Chemical injection to kill a nerve

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opnwhl4
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Date Joined Dec 2008
Total Posts : 4896
   Posted 11/16/2009 2:11 AM (GMT -7)   
Hi Y'all-
Well saw a PM doctor at Loyola last week about the nerve pain in my ribs. They tried a temp. injection they thought would last about 12 to 24 hours. If this did they want to inject Phenol(sp) into the scar area and kill the nerve and hopefully stop the pain. The only problem is it lasted about 2 to 3 hours and had worn off completely before I got home. If this worked they wanted to do it next week or the following week. If it didn't work they wanted me to try the Lyrica and a version of amytriptoline that isn't so sedating for a month and come up with a new game plan based on how that goes. I need to call them tomorrow and see what their take is, whether it was successful or not. I don't think 2 to 3 hours of moderate pain relief was successful myself. I was wondering if anyone has an opinion as to whether they think this was a success or not. Kinda of worried about having them attempting to kill this nerve and it not working and possibly making tings worse.
I can keep it under decent control, but have to use the pain meds regularly now. I would like to not have to use them at all, but afraid this may make things worse and have to up the dosage to get any relief.
Has anyone had this done and did it work for you?

Take care,
Bill

Post Edited (opnwhl4) : 11/16/2009 1:20:09 AM (GMT-7)


PAlady
Veteran Member


Date Joined Nov 2007
Total Posts : 6795
   Posted 11/16/2009 2:26 AM (GMT -7)   
Hi, Bill,
I've heard of chemical ablation, but never had it done. There's also Radiofrequency ablation. I think there are some members here who have had both procedures, and hopefully they'll see this.

I would have loved to have the RF procedure, but they couldn't precisely locate the nerve that was causing the pain with the injections. I'm not sure if 2-3 hrs is a good enough result either, as that may just be the short acting anesthetic. I think you need to ask them, IMHO if you don't have a clearly positive result then waiting for another game plan may not be thrilling, but as you say may be preferable to making it worse.

None of us here really want to be on the meds. we take. I'm sorry you're starting down this road, and I hope that something can be done so you don't have to take any stronger meds for a long period.

I wish I could be of more help here - but trust your own gut after you get your questions answered by the doctors.

Take care,

PaLady

opnwhl4
Forum Moderator


Date Joined Dec 2008
Total Posts : 4896
   Posted 11/16/2009 11:32 AM (GMT -7)   
PaLady-
Thanks, guess I am more looking for confirmation my gut feeling is correct and the short time I had any relief just wasn't good enough to be sure they had the right spot. They explained to me that the chemical is basically a poison to the nerve and that's what kills it. I am worried that if they don't have the exact one I will end up with worse problems than I have now.

Take care,
Bill

patsie
Regular Member


Date Joined Dec 2008
Total Posts : 478
   Posted 11/16/2009 10:25 PM (GMT 0)   
Dear Bill,

I am a regular member of the Fibro group and since I have such chronic pain happened over here to take a look. When I read your post about the scar I wondered if this is your pain issue. I do not know your history so forgive me if I am asking a personal question.

I have Fibromyalgia and had breast surgery almost 2 years ago. Since that time I have had major pain in the scar tissue. When questioning my doctors, yes several, they have commented that often nerves get trapped in the scar tissue and cause this stabbing pain for some time. How long they were vague about. I assumed it was a Fibro issue and have posted there asking others if they have this. Only a couple responded.

Thank you for taking the time to answer me if you think you can be helpful.

Patsie

opnwhl4
Forum Moderator


Date Joined Dec 2008
Total Posts : 4896
   Posted 11/16/2009 8:51 PM (GMT -7)   
Patsie-
Yes the the scar area is my pain issue. I had lung surgery 12/28/07 and the incision on my back has given me trouble ever since. It has gotten a lot worse lately and I was sent to a PM doctor in Loyola. He thinks it is either scarring around the nerve or the nerve grew back "wrong", of course he had some medical term for this and I can't remember what it was. LoL! I have burning stabbing pain that is followed by a shock feeling that goes the length of my rib.

I talked with the doctor today and he recommends trying the Lyrica nd the other med for 4 to 6 weeks and see what happens. Then repeating the temp. nerve block again and if I get 50% or better relief from it he wants to kill the nerve then.

Take care,
Bill

PAlady
Veteran Member


Date Joined Nov 2007
Total Posts : 6795
   Posted 11/16/2009 10:16 PM (GMT -7)   
Bill,
I've got a better understanding now. Scar tissue (adhesions) and herves. Bad combination. A lot of us that have had back surgery have probems with scar tissue growing around a nerve. My neurosurgeon said he could do a more "traditional" surgery (bigger incisions, more cutting of other tissue, etc.) and remove the scar tissue. Course there was still no guarantee the nerve wouldn't have been injured beyond repair. And of course there's the NEW scar tissue that will form after the surgery. It seems sometimes to be a never ending cycle. But I hope maybe they can locate yours and do some kind of an ablation, since it's getting worse over time.

Fun, eh? NOT!

Take care,
PaLady

Tirzah
Veteran Member


Date Joined Jul 2008
Total Posts : 2203
   Posted 11/16/2009 10:26 PM (GMT -7)   
Bill,
It sounds like what you are talking about is chemical nerve ablation. I have had radio frequency nerve ablation a few times (2x in my neck, 1x in my low back) & I found it really helped. The surgeon should do a few trial runs before the final procedure. If those trial runs help (usually they will last for 1-2 days), then there is a good chance the ablation will work. For me & others I've talked to the trial is a good indicator for how much relief you would get from the ablation procedure.

I would add, however, that it does not "kill" your nerve, as in something final & permanent. It is nearly certain that your nerve will grow back & be in as much or more pain as before. Your nerve is damaged by the procedure -- the way I think about it is that 2 walls of scar tissue are built up around your nerve on either side of the painful area; then the pain signal gets trapped inside those 2 walls; it still tries to get to your brain, but it can't get past the walls; eventually, though, the walls are repaired by your body & then usually the pain signals will get to your brain. But sometimes they will stop completely. There are a small number of people whose bodies get tired of trying to send the pain signal & failing over & over & over so the painful place gives up & stops sending the signal.

For my first procedure, it was on my neck. I was told that typically relief lasts 12-18 months, but anything over 6 months is considered a "success". It does take a 4-8 weeks for the scar tissue to form after the procedure, so the relief is not immediate. In fact, that first week post-op was really, really miserable & my pain was through the roof. But fortunately, once the scar tissue formed, I got very, very good relief (down from a 7-8 to a 2-3, and some days were only a 1). My relief lasted much, much longer. I got about 6 years of really good relief & then it slowly started getting worse. We repeated the procedure & I got decent relief, but it didn't last quite as long. I'm thinking about repeating it as recently my neck has been in a LOT of pain.

For me, there were only 2 downsides: cost & post-op pain. But some people don't feel it's worthwhile for only 6 months of relief (& that is a possibility). Honestly, even though the second time I only got about 15 months of relief, it was still worth it. Even if I had only gotten 6 months of relief, I would have done it. My meds were up for about 6 weeks post-op (what can I say? i'm a very slow healer -- high SED rate), but then I was able to cut them way down & still had much less pain than even what I had ON meds pre-op.

From what you write, though, it sounds like you maybe only got relief from the local. Maybe they didn't find the right place. Is there any way they could repeat the trial in a different place? The second time I had the ablation on my neck, it took my PM 4 trials to find the right place (well, 3 & then we had to repeat it to make sure). Maybe get a second opinion if you're not comfortable.

I'm wondering whether you're referring to Loyola in Chicago. If so, we're neighbors. :) Yea, Chicago!

take care,
frances

opnwhl4
Forum Moderator


Date Joined Dec 2008
Total Posts : 4896
   Posted 11/16/2009 11:06 PM (GMT -7)   
Frances-
Thanks for the response. It is very helpful. It is Loyola in Chicago, I also went there for my Nissen redo. I am about 2 1/2 to 3 hours Southwest by the Iowa border. The doctor did say they may have to try a few different areas to get the right spot. I also believe this local only numbed the surface area and tat is why it came back so fast. He thought I would get 12 to 24 hours from it. Even when my surgeon here has done the nerve blocks sometimes he doesn't get the exact spot and it will only last a couple days. Seems to be a very touchy and finicky thing to get relief from.
Right now he wants me to give the nortriptyline and Lyrica a try together for 4 to 6 weeks. I tried Amitriptyline once and don't remember 2 days. He said I shouldn't take that ever again and this one is a cousin to it, but isn't so sedating. I also am a slow healer and have had issues with scar tissue in the past, so I am sure it is the scar tissue causing the pain.
I have to remember to call this procedure chemical ablation. It sure sounds better than "killing" the nerve!

PaLady-
I keep forgetting to give everyone the back story. It's kinda like the Paul Harvey isn't it! LoL! He did tell me today that he would probably have to do 2 or more trial trigger point injections to find the right area since it didn't do much the first time. Since I live so far away he doesn't want me driving there several times without trying the meds first, but also said I may have to use the meds and still have the ablation. You are definitely right about this being fun. Sure is frustrating when you think it is getting better then for no reason it gets 10 times worse.
I am beginning to understand your frustrations a bit better. Just when you think one problem is getting better something else rears it's head. How is the jaw healing? I sure hope it is getting better. I need to get to the dentist myself, but sure hate to go. I still have a baby molar that has a silver cap from when I was a kid, it put pressure on a corner of the molar next to it and now it broke a small piece off. I know I should get it fixed. Well someday.

Thanks again for the responses. Michelle and I were trying to figure out the best options for this and can use all the help we can get.

Take care,
Bill

PAlady
Veteran Member


Date Joined Nov 2007
Total Posts : 6795
   Posted 11/16/2009 11:54 PM (GMT -7)   
Bill,
It sounds like you need to at least try some more injections at different sites. It's too bad there's no one closer, but then again when I was doing the injection run around a few years ago there were often long waits between them because the doctor was so booked. And that's before I had any serious medication to help me with the pain.

I do hope that something can be found so that you can get some type of ablation. Frances is right; whether it's chemical or radiofrequency (RF - the same thing they use for the HALO procedures with the Barrett's!) the idea is to injure the nerve so it doesn't transmit pain signals. I remember my doctor telling me that years ago when they first started with the RF they did kill the nerve and learned that caused phantom pain which was as bad or worse than the original pain. Just injuring rather than severing the nerve avoids this. But nerves grow back so just like Frances said it's hard to tell how long it wil last for a person but in her case initially it was for several years. I would have had RF if the could have located the exact spot. I'm hoping that I'll be a candidate (and my insurance will pay) for the RF (HALO) for the Barrett's. I have my appointment next week with the new GI doc.

Thankfully, the jaw is finally healing up. Matter of fact I see the dentist tomorrow, and he wants to take an X-ray - maybe to see how loud I can MOO? LOL Seriously, I hope it shows bone is growing, although at the moment it's not causing me any pain so I'm tempted to just tell everyone to let it be!

You're right - we all need all the help we can get!

Hugs,

PaLady
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