Written by Emma Semwayo, senior solicitor in the Medical Negligence Department
An inspiring story of NHS treatment at its best emerged last week from the University Hospital Southampton NHS Foundation Trust which may offer hope to the millions of people suffering with Chronic pain conditions.
The full article can be viewed here: https://www.bbc.co.uk/news/health-48472388
Ms Cameron had suffered over 30 years with debilitating pain from nerve damage following appendix surgery and was recently provided with innovative treatment in the form of a paddle implant combined with a spinal cord stimulator which resulted in her being off all her medication within five weeks.
The striking thing about this case is the care and dedication taken by the clinicians to find a solution for Ms Cameron’s chronic pain condition and to prevent the serious side effects caused by the treatments.
This is not the experience of many patients: Pain is a complex condition which affects individuals differently. There are no objective tests to diagnose or quantify pain, all current tests rely on the patient’s own report. Pain has many factors both physical and psychological and explaining the nature of the pain suffered to a clinician can be difficult. Essentially the subjective nature of the tests applied means that patients may not be taken seriously.
This is notwithstanding the fact that many chronic pain conditions are actually a side effect of treatment. This is what happened in Ms Cameron’s case and the length of time she was afflicted following routine surgery demonstrates just how devastating this can be.
Ms Cameron suffered neuropathic pain which follows damage or injury to nerves. Symptoms include burning sensations, excruciating pain, pins and needles and numbness. Surgical nerve damage is one of the most common causes of neuropathic pain and is a common side effect of surgery. One study placed the incidence of surgically induced neuropathic pain at between 10 and 40% of surgical patients. The mechanism of the damage can result from direct damage/severing of nerves or from nerve inflammation. Even when the nerves are preserved, central sensitization can occur when persistent post surgical pain is poorly managed and becomes treatment resistant.
It should be remembered that nerve damage does not just lead to neuropathic pain, in extreme cases it can lead to incontinence, localised paralysis and even death. It is telling that successful cases for the recovery of compensation for nerve damage inflicted during surgery are relatively rare: It is generally accepted as an acceptable risk of surgery despite the devastating consequences. Cases which are successful usually involve nerve damage from unnecessary surgery or where the nature of the damage makes clear this could not have occurred during the course of reasonable surgical technique.
Whilst we will no doubt one day look back on current surgical techniques with the same horror reserved for the unanaesthetised butchery of the surgeon barber, things are moving on: There is a recognition that in the absence of treatments with high efficacy and low side effects, the goal of surgery must be to minimise the risk of nerve damage. New technologies such as fluorescence imaging directed at nerve identification and preservation during surgery are being developed and aggressive analgesic therapy to manage pain post surgery is recognised as vital.
The work done by Mr Girish Vajramani and the team at Southampton is inspirational and provided an escape to decades of suffering. However it is not an easy or straightforward solution to chronic pain by any means.
It appears that modern medical practice is moving away from the dismissal of these type of injuries as just a side effect of modern surgery. Part of that journey appears to be the recognition that neuropathic pain can be devastating and is not just in the mind.