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Suggest Treatment For Spontaneous Pneumothorax And Left-sided Pain Below Rib-cage
Question: Spontaneous Pneumothorax back in 2008. I have been under a Doctors care and have seen many specialists. Also I have run the full gamut of pain relievers. I am currently taking oxy codone (ir) which I know causes constipation. That is one of my issues. Over the counter remedies do nothing to alleviate this. My pain resides below my lower left rib and radiates into a muscle under my left shoulder in my back. Pushing on this area on my back is felt in the pain area in the front. I also have an egg shaped area by my left rib that sounds hollow when tapped. If I reach under my left rib the pain is excruciating. I have not had a pain free day since 2008 and the medication is losing its effectiveness. Blood tests show nothing. To add to the pain and constipation, I now have pain after eating. I’ve been told I have nerve damage in my rib cage from the entry point where a tube was put in my chest but the real pain didn’t start until the Doctor yanked the tube out. It had been in for 5 days. The tube had become attached to something inside. The pain was unbelievable. I am at wits end on dealing with the symptoms I have.
I have a couple of theories. The entrapped nerve has grown or moved over time creating a splenic frecture or the nerve is pushing on my bowel or intestine? I have had bouts of fatigue due to getting up in the night and some episodes of depression from this. I've read that this can be a pain signal that is stuck and that burying the nerve is an option?
I have a couple of theories. The entrapped nerve has grown or moved over time creating a splenic frecture or the nerve is pushing on my bowel or intestine? I have had bouts of fatigue due to getting up in the night and some episodes of depression from this. I've read that this can be a pain signal that is stuck and that burying the nerve is an option?
Brief Answer:
Please make a few things clear-
Detailed Answer:
Hi XXXX,
Thanks for being in healthcaremagic.com.
I am Dr.Ajay Panwar,a neurologist,here to answer your query.
I appreciate your detailed medical history and at the same time,i feel
concerned for you.
Of course,with this clinical setting,the diagnosis appears to be the 'neuropathic pain' only.Any type of surgical procedure,howsoever small it may be,may trigger neuropathic pain, if it interferes with or irritates some nerve/nerves in the region.Same appear to have happened while the tube was put in.
Your medcial history shows that you have taken multiple anti-neuralgic drugs and opioids as well.Your pain has not responded to multiple medications,so it can be classified as 'Refractory neuropathic pain' now.
Treatment of 'Refractory neuropathic pain' is really tough and a therapeutic challenge to the neurologists worldwide.
A holistic approach is generally used to manage such patients with a combination of medicines,acupuncture and massage therapy.
Advanced options like Electrical stimulation of nerves may help in persons not responding.
I suggest you to visit a specialized Pain centre so that the management plan for you can be established.
I could not understand the following points in your query-
1)'The entrapped nerve has grown or moved over time creating a splenic frecture or the nerve is pushing on my bowel or intestine?'-How can a nerve grow and cause splenic fracture or push bowel/intestine.If you mean to say that,a nerve has gone neoplastic and is causing mass effect,then it's not the setting.Did any of your investigations say that you are having splenic fracture or compression on intestine?Nerve endings gets irritated when cut on surgery.It is nothing like nerves are entrapped.
2)'I have had bouts of fatigue due to getting up in the night and some episodes of depression from this. I've read that this can be a pain signal'-How is fatigue and depression a pain signal?Please make it clear what do you want to convey through it?
If you have further queries,I shall be glad to answer.
Regards
Dr.Ajay Panwar,
MD,DM(Neurology)
Please make a few things clear-
Detailed Answer:
Hi XXXX,
Thanks for being in healthcaremagic.com.
I am Dr.Ajay Panwar,a neurologist,here to answer your query.
I appreciate your detailed medical history and at the same time,i feel
concerned for you.
Of course,with this clinical setting,the diagnosis appears to be the 'neuropathic pain' only.Any type of surgical procedure,howsoever small it may be,may trigger neuropathic pain, if it interferes with or irritates some nerve/nerves in the region.Same appear to have happened while the tube was put in.
Your medcial history shows that you have taken multiple anti-neuralgic drugs and opioids as well.Your pain has not responded to multiple medications,so it can be classified as 'Refractory neuropathic pain' now.
Treatment of 'Refractory neuropathic pain' is really tough and a therapeutic challenge to the neurologists worldwide.
A holistic approach is generally used to manage such patients with a combination of medicines,acupuncture and massage therapy.
Advanced options like Electrical stimulation of nerves may help in persons not responding.
I suggest you to visit a specialized Pain centre so that the management plan for you can be established.
I could not understand the following points in your query-
1)'The entrapped nerve has grown or moved over time creating a splenic frecture or the nerve is pushing on my bowel or intestine?'-How can a nerve grow and cause splenic fracture or push bowel/intestine.If you mean to say that,a nerve has gone neoplastic and is causing mass effect,then it's not the setting.Did any of your investigations say that you are having splenic fracture or compression on intestine?Nerve endings gets irritated when cut on surgery.It is nothing like nerves are entrapped.
2)'I have had bouts of fatigue due to getting up in the night and some episodes of depression from this. I've read that this can be a pain signal'-How is fatigue and depression a pain signal?Please make it clear what do you want to convey through it?
If you have further queries,I shall be glad to answer.
Regards
Dr.Ajay Panwar,
MD,DM(Neurology)
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
1)'The entrapped nerve has grown or moved over time creating a splenic frecture or the nerve is pushing on my bowel or intestine?'-How can a nerve grow and cause splenic fracture or push bowel/intestine.If you mean to say that,a nerve has gone neoplastic and is causing mass effect,then it's not the setting.Did any of your investigations say that you are having splenic fracture or compression on intestine?Nerve endings gets irritated when cut on surgery.It is nothing like nerves are entrapped.
I understand. Thanks for clarifying that. I've been told there is compression with the nerve being compressed in between the ribs however I have an egg shaped area that is risen up below the left rib. I am going to request another x-ray and ask to see if anything has changed as per compression.
2)'I have had bouts of fatigue due to getting up in the night and some episodes of depression from this. I've read that this can be a pain signal'-How is fatigue and depression a pain signal?Please make it clear what do you want to convey through it?
The fatigue is from the constant pain and it wakes me up. Since it has been seven years, I have been unable to sleep normally and depressed on occasion. Pain signal - I have read that the signal comes from the brain and down the spine.
I have been given the option to have an injection to freeze the area.
Your thoughts on this?
Also, I am going to try a different massage therapy that I've heard about who know more about this type of injury.
Constipation wise do you have any suggestions. That is really irritating (pain) both my stomach and nerve pain due to their close location to each other and the pressure created.
Thank you.
I understand. Thanks for clarifying that. I've been told there is compression with the nerve being compressed in between the ribs however I have an egg shaped area that is risen up below the left rib. I am going to request another x-ray and ask to see if anything has changed as per compression.
2)'I have had bouts of fatigue due to getting up in the night and some episodes of depression from this. I've read that this can be a pain signal'-How is fatigue and depression a pain signal?Please make it clear what do you want to convey through it?
The fatigue is from the constant pain and it wakes me up. Since it has been seven years, I have been unable to sleep normally and depressed on occasion. Pain signal - I have read that the signal comes from the brain and down the spine.
I have been given the option to have an injection to freeze the area.
Your thoughts on this?
Also, I am going to try a different massage therapy that I've heard about who know more about this type of injury.
Constipation wise do you have any suggestions. That is really irritating (pain) both my stomach and nerve pain due to their close location to each other and the pressure created.
Thank you.
Brief Answer:
You should go ahead with that 'freezing' option.
Detailed Answer:
Hi XXXX,
Thanks for being in follow-up and clearing the confusing points.
I suggest that you should go ahead with the freezing option as I already said that the pain is 'refractory'.So,its time to go for it.
I read,you mentioned that constipation is due to oxycodone.So,You may discuss with your treating doctor to withdraw the offending drug and try to substitute it with some other drug,if possible.
Otherwise,general measures for constipation-plenty of water,high fiber diet and medicines like lactulose syrup,if needed.
Hope that I have answered your query.If you have some follow-up questions,I shall be glad to answer else please close the thread,rate it and write a review as your rating will be of help to me.
Regards
Dr.Ajay Panwar,
MD,DM(Neurology)
You should go ahead with that 'freezing' option.
Detailed Answer:
Hi XXXX,
Thanks for being in follow-up and clearing the confusing points.
I suggest that you should go ahead with the freezing option as I already said that the pain is 'refractory'.So,its time to go for it.
I read,you mentioned that constipation is due to oxycodone.So,You may discuss with your treating doctor to withdraw the offending drug and try to substitute it with some other drug,if possible.
Otherwise,general measures for constipation-plenty of water,high fiber diet and medicines like lactulose syrup,if needed.
Hope that I have answered your query.If you have some follow-up questions,I shall be glad to answer else please close the thread,rate it and write a review as your rating will be of help to me.
Regards
Dr.Ajay Panwar,
MD,DM(Neurology)
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Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
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