiologists, “Opioids block pain messages sent from the body through the spinal cord to the brain.” When the pain relief wears off, addicted individuals can feel an urgency to find the next available relief and get another break from the constant pain.

Individuals experiencing chronic pain due to nerve damage could avoid prolonged use of pain relievers by considering a surgical option.

treating the source, not the symptoms

If you’ve been experiencing chronic pain after surgery, traumatic injury or amputation that lingers beyond the normal recovery time, it could indicate a nerve injury. Some studies have found that up to 77% of individuals have pain six or more months after experiencing trauma.

Unfortunately, the first course of action for patients with chronic pain is often to manage the symptoms through pain medications, which offer temporary relief but do not fix the source of the pain.

understanding your risk

Addiction is a disease that doesn’t discriminate. This means that anyone could be at risk of becoming addicted to pain killers—through no fault of their own. But individuals experiencing chronic pain have a higher risk than most of misusing their prescriptions with prolonged use. According to the National Institutes of Health, “With an increase in chronic pain, there has been a simultaneous rise in opioid use. This use has been associated with pain relief, but also with an increase in adverse outcomes (e.g., addiction, overdose, insufficient pain relief).”

Because of their addictive quality, it’s important to understand the risk when starting a prescription painkiller. By 2015, roughly 21%–29% of patients prescribed opioids for chronic pain misused them. And between 8%–12% of people using an opioid for chronic pain developed an opioid use disorder.

These numbers are staggering and emphasize how overwhelming the opioid crisis has become. But for those living with chronic pain due to a nerve injury, there is hope for another option. One that treats the source of the problem.

understanding pain

Pain is different for everyone. Some complain of tingling, numbness or pain all over. Others describe it as “pins and needles,” sharp spasms, a burning sensation, or extreme sensitivity to touch or heat and cold. It may be constant or intermittent.

When nerve damage causes nerve pain, it’s important to understand the options for repairing the source of the pain rather than typical treatments—like opioids—which may only temporarily manage the symptom.

As an alternative to prolonged use of opioids, surgical nerve repair focuses on identifying and repairing the cause of the pain, potentially providing a much more permanent solution.

patient spotlight: Achilles

On the brink of paid medication addiction, Achilles broke the cycle of pain and refills to find a better solution. Learn more.

repairing damaged nerves

Nerves can be injured in more ways than you might think. There are four common types of nerve injury that can sometimes lead to chronic pain:

• Cut or laceration
• Stretching
• Compression
• Neuroma

Nerves need a structure to help guide the regenerating fibers to grow properly. If a nerve is damaged, it may no longer have the proper structure to guide this growth, leading to pain. Depending on your specific nerve damage, your surgeon may be able to repair the nerve with a variety of different techniques.

Surgically repairing a damaged nerve can significantly improve a patient’s quality of life and even help them to live without pain entirely.

could surgical nerve repair help you?

If you’re facing chronic pain after a traumatic injury or a surgical procedure, answer these questions to determine if you’re a candidate, and get connected to a specialist who may be able to help.

 

When you’ve been dealing with ongoing pain, a visit to a peripheral nerve surgeon to determine if nerve damage is causing the pain and options for nerve repair surgery is an important step. It’s normal to have questions about the process. From your first visit to the post-surgery recovery, here’s a guide to everything you need to know.

considering nerve surgery

should I see a surgeon about surgical nerve repair?

If you’re experiencing pain persistent beyond a normal recovery time (3 months or more) after an injury (like a car accident, sports injury or glass or knife cut) or surgery (like an amputation, hip replacement, knee replacement or hernia repair), your pain could be due to a nerve injury. If it is, you may be a good candidate for surgical nerve repair and should see a surgeon. In one study, 70% of surgical nerve repair patients wished they would have been referred for surgery sooner.

In these cases, it’s important to see a nerve surgeon as soon as you can because the earlier you get surgery, the better your chances of restoring function and easing pain to the affected area.

If your symptoms are due to something other than a nerve injury, like diabetic neuropathy, nerve repair surgery is not likely to help.

what kind of questions will a peripheral nerve surgeon ask?

When you first visit a peripheral nerve surgeon, it’s helpful to be prepared for the questions they might ask. The more information you can provide the surgeon, the better they will be able to diagnose your issue and find a potential solution. It may help to write down answers to the following:

• How long have you been experiencing your symptoms?
• What body part or parts are affected?
• Did your symptoms begin after a specific event, injury, surgery (including an amputation or joint replacement) or accident (like a car accident or a serious cut)?
• What methods of controlling the pain have you tried (physical therapy, medication, etc.)?
• What medications are you taking, if any?
• What other specialists have you seen, if any?
• Have you had any other medical tests like an MRI, CT scan, nerve conduction study or X-ray?

what kind of tests will my surgeon have me do?

The types of tests ordered can vary based on your symptoms and the type of nerve damage suspected, but a nerve surgeon might ask you to undergo one or more of the following in addition to an in office exam:

• Ultrasound: A noninvasive test that uses sound waves to generate an image of the nerve.
• MRI/CT: Magnetic resonance imaging (MRI) and computer tomography (CT) exams provide a detailed view of the body in the area where nerve damage is suspected.
• Nerve Conduction Study: This is a study that tests your nerves with an electrical signal to pinpoint problems. Some patients report that it hurts a little, but most say it’s tolerable.
• EMG: An electromyogram (EMG) exam determines how well a motor nerve is working by measuring the electrical activity present in a muscle.

before the surgery

what questions should I ask before surgery?

• What kind of surgery am I having? It’s okay to ask for your surgeon to explain this multiple times to make sure you understand.
• When can I expect to notice improvement or relief after surgery?
• What outcomes can I expect?

how do I know what kind of nerve surgery I need?

Your surgeon will decide what kind of nerve repair may help you. The type of nerve repair will depend on your type of nerve damage.*

repair techniques based on type of nerve damage

• Cut: A cut nerve will require surgical nerve repair to bridge the gap between the two nerve ends and reconnect them, allowing the nerve to regenerate and restore the lost function.
• Compression: Cutting or removing the tissue restricting a compressed nerve allows the nerve to heal and restore normal signal transmission. After releasing the nerve, the surgeon may decide to protect the nerve by placing fat around it, wrapping the nerve with vein tissue or using a nerve protector.
• Stretch: A nerve can be damaged, even if it isn’t cut. The type of nerve repair performed for a stretched nerve will depend on the extent of the damage. This means using methods similar to repairing a nerve cut or a nerve compression.
• Neuroma: If a neuroma is identified as the cause of the pain, your surgeon will first locate and remove the neuroma to get rid of the painful stimulus and stop the pain signals to the brain. Then your surgeon can either repair the nerve by reconnecting it with a nerve graft (autograft or allograft) to allow restoration of normal signals to the brain, isolate the nerve end with a nerve cap to reduce the potential for symptomatic or painful neuroma formation, or in some instances reroute the nerve.

after the surgery

how long will I be in the hospital?

Your surgeon will work with you to determine your needs based on your specific case. However, many nerve repair procedures can be done on an outpatient basis.You may be asked to stay for observation for 24 hours, but in most cases, people are able to go home the same day.

when will I know if the nerve surgery was successful?

Some patients may get immediate relief—it depends on your nerve damage, and how long you’ve had it and how severe it was. However, if your nerve is reconstructed, return of sensation or nerve function takes time and can feel a little strange. You may feel some small zings and zaps as your nerve starts to heal, but that may be good news and a sign that your nerve is starting to work again.

You might notice the following sensations during the first six months after surgery, but they typically go away within 12 months:

• Hot or cold sensations and sensitivity
• Little shocks or zaps
• Aching or tingling feelings

If your pain persists or there is no return of nerve function, you should consult your surgeon.

how can i improve my chances of a positive outcome?

Be an advocate for yourself. Even if another doctor has told you that your chronic pain will get better on its own, or that physical therapy is your only option, you can still reach out to a nerve surgeon for a second opinion.

Do your research, and remember that nerves are delicate and deserve care.

You may want to bring another person, like a partner, family member or friend to any or all of your appointments. Your surgeon will be giving you a lot of information, and many patients find it helpful if another person has heard the same information and can help you remember.

is surgical nerve repair right for me?

*Source: https://www.axogeninc.com/patients/repair-options/

Chronic pain impacts more than just those who experience it firsthand. Taking care of those who experience pain day in and day out is as taxing as it can be rewarding. Living with someone with chronic pain brings new challenges into a household dynamic that can be difficult to navigate.

6 ways to care for someone living with chronic pain

Here are some tips on caring for someone with chronic pain—and caring for yourself along the way.

1. believe them

An important thing you can do for someone living with chronic pain is believe them when they say their pain is real. Chronic pain is an invisible ailment that can be hard to identify in others.

Asking about their pain and working to grasp its impact could help you better relate to what they are going through. We may never know just what chronic pain does to a person—as each experience is unique—but putting in the effort to empathize rather than sympathize could make a difference.

Once you establish that trust, it may be easier for the person in pain to accept your help and support as they navigate through their journey to relief. Advocating for someone with chronic pain is easier when it stems from a place of respect and understanding.

2. address their physical needs

When living with chronic pain, even the smallest tasks can be daunting. It’s important to make sure that the physical spaces where your loved one spends their time are catered to their needs and habits.

Make sure essentials are within reach and at a level where they can be easily accessed. Toiletries, groceries and medications should be stored where no one has to reach too high or bend too low if mobility is a challenge. Come up with a plan for easy organization so that it’s fast for you to find what they need when you’re around, and simple for them to do the same when you’re unavailable.

Often, chronic pain leads to lots of downtime spent in bed. Bedside organizers are helpful for making sure that all needed items are within reach when a person is sequestered to their bedroom. Books, remotes, medication, tissues, eye masks and more can all be kept close to eliminate the need to move around and potentially further agitate a body in pain.

3. consider their barriers

After everything is situated properly on the home front, it’s time to tackle other factors in their environment. Do they live close to their doctors, their physical therapists, their pharmacy or grocery store? Are they able to drive or work?

Whether it’s food delivery, meal-prep kits or mail-order medication, figure out a way to ease barriers to getting things done. It may be helpful to identify days that you can run errands for them or help them schedule doctor appointments for days when they need someone to take them to and from hospitals or clinics.

4. advocate for their best interests

Doctor appointments can be overwhelming for anyone, and it’s easy to get wrapped up in the moment. When that happens, a person may forget to ask questions or leave the office feeling like they don’t understand all their options.

When it comes to caring for someone you’re close to, offer to attend their appointments with them. Take notes. Ask questions. Make sure that their pain is taken seriously, and not dismissed.

Partner with your loved one to research potential solutions or identify opportunities to meet with new and emerging care teams.

5. manage financial expectations

Chronic pain may lead to a significant financial burden for those who experience it. As a caretaker, it may be helpful to work with your loved one to comprehend their medical bills if they have questions or see if there is some other way you can support them as they navigate their financial needs.

Insurance can be tricky, especially when lots of specialists are involved. If your loved one needs help, most providers can connect you with financial counselors who specialize in medical expenses.

Try to plan ahead so nothing takes you by surprise.

6. focus on emotional needs

It’s good for both you and the person you care for to maintain connection with the outside world. Those living with chronic pain may have a desire to hide away from friends and loved ones in an effort to not let their pain impact the lives of others. There is a strong correlation between chronic pain and mental health disorders. Help them to see how important they are to you—and how important it is to maintain a positive outlook while facing troubles caused by poor physical health.

Continue to invite them to things, continue to include them. Small gestures like an invitation are a great way to let them know they are cared for.

Try not to lose sight of yourself as a person outside of the caregiver role. Make sure that you are taking time for yourself to do the things that bring you joy. You’re best suited to help others when you help yourself first.

chronic pain isn’t one size fits all

Sometimes, chronic pain is caused by nerve damage. This type of chronic pain may be repairable. To learn more about nerve pain, check out our nerve pain 101 page.

Could your loved one’s chronic pain be the result of nerve damage? Take the quiz with them to see if they’re a potential candidate for nerve repair.

Take the quiz

 

Resources:

• https://www.neuromodulation.abbott/us/en/caregivers/becoming-caregiver/chronic-pain.html
• https://training.mmlearn.org/blog/caring-for-someone-with-chronic-pain-tips-for-elder-caregivers
• https://www.practicalpainmanagement.com/patient/treatments/mental-and-emotional-therapy/6-ways-be-friend-friend-living-chronic-pain
• https://www.bonejoint.net/blog/how-can-i-support-a-family-member-who-suffers-from-chronic-pain/
• https://www.southsidepainspecialists.com/supporting-the-ones-you-love-who-have-chronic-pain/
• https://www.health.qld.gov.au/news-events/news/caring-for-someone-with-chronic-pain
• https://www.pathways.health/how-you-can-help-your-loved-one-with-chronic-pain/
• https://www.neurosurg.org/articles/taking-care-of-a-person-suffering-from-chronic-pain