11.       Scar tissues issues

post operative and other unexplained painful issues

The scar tissue and adhesion from the surgery can cause significant health problems down the line. Sometimes the issue may not be obvious but people might suspect the link. One frequent population is from women who have had caesarian. They started having low abdominal issues like chronic low grade pain, constipation or general malaise which wax and wane with time. When severe, it can cause cramping, vomiting. Which lead to doctors to suspect Gall bladder problem or appendix problem. The best way to resolve such problem is to use moxibustion over the scarred area, using infrared lamps over the low abdominal area consistently until the problem got resolved. Some people needs a few times of treatment. In extreme cases, it could take years.


   I had a 43-year old female patient who has a 3 inch- long surgical scar on the lower back from a disc operation. She comes in for acupuncture when the low back pain become intolerable, which is about twice a month. Acupuncture gives her complete relief of pain for a few days to weeks each time. Her case is by no means an isolated situation.


    Post -operative pain is common among patients shortly after surgery.  What is difficult is to do right diagnosis. Often easily neglected is the post-operative pain that appears much later after surgery. Such problems can be successfully treated with acupuncture. According to the American Society of Anesthetists (ASA) 2007 Annual Meeting in San Francisco, acupuncture and Chinese herbs are very effective in reducing the post-operative pain. http://www.newswise.com/articles/view/533691/

One very interesting observation is that, often times, the pain onset can be years away from the surgery. There can be difficult for doctors to accept its cause effect.

Same thing goes with the physical injury, especially the injury to the head. The effect from the injury can show up long after the injury by which time the injuries have apparently healed.

The treatment method for such types of pain will be discussed later.

11.3     Why is post-operative pain so difficult to diagnose?

Because Qi and blood stasis caused by operation can't be detected by x-ray or other imaging method. The blood test would be normal. Medical doctors are often at a loss as to what is causing the pain. Even though medical history would reveal the prior surgery around the affected area, it is generally assumed that after the wound has healed, it should not cause future pain.

Often, there are shown as spots of hardened tissue resulting from healing process that are tender to the pressure. In some cases, medical doctors define them as neuroma.

What causes pain?

The Answer: Most likely, Qi stagnation and Blood stasis according to a TCM diagnosis. In TCM, it is recognized that such stagnations would reduce circulation and result in pain. It goes like” No circulation, there will be pain.”

This is the most important concept in pain treatment. Without the clear understanding of this issue, treating pain will be very frustrating. In modern pathology, pain is all about the nerves and the brain function. Numbing or killing the nerves, there will be no more pain signal and no pain sensation. Sedate the brain and there will be no more feeling of pain. Simple, right?  But life is not easy under such situation.  

On the other hand, from the perspective of Qi and Blood concept, if we can somehow restore the proper Qi and Blood flow, there will be no reason for pain.

Qi sounds so mystique and hard to grasp. It is actually quite easy to understand. Say you went to a party and had a good time.  Unfortunately, you had too much to eat. Your stomach becomes unhappy and painful. What happen? It is your stomach on strike- Stomach Qi stagnates. What to do? Insert a needle or rubbing your He Gu (Large Intestine point 4, the center of the thick web between the thumb and index finger.) The stagnated Stomach Qi will be moved and you start to feel yourself again. 


The following paragraph  in Italic is from textbook from UT medical school


Notice that in this paragraph, the chronic pain is explained in terms of "sensitization" .  Such explaination is not satisfactory to me. For one thing, if an acute pain is not properly taking care, the whole body starts to undergo changes to accommodate the pain. Such accommodation would create structural deficit which will be discomfort for many people, more for older than younger because the body's ability to accommodate. Such accommodation is a source for chronic pain. So, the key is still to resolve the problem caused by the acute problem and at the same time attending to the prolonged consequence due to the acute pain.  


"7.4 Chronic Pain

Chronic pain is prolonged pain lasting for months or longer that arises from tissue injury, inflammation, nerve damage, tumor growth, lesion or occlusion of blood vessels. Chronic or inflammatory pain can sensitize (see "Sensitization" below) the nervous system, evoking chemical, functional, and even structural changes that serve to “prime the pain-processing pump”. Chronic pain, such as lower back pain, rheumatoid and osteoarthritis, and headache (see "Headaches" below) may result from constant inflammatory activity which activates G proteins. In some cases, the pain persists long after the injury heals, but there is no treatment that will eliminate the pain.


One possible explanation for chronic pain is a phenomenon called sensitization. Following continuation and prolong noxious stimulation, nearby silent nociceptive neurons that previously were unresponsive to stimulation, now become responsive. In addition, some of the chemicals produced and released at the injured site also alter the physiological properties of nociceptors. The nociceptors begin to initiate pain signals spontaneously, which cause chronic pain. In addition, weak stimuli, such as a light touch that previously had no effect on these nociceptors, will further activate the nociceptors which result in severe pain signals. This phenomenon is referred to as “peripheral sensitization.” The outcome of peripheral sensitization results in a greater and more persistent barrage of nerve impulses firing in the CNS. The persistent barrage of nerve impulses results in long-term changes in nerve cell activity at the level of the spinal cord and higher centers in the brain. This phenomena is referred to as “central sensitization”. It appears that peripheral and central sensitization persists after the injury apparently has healed. The sensitization of nociceptive neurons after injury results from the release of different chemicals from the damaged area. It is known that substance P and calcitonin gene-related peptides are released from peripheral nerve ending which stimulate most cells to release algesic substances which further potentiates the pain from the injury. In contrast, central sensitization resulting from severe and persistent injury which cause prolonged release of glutamate on nociceptive dorsal horn cells, this constant glutamate release via G protein dependant phosphorylation cascades results in opening of postsynaptic ion channels gated by the NMDA receptors. This phenomenon is also termed "wind up." This activation produces hyperexcitability of the dorsal horn cells and causes "central sensitization." Pain experts now agree that treating chronic pain early and aggressively yields the best results and prevents patients from developing physical and psychological conditions that could worsen the pain."


Comment: Why do the Qi and Blood become stagnated?

Causes are so numerous. Stress, physical as well as mental, is the number one culprit. In many mysterious pain situations, they are quite likely due to prior surgeries or physical accidents that caused body injuries. The problem was not resolved satisfactorily which " sensitize" body to future pain.