Case report of patient with post surgical neuropathic right iliac fossa pain treated with pregabalin
Introduction
A 71 year old gentleman was seen in the Pain Clinic with right iliac fossa pain.
Examination findings
On examination he had right iliac fossa pain and neuropathic type pain which he described as a clawing, spasm-like pain, which was better on lying down. There was local tenderness on palpation, no masses were present and he felt there was an acute, sharp, dragging pain which he got up to 4-5 times per day. This started after his most recent right hemicolectomy operation.
Diagnosis of post surgical neuropathic pain
My impression was that he had elements of post surgical neuropathic pain and we discussed the various mechanisms, including adhesion formation and localised nerve damage, secondary to the procedure, and that up to 10-15% of patients can manifest with this.
Ilioinguinal and iliohypogastric nerve blocks as a diagnostic procedure
In the first instance, I performed ilioinguinal and iliohypogastric nerve blocks as a diagnostic procedure, and he was later reviewed. He got some slight benefit from the procedure but this was not long lasting. He was then started on Pregabalin 25 mg twice per day. This was increased to 50 mg twice per day, which he was able to tolerate. He still had some deep burning pains, so this was further increased to 75 mg twice per day.
Five month review
At 5 months, he was reviewed in the clinic. His symptoms were dramatically improved and the Pregabalin was tailed off and stopped.
