Chronic Pain - Bowels - Pain Management Message Board

Josh Mann · 10-09-2006, 10:16 PM

Hi All.

I have a client who has been diagnosed with have Chronic Pain from his Bowel condition.

The issue is, the client is non-verbal and has suffered a profound disability from birth. Making communication very difficult and basically we try to read the different signals he is putting out.

We are looking at discussing with his GP about the pain issue and we feel he has his own thoughts on the whole thing, saying that the pain should only come when he is having bowel difficulties.

We now this is not the case.

Unfortunately we have the issue that the client also smears feaces over himself (causing infections to eyes, ears,etc). The pysicologist thinks that he is releived after a bowel motion and often will fall to sleep straight after (which when he wakes, he has smeared everywhere).

We are looking at getting him some permenent pain releif as the problem can only be resolved with a Bowel Resection (which he can not have due to being an anaesthetic risk) Panadol elixier just does not do the trick.

Can anyone assist with some tails about there experience working with thier GP??

Can anyone suggest a pain treatment other than medication as he is on enough of them at present?

We are trying really radical things such as turning his routine upside down from day to day, even painting one wall of his bedroom every month to try and make a different environment.

Thanks for reading this long saga, but it has gone on for 28 years and still going.

Cheers

Josh

RetiredDirector · 10-10-2006, 12:30 PM

Wow Josh, this is some kind of a challenge you have to work on with this client. Have you read any posts on this board from Bowel Disorders, Digestive Disorders, or Irritable Bowel Syndrome? You might look through these for any ideas.

I suffer from Irritable Bowel Syndrome and have constant lower left quadrant pain all the time. I take Methadone for my pain which is not only from the IBS, but from a lung surgery I had where ribs had to be removed and I suffer from nerve pain.

You said your client doesn't need any more medication because he is already on a lot, but the first thing that popped into my head was was a pump implanted under the skin that would deliver a constant amount of pain medication. No pills to worry about, just a refill of the the pump every 60 days or whatever. It's called a Medtronic Intrathecal Pump. You might want to look into something like this for your patient.

Josh Mann · 10-10-2006, 05:25 PM

Thanks for the thoughts and your story Director

I have looked at some other posts but they all seem to have medication as a solution. I am also looking at what alternative things we could do to assist keeping his mind away from the constant pain.

Unfortunately we can not look at an anesthetic for him so it would have to be done under a local and I really don't think he would comply with sitting still or even being sedated.

The issue is

He has a condition that is known only (apperently) to 17 others in the world. He has a duplication of the long arm of Chromozone 6

So are we!

There is not a lot you can find out about this Chromozone issue as you need to be a genetic engineer to understand any of it. It basically means he has twice as much chance of a tumour turnig bad or a cold to turn into something nasty. His immune is quite low and suffers infections quite commonly.

This put together with his bowel issues (tangled redundant bowel) causes very limited choices in the direction we go with treatment.

Once again thanks for the thoughts and best wishes.

Take Care.

Josh

RetiredDirector · 10-10-2006, 08:39 PM

I understand what your saying, Josh, but couldn't he be sedated just enough with something like Fentanyl and be given a local or spinal to do the procedure? Maybe someone on the boards that has an implanted pump will come up with some ideas. I don't know how long the procedure takes, but if he had it, he wouldn't most likely even know it was there. He could be getting a constant dose of Morphine or something to bring his pain level down.

Is there anyone who can help out here and let us know how long it takes to implant a pump?

Josh Mann · 10-10-2006, 10:43 PM

Thanks again Director.

I understand what you are saying about having a pump of some sort to give constant pain releif, but we are really looking for an alternative to this type of procedure.

Hi gastro specialist said that his body would not handle a general and he does not even considered a local or block to have something like this inserted as safe.

Thanks again for your thoughts Director!