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Advice Seeker: Myofascial Pain (Surgical Trauma)

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Old 07-19-2012, 07:57 PM   #1
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Arrow Advice Seeker: Myofascial Pain (Surgical Trauma)

I have had 15 surgeries in my life and I am nearing 35. I had been the first person in Western Massachusetts diagnosed with Endometriosis in my county back in 1997. I am from what used to be a small town in the foothills of the Pioneer Valley. The doctors here are less than knowledgeable and provide very poor medical care. However, I have gone to Boston for 2 of my surgeries and the worst surgery I ever had was in Boston, at Brigham & Women's Hospital, a year ago, July 2011. I had been schedule for a simple Laperscopy for lysis of Endometriosis and when the Dr., went in and found NO ENDOMETRIOSIS, he instead lysis'd ahdeshions he found adhering my intestines to my pelvic floor.

To make a long and miserable story short... He injured an abdominal nerve when entering with the (R) trocar instrument, causing Trocar injuries in laparoscopic surgery to be a lasting issue for me. NOT ONLY, did the abdominal nerve get injured but the Dr. also damaged my pelvic floor muscles when unadhereing my intestines from my pelvic floor. IT HAS BEEN AN EVERLASTING MESS!

The Dr. FOUND NO ENDOMETRIOSIS, this time around. I was confused. I had several surgeries for Endometriosis and none that had not found any Endometriosis.

I have been on a narcotic regeimen for over a year now. I have tried several other Rx. concoctions with no improvement or side effects so terrible, I could not tolerate the medicine long enough to gain any benefit. I have A LOT of drug allergies and generelly a "paradoxical" effect to what most doctors expect or have experienced with a 95% of their patients.
I also tried "Internal Physical Therapy",... that was a disaster!
I tried being in a wheelchair in the beginning, it was impossible to walk. That taught me a lot and now I use it as little as possible or only on the bad days. I appreciate my mobility and have a new found respect for those who have mobility issues, handicapped or confined. The elderly as well. Patience is in short supply when I found myself in those circumstances. People, really need to be more tollerant to all people.
I have recently began "Injection Treatment" for "myofascial pain" in the abdominal area and soon to be vagina injections into the damaged portion. Here is the thing.....

I had a set of injections with Lidocaine... was rough. Very sick and on my a$$ for days. Caught a stomach flu, had to skip the next round of injections. Went this Monday for Round #2 of injections. The Dr. injected me three times with "lidocaine and epinephrine". I had no pain relief and the next day I had a bright red ring around the whole area that was injected, about a 2 inches round. Then Wednesday, the 2 inch ring turned bright red inside and my pain has been worse then the "8" I am always at. So I called the Dr. Tuesday morning, he was in another office and the nurse was to pass a message. Never heard back Tuesday. Then Wednesday, I called again and they told me to call an office I had no idea the Dr. even practiced at. They put me on hold and then came back and said to go to the ER? (Two days after the initial injections). I tired to explain the the Dr. told myself and my boyfriend along with my Mother.... to NOT go to the ER, if the pain worsened with any of the injections, as sometimes that is how they work... A better before worse approach. So I called my PCP, they had no idea what type, amount or area that was treated, nor where they familiar with that type of treatment. To ice that cake, MY Dr. (PCP) was not even in that day, so they told me to go to the ER! I did not go. I made a homemade lidocaine patch and have been in bed and not able to do much since Monday the 16th. It is not Thursday the 19th. I am due for Round #3 of injections Monday and here is where you cone in... With that brief background I gave you... I want you to know I am scared as I obviously had a reaction to the lidocaine and epinephrine concoction... I have not been able to get a hold of anyone who was in the room that day... The Dr. himself had a message from the nurse on Tuesday and I have not heard from him nor will anyone connect me to him or a voicemail for him or have him return a call. I am scared and not sure that this is the answer. If not there are no other offerings on trying torid the suffering.... Any other Endometriosis Ladies have advice, etc.?

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Old 07-20-2012, 05:35 AM   #2
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Re: Advice Seeker: Myofascial Pain (Surgical Trauma)

NI do not have endometriosis but I do have myofascial pain syndrome and have a lot of experience with trigger point injections. They say the pain is always "a little worse" after getting TPI done. Well I can tell you it can be excruciating for the first 48 to 72 hours. If you are still not getting any relief today I would call the doctor back and just ask what
you should do. If you do decide to go through with the rest of the injections, ask if your pain medication can be increased for the first few days. Ice packs (no heat) over the injection site may bring you some relief.

Good luck and I hope you start getting some relief.

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ParadoxicalLife (07-21-2012)
Old 07-20-2012, 09:56 AM   #3
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Re: Advice Seeker: Myofascial Pain (Surgical Trauma)

Usually trigger point injections are done with just lidocaine. I've never even heard of mixing in epinephrine. Some doctors actually do the injections with no drugs at all (dry-needling.)

I'm currently undergoing a series of injections. I usually do need pain medication the day after the injection.

I have chronic myofascial pain through most of my body, and recently it hit my abdominal muscles following laparoscopic surgery on my digestive system. In my case, the surgery was necessary and it worked, but now I have this price to pay in muscle pain.

For me, gentle exercise is absolutely critical. The yoga pose "cobra" or "upward dog" soft-stretch the muscles of the abdominal wall. The pelvic floor muscles are hard to stretch, but some regular back stretches can loosen them indirectly.

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ParadoxicalLife (07-21-2012)
Old 07-20-2012, 10:12 AM   #4
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Re: Advice Seeker: Myofascial Pain (Surgical Trauma)

Just FYI but most lidocaine shots that Drs. use already have epinephrine mixed in them. Just like in the dentist office..

This is where if someone has a reaction to this...they can easily request to choose the lidocaine without it.

Old 07-22-2012, 06:29 PM   #5
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Re: Advice Seeker: Myofascial Pain (Surgical Trauma)

Lidocaine inj do NOT have Epinephrine in them. Some trigger point injections have a steroid in them, generally a tiny amount of an injectable form of prednisone, generally referred to as cortisone. About 10% of the population will get an effect from cortisone injections where the cortisone part of the injection sort of crystallizes causing increased pain and inflammation for 3-4 days before it reduces the inflammation that is part of the pain that is being treated. Epinephrine stimulates the heart, and while it is used in cases of severe allergic reactions (epi pen)to keep the airway open, if used you MUST seek emergency medical assistance within about 15 minutes, and you are likely to be intubated to be sure that a secure airway is maintained until the allergic reaction is under control. The routine novacain dentists use does not contain epinephrine nor does it contain a cortosteroid. If you are one of the 10% who get the adverse reaction to corticosteroids you will need to ice the area 20 min on and 20 min off for the first 3-4 days. In my opinion, if you are in the 10% ou should seek alternate treatment for trigger points, the bad effects of it outweigh any potential benefit.

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ParadoxicalLife (07-23-2012)
Old 07-22-2012, 07:10 PM   #6
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Re: Advice Seeker: Myofascial Pain (Surgical Trauma)

Please speak to your Dr. or a Pharmacist about this. As well as you can google lidocaine injections. (different from cortisone injections)

This is information from NIH about epidural injections as well as dental procedures:

Lidocaine Hydrochloride and Epinephrine Injection, USP is indicated for production of local or regional anesthesia by infiltration techniques such as percutaneous injection, by peripheral nerve block techniques such as brachial plexus and intercostal and by central neural techniques such as lumbar and caudal epidural blocks, when the accepted procedures for these techniques as described in standard textbooks are observed.

Lidocaine and Epinephrine Injection, USP is indicated for the production of local anesthesia for dental procedures by nerve block or infiltration techniques.

***I have reactions to the epinephrine so I have to specifically ask both my dentist as well as my PM to use lidocaine WITHOUT epinephrine.

It is absolutely used in most cases of dental work as well as many spine injections.

***Lidocaine injections are different than cortisone injections. Many Drs. do different types of injections depending on what is needed. I have had many of each of these types of injections over the years with my spine issues.

Last edited by Ilovemycutedog; 07-23-2012 at 04:43 AM.

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Old 07-28-2012, 09:19 AM   #7
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Re: Advice Seeker: Myofascial Pain (Surgical Trauma)

the things/procedures you listed are all mostly "spinal blocks and dental procedures. epidural(meaning outside/above the dura itself) injections are simply that, given above/around the dura with hopes it will spread out and hit the offending nerve roots(this is why they also inject a contrasting agent with epidurals and also should be using flouroscopy just so they can see that spread, and for the patients safety as well). epidurals are just very different than actual TP injections and given for a different reason. great explanation tho.

what my PM actually has used now for many years for "only' trigger point injections(i have had hundreds at this point) is a mix of "maricaine(similar to lido. anything with the suffix 'caine" is a numbing agent.) and some alcohol. while the maricaine does the numbing, the alcohol is what helps to actually break down and help to try and release at least to some degree that now hardened tissue and muscle caused by overly tight fascia that when it gets inflamed, and it most certainly CAN by any surgical procedure(usually alongside the incision or anywhere actual muscle/fascia was cut into in this type of instance).the surrounding and inflamed fascia will clamp down around the muscle since fascial tissue surrounds every muscle, organ and blood vessel we just have in a type of thin spider web like sheet litterally running from head to toe inside our bodies. basic TP injections will NOT break down scar tissue unfortunetly, since it is made up from a totally different type of tissue(it gets like a very "hardened skin overgrowth). but for actual real trigger points, that "caine/alcohol mix should be what is being used if this IS indeed actual TP injections and not some other 'type' of the many different injections that docs can do for specific issues we just can have that need some help..

but you most certainly DO need a much more caring doc,and one that KNOWS for certain just what they are doing as well. from your description, it sounded like he had some 'issues' in the knowledge area? it sounds like he is now trying to simply just blow you off, to me anyways. i seriously would consider possibly seeking out another doc to continue any real treatments for what you are dealing with, mostly because any patient 'deserves" to be able to have questions answered and speak to the appropriate people at any type of specialists or docs office. every surgeon has either an NP or PA that is supposed to be the "go between" from specialist to patient. they also are supposed to answer questions and Rx meds for the patients who have had sugery by their particular surgeon. that is the one person who you SHOULD be able to speak to about anything related to your surgical post op period until you are actually fully released from that surgeons care anyways.

i just think that trying to get pain care managed by an actual pain doc, or at least trying to find another of the same type of specialist just to find out if nothing else, if what THIS doc is doing is even the most "appropriate' type of treatment for what you have going on there. while you were definitely IN one of the top hosps in the US, it does not appear you got one of their 'top surgeons' there.

if you want to know just what has helped me in soo many ways with my insane level of trigger points, just ask and iwill let ya know. it may help with at least some of the more in depth abdominal muscles being kind of held hostage in there right now. which in turn may release whatever is simply attached to those larger muscles. alot really depends upon just what needs a myofascial release and what is actually scar tissue/possible adhesions too. i just do hope things can get much much better for you hon. using whatever you have to actually do to get there. marcia
3-22-01,herniated C-6-7
11-20-01,placement of hardware for failed fusion
9-22-03,removal of cavernous hemangioma that was inside spinal cord. Neuro damage to L hand L leg and R leg.

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