Doc: Surgery complicated by post-op pain management

Dear Dr. Roach: I am a 78-year-old with severe back pain due to compression of the nerve. My activities of daily life are more and more limited, and my quality of life is suffering. I am told I need a back operation, and I agree that it is necessary. However, when I consult with the anesthesiologist or pain management doctor about post-operative pain management, I always get vague and unsatisfactory answers. You see, I am highly intolerant of opiates. I get violently ill, feel like my body and brain are turned inside out, perspire profusely and vomit until I feel as if my stomach is coming out of my mouth.

Besides my back, I’ve no other health problems. What I can take for pain after a back operation other than opiates? Whom should I consult with to have my problem taken seriously?

F.W.

Dear F.W.: Because opiates are such a problem for many people (due to intolerance, like yours, or a past history of abuse), there is increasing interest and expertise with performing surgery and treating post-operative pain entirely without them. Instead, pain is controlled with a combination of several treatments: non-opiate pain relievers, including anti-inflammatories and Tylenol; topical and regional anesthetics to block nerve fibers; and non-pharmacologic treatments, including massage and meditation.

I spoke with an expert in the field, who noted that for back surgery in particular, it is difficult to avoid opiates entirely, but that you could work toward minimizing the amount that you take. You would need a pain specialist who really understands your concerns, which it doesn’t sound like has been the case until now.

I can’t say that this will be easy to find, and it may require you to travel. I do know of several hospitals that have expertise in this area, including Virginia Mason in Seattle and Hospital for Special Surgery in New York City.

I should note that your back pain hopefully will be better after successful decompression of the nerve. It’s getting through the first few days to weeks after surgery that will require expertise and planning.

Dear Dr. Roach: Is it true that surgery for bunion removal has advanced very little?

R.E.

Dear R.E.: No, not really. There have been over 150 surgical procedures published for treatment of bunion deformity, which is a deformity of the great toe on the metatarsal bone of the foot, where the toe points inward toward the second toe. The rates of patient satisfaction with surgery generally have improved over the years, with current rates between 50 and 90 percent satisfied. I send only patients with moderate to severe symptoms despite these treatments for consideration of surgery. A foot specialist who is expert in performing surgery is of the highest importance.

The average time to return to work after surgery is six weeks, but that’s what it takes for the bone to heal.

Email questions to ToYourGoodHealth@med.cornell.edu.