Expert: Dr Ian Jackson - please note UK based - 1/28/2009

Question
Hi. Last May I had my LUL removed due to a small tumour/lung cancer (non-smoker). The surgeon said that the nerves could cause pins & needles & discomfort for about a year. I haven't had pins & needles, just discomfort & stabbing pain at times when the skin is touched. At the same time, I also had a mastectomy on my other side. That doctor recently sent me to a pain specialist because I can't wear a proper bra due to pain when touching my rib area on the lung surgery side (& I'm not small). The pain doc has referred me to an anaesthetist to do something to block/kill? (not sure which) the pain. What is the disadvantage of doing this? Do I lose all sensation in the area? Any other possible longterm side effects? I can live with the pain, it just affects what I can/can't wear, which can be uncomfortable(and maybe affect other muscles/ posture due to lack of support?) Thanks for any info/ suggestions you can give me. I know my lung doc said 1 year, but the pain doc didn't seem to care about that.

Answer
I am really sorry to hear that you have had to have two fairly major ops in the last year.
Neuropathic pain (pain from damaged nerves) following thoracotomy (opening your chest) is not uncommon and your surgeon was right to warn you about this. Your description of this is excellent and it is likely that it will not disappear at this stage - it has become a chronic condition. I suspect the pain specialist will try local anaesthetic blocks on the affected nerve to see if this helps you. That should give you a narrow numb band in the area blocked for 5-6 hours - they will then hope that this may help the nerve modify how it is responding to touch. I'm not an expert in chronic pain and I'm uncertain if they would try to do much more than that. Personally I wouldn't be keen on anything that tries to permenantly damage/block the nerve unless they can provide good evidence of successful outcomes for this. If you are living/coping well with the pain then you would need good reasurance that the treatment wasn't going to leave you in a worse position.
Sorry I can't be more concrete about this but it is more than 20 years since I took part in pain clinics as part of my training!
Kind regards
Dr Ian Jackson