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From: B. Harris)
Subject: Re: Pain Questionnaire
Date: 24 Oct 1998 07:37:43 GMT

In <> (Don
Sterner) writes:

>>> I'm undertaking a study looking at chronic abdominal pain attributed
>>> to adhesions following surgery. Can anyone suggest a validated chronic
>>> pain questionnaire that can be mailed to people in the study? I
>>> already intend to send the Hospital Anxiety and Depression Scale
>>> (HADS).
>>Chronic pain after abdoninal surgery???? Get real. Chronic intractable
>>pain doesn't occur in soft tissue. Save your "Questionaire for real
>You haven't the slightest idea what you're talking about. Chronic
>pain is all too common after surgery.

   Yep.  Post surgical adhesions can be hell.  I wouldn't say it's
usual in abdominal surgery, but it happens often enough that the total
numbers are scary even if the percentages are low.

    NON-chronic post op pain, for any kind of surgery, is also
something that needs to be addressed more in medicine.  This may last
only a couple of days, but it's hell also, and much of it is probably
avoidable.  For too long, we've had the idea in medicine that
anaesthesia is the same as analgesia, and today we know it's not.  "No
brain, no pain" is a very bad paradigm, because the truth is that
"pain" is something that is processed at many levels in the nervous
system, and only some of them are conscious.  Pain paths start as local
nerve irritation, and they set up complex self-reinforcing circuits in
the spinal cord, even if the patient is unconscious.  These connect
with similar paths in the thalamus, all of which are activated and
going during anaesthesia, spitting out the message "pain..pain...PAIN!"
and just waiting for the cortex to wake up.  When it does, it gets

   All this can be blocked in many ways, from iNOS inhibitors to NSAIDS
to local anaesthetics (not usually used in general anaesthesia) to
experimental opioids that don't cross the blood-brain barrier (an odd
concept, but one that makes absolute sense if you know anything about
it).  All these things are being used more and more in animal surgery,
and the results are quite dramatic (I've seen them myself).  In the
next five years, I'm afraid the animal surgical patients are going to
get better post op pain control than the human ones.  A shame, but
there it is. Medicine is nothing if not conservative.

                                          Steve Harris, M.D.

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