FAMILY MEDICINE® COLUMN

By Martha A. Simpson, D.O., M.B.A.
Associate Professor of Family Medicine
Ohio University College of Osteopathic Medicine

Question: I’m an 82-year-old man who was hospitalized and operated on two years ago for arthritis of the spine.  I was doing pretty well until two weeks ago when I started having terrific pain every time I get out of bed.  After an hour of intense pain, I’m OK for the rest of the day.  My doctor says I have scar tissue and post-operative pain syndrome.  He prescribed two gabapentin pills before I go to bed at night, but these haven’t helped.  My questions are: Why did this take two years to show up?  Do you have any suggestions about possible treatments?

Answer: You have a very interesting query, and in reply I actually have more questions than answers for you. Since I can’t examine you personally, it would be much more fruitful to direct your questions to your own physician. However, I’ve decided to answer your question in my column with one very specific goal in mind. I hope that the way I approach your inquiry will help you and my other readers see why good patient-physician communication is so essential to receiving the optimum in personalized health care.
Now, let’s look specifically at the questions you ask and the new questions they raise. Your first question -- why this took so long to show up -- makes me question the diagnosis of post-operative pain syndrome and scar formation. Post operative pain syndrome commonly shows up about three to 12 weeks after surgery. The fact that you did well for two years brings that diagnosis into question for me.
Excess scar tissue formation after spinal surgery causes a problem called epidural or peridural fibrosis, depending on where the scar forms. This also comes on three to 12 weeks post operatively.
Another factor making me doubt the diagnosis is that both post-operative pain syndrome and peridural fibrosis worsens gradually rather making a sudden appearance as you describe. Also, scar formation doesn’t usually change over time -- once a scar is formed it remains fairly stable.
So here are a couple of things that might be going on that you should discuss with your physician. You may have developed an entirely new back problem close to the location of your original problem. This could be a herniated disc or new arthritis formation. It’s also possible that you developed a bone spur in the area of your previous surgery.
Be sure the diagnosis is correct. Sometimes when a medication fails, it is because the condition and treatment don’t match. Have you had a recent MRI of the problem area? Will your physician let you take ibuprofen or another type of anti-inflammatory that might help your pain?
Go back to your doctor and tell him that the gabapentin is not working. But, in the meantime, keep taking the medication. Ask your doctor why he feels this is post-operative pain or scar formation. Try a hot pad or a cold pack on your back and report to your physician if either has helped. Try sleeping elsewhere for a few nights, like on a recliner or on the other side of the bed. You may wake up feeling better.

Family Medicine® is a weekly column. To submit questions, write to Martha A. Simpson, D.O., M.B.A., Ohio University College of Osteopathic Medicine, P.O. Box 110, Athens, Ohio 45701, or via e-mail to readerquestions@familymedicinenews.org. Medical information in this column is provided as an educational service only. It does not replace the judgment of your personal physician, who should be relied on to diagnose and recommend treatment for any medical conditions. Past columns are available online at www.familymedicinenews.org.