Identify the locus of the pain
The hardest part of the job
One of the hardest aspects of my job – harder than performing surgery on patients – is identifying the cause of a patient’s pain. When patients come to me, they will have certain symptoms, and I will try to identify the locus of the pain by asking the right questions and carrying out a neurological examination. However, even MRI scans don’t always show which nerve, in which location, is causing the pain. Take, for instance, a double hernia. If a patient suffers from a double hernia, the image will show two instances of disc herniation on the same side of the spine, but which hernia is the one causing the pain in the patient’s legs? Team work will be required to answer this question. My ally in all cases requiring detective work is an anaesthetist specialising in pain management named Dr Poell. Like a modern-day Sherlock Holmes and Dr Watson, Dr Poell and I go on the hunt for the hernia which is causing all the trouble. One of them is bound to be more painful than the other. You see, generally disc herniation doesn’t cause any pain, so I can’t just operate on any old hernia.
Our method is simple. Dr Poell administers a numbing injection to the part of the back we suspect is the culprit. If the pain then subsides, I’ll know that this is the spot I’m going to have to operate on, because clearly, that was the spot causing all the trouble. If we are lucky, Dr Poell will identify the location on his first attempt, but every once in a while, several injections will be required to temporarily relax the affected sciatic nerve. The numbing agent will not last for long – half an hour to a day at most. Long enough to give the patient some respite, and for me to decide on which part of the back I should operate.
The same identification method works very well in other situations, too. Muscles or the cavities of joints can also be subjected to test numbing. If, once a patient has been given a numbing injection, his or her pain subsides, we know that we have identified the cause of his or her pain. I use this identification method several times a week, so as you can imagine, it’s a good thing that Dr Poell works in the same building and that we get on well!
Last but not least, you’ll wonder how badly the injection will hurt and whether there are any risks associated with it. I find it interesting that many patients are happy to request surgery but refuse to receive any injections, most likely due to a fear of needles which developed at some point during their childhood. It seems that many grown-ups can remember their childhood jabs all too well and do not particularly cherish the memories. So I’m pleased to say that Dr Poell works with very thin needles and is a kind and patient man, as well as a very competent and experienced doctor. The great majority of patients hardly experience any pain when injected. And even if the sensation should be somewhat unpleasant, remember that you are suffering for a good cause. Once Sherlock Holmes and Dr Watson have pointed out the culprit, a solution can be found. It is then up to you whether or not you wish to undergo surgery. Just remember: the relief you will feel after your surgery will last a great deal longer than just a few hours.
It should be noted that there are certain types of pain which cannot be surgically remedied. In many of these cases, Dr Poell will have some other therapies up his sleeve with which we will be able to reduce your pain.
