Expert: Dr Ian Jackson - please note UK based - 11/3/2008

Question
this is a question about my nephew, about a year ago he had an hip operation wich has been causing him pain all year, he was put on very strong pain killers to ease the pain to wich we had another doctor inform us that as a 14 year old he should't be on , so we had to wean him of , wich made him slightly agressive as he was dependent on them, 4 weeks ago he had surgery  to correct his hip wich was giving him pain, but my main question is ever since his first operation wich he has  had three in three years, his temper gets worse and he''ll lose control over nothing ang punch and kick anything in his way wich in the past few moths has caused his mum to call the police, he does talk to me  and admits he feels anger welling up untill he explodes and cant stop himself , he also has migrains, we have eventually got some counciling for him after fighting to get some one to admit there was a problem, my sister in law informed me that a year ago a doctor said it could be post anesthetic delayed reaction, and a friend who is a nurse has informed us of the same thing this time when she saw him, is there anything to back this up ? anger wich wells up untill you explode and migrains,14 year old boy, it has got progresivly worse after each operation

Answer
Steven
Hi there. I'm sorry to hear about your nephew. This sounds a very complex story and I'm sure the chronic pain he has been experiencing and the strong drugs he has become addicted to has played a part in what he is experiencing. I am also sure that the changes he is going through as a teenager are also playing a major part in this - these effect some people far more than others.
I know of no evidence that would suggest that this could be a delayed post anaesthetic reaction. Indeed I become tired of the use of anaesthesia as an 'excuse' by clinicians as a possible cause of many problems. He will have problems after each operation as his body is exposed to strong pain killers again and has to come off them. This will be difficult for him as most patients who become addicted to a drug then go through the whole problem again each time they are exposed (eg alcoholics)
Your nephew has a problem and both he and his family need support in managing this. I think that counselling is needed but alo that anger management courses may be helpful.
Sorry I can't provide any other insights, but I hope things improve with time (I suspect they will)
Kind regards
Dr Ian Jackson