Pain Clinic #6: Acute Pain Service

I’m steadily working my way through my pre-surgery appointments. My next appointment at the pain clinic was supposed to happen in August, but because of my upcoming surgery, they moved it up to this past Tuesday. I met with a doctor who recently started his one-year Fellowship in Anesthesiology and Pain Management at the hospital’s pain clinic – there is an annual program rotation that starts at the beginning of every July. I had to catch him up on what’s been happening since I had my nerve block.

I told him that I had dutifully kept my pain log every two hours for 48 hours after the nerve block and sent the log back to the pain clinic as instructed. I also expressed my disappointment that the nerve block didn’t last longer than two weeks, but I tempered that by letting him know that it was still nice to have had a little pain relief even if it was for such a short time. He asked if the nerve block had made it possible for me to reduce my pain medications. Unfortunately, the answer to that question is “no.” I wasn’t able to reduce my pain medications but I believe that during that short period I felt some benefit from them for the first time in a long time. They enabled me to do a bit more than just the basic daily functioning of moving around. For instance, I was able to go out with a friend to a local market where I picked out fruit, vegetables, spices, and cheeses for myself from different shops; and the relief was enough to make it possible for me to cook myself a complete Sunday dinner. It was good to get out of the house and walk through the market for the first time since becoming ill and it was even better to use produce I selected – instead of some anonymous person from my online grocer – to make myself a tasty meal.

After talking about the nerve block, we moved on to my surgical pain management plan. I will have an Anesthetic Clinic consultation during my pre-admission appointment. During that consultation, an anesthesiologist will review my current pain medications, the pain management plan designed for me a few months ago by the pain clinic, and factor in the results of my nerve block to determine the level of pain medications I will need during surgery. My pain specialist believes that the suggested epidural should remain a part of the pain management plan so that I can receive a constant flow of pain medication during surgery and for up to two days after because my surgeon is going to use a vertical abdominal incision, which is of course the more painful technique. Following surgery, I may also have a patient controlled analgesia (PCA) pump so I can control the frequency of the doses of narcotic/opioid pain medications I receive immediately after surgery.

In addition to having my body flooded with pain medications through these invasive methods, I will be closely monitored for the length of my hospitalization by the Acute Pain Service (APS). The job of the APS is to “to ensure patients with pain have individualised, safe and effective therapy” and “to provide safe and effective pain management to patients undergoing surgery…from admission to discharge”. An anesthesiologist will lead the APS team. The team will see me daily to assess my pain management needs, make adjustments as required, and measure my rate of recovery from my surgical pain and chronic pain. The team will also make recommendations about the type and amount of pain medication I’ll need when I’m recovered enough to be discharged from the hospital. Before this conversation, I had no idea that such a service existed and that I would receive this level of pain management care after surgery.

Surprisingly, I left that appointment feeling buoyed with confidence. A few days ago, I didn’t feel that. I instead felt overwhelmed by anxiety and fear. I think the anxiety is starting to shift because as I go from appointment to appointment and make phone call after phone call from the many points on my to-do-list, I’m realizing there is a supportive network of healthcare professionals around me who feel invested in getting me better. To meet that goal they are openly communicating and sharing information with each other and me so all I have to do is show up. I just have to show up and let them worry about the surgery and the post-operative care. Let them worry about the sharpness of the blades of the scalpels; the amount of pressure in surgical suction pumps; the number of stitches and staples needed to close my incision, and when they will reintroduce solids to my diet. I’ll let them worry about those things and the piles of other things rolling around in my head and in the meantime, I’ll work on trying to sleep more, laugh more, and take in the love and support of the many friends and family who want to carry the rest of my worries for me.

Now on to doing the work of making this positive perspective my reality…

 

Bob Marley – Three Little Birds

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2 thoughts on “Pain Clinic #6: Acute Pain Service

  1. Pingback: Successful Surgery With A Disappointing Recovery | My Small Surrenders

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