The perception of pain is a common reason why patients see their physicians. Pain is also an important concern after surgery.
Treatment of patients with chronic (long-standing) pain is complex and often requires involvement of a multidisciplinary team that includes a pancreatic surgeon, gastroenterologist, pain physician and a psychiatrist. This comprehensive evaluation of pain is important for optimal outcome.
Over the past two decades there has been a significant improvement in the treatment of pain after surgery. Most patients are provided with excellent pain relief after surgery and experience only minimal discomfort.
Good management of postoperative pain is very important not only for comfort reasons, but also to encourage the patient to carry out chest physiotherapy exercises such as utilizing the incentive spirometer to prevent post operative pneumonia and collapse of the lung that is otherwise common with a large abdominal incision that are often made for big operations on the pancreas and the liver.
In this technique the patient uses an infusion pump that contains morphine or morphine type of narcotic pain medication. The pump provides a small continuous dose of pain medication to the patient. In addition to that the patient can inject himself/herself with additional doses of pain medication to control the pain. This is an excellent technique for the management of post-operative pain and the vast majority of patients obtain satisfactory pain relief with this technique.
A patient who presents with pain from chronic pancreatitis requires careful evaluation prior to any form of surgery. These patients have complex psychosocial problems associated with long usage of narcotic type of pain medications over many years for relief of their pain.
In many patients chemical dependency on alcohol and narcotic pain medication are difficult to distinguish from true pain originating from the pancreas. A careful evaluation of the patient for chemical dependency is critical for good outcome from surgery since patients who have chemical dependency would continue to be dependant on narcotic pain medication leading to poor results from the surgery. Furthermore, alcohol addiction is crucial to recognize prior to surgery since the results of the surgery for pain is not good if the patient continues to abuse alcohol. Removal of parts of the pancreas in a patient who continues to abuse alcohol may produce dangerous side effects associated with low blood sugar.
In many patients a careful psychiatric evaluation may be required to distinguish between a chemical dependency and severe pain from chronic pancreatitis. Furthermore many patients may have both severe pain from chronic pancreatitis and a chemical dependency that is difficult to resolve until the patient has undergone surgery. In these patients post-operative treatment for chemical dependency is critical for good long-term results.
Severe abdominal and back pain is a significant complication in patients who develop unresectable (surgically not removable) pancreatic cancer. Management of pain is important for providing good palliation in patients with advanced pancreatic cancer.
In this procedure the radiologist inserts a needle into the nerves around the pancreas utilizing images from the CT scan for guidance and alcohol is injected into the nerves to destroy the nerves.
Utilizing a combination of these techniques, the majority of patients may obtain good or excellent relief from their pain. Careful evaluation and optimization of the different treatment modalities is important for the best results.
Senior Consultant Single Keyhole Laparoscopic Surgeon
MBBS, M.S (Gen Surg – KEMH, Bombay), FAMS
Over 30 years of clinical experience in gastrointestinal and metabolic surgery
Dr. Ravi has been practicing surgery for more than three decades, with extensive experience in Hepato Pancreatico Biliary conditions with advanced laparoscopic surgery inclusive of one key hole laparoscopic surgery and liver transplants
His clinical focus includes:
Dr. Ravi routinely performs laparoscopic (keyhole) and endoscopic procedures, which are associated with smaller incisions and faster recovery times compared to traditional open surgery.
(Based on standard clinical outcomes for minimally invasive techniques.)
He holds a university academic appointment and is actively involved in teaching medical students and surgical trainees in Singapore, reflecting his commitment to medical education and continuous learning.
Dr. Ravi is affiliated with various international and local professional bodies including:
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