Perineal pain after rectal amputation: A 5-year follow-up

Abstract

A long-term study was undertaken on 286 patients who underwent perineal resection for rectal cancer to ascertain the incidence of chronic post-surgical pain in this group and to determine the likely cause for these pains. In 33 patients (11.5%) experiencing persistent perineal pain over the 5-year follow-up, most (70%) developed pain within weeks after surgery. The remaining 30% presented with pain several months later. This group with late onset pain died from known recurrence of adenocarcinoma in 80% of cases, giving this symptom the highest early confirmatory sign for tumour over other clinical tests. Those with early onset pain had a 26% tumour recurrence rate and clinical features of pain indicative of phantom anorectal pains in most cases. While the pain-onset time from surgery was the most sensitive predictor of cause and outcome, other distinguishing features in respect of site and quality of pain as well as differing responsiveness to drug therapy allowed for further separation of deafferentation from nociceptive pain for these two clinical groups.

Visceral pain in humans: Lessons from animals

“…Trauma, most commonly to the upper limb, resulted in chronic pain in 18.7% of patients (46% female, 54% male). In a study of 86 patients who underwent perineal resection for rectal cancer, 33 patients (11.5%) experienced persistent perineal pain during the 5-year period of followup [61]. These results demonstrate that, although most patients have sufficient resources to overcome the nociceptive mechanisms set into play by surgery and trauma, significant numbers of patients develop chronic pain after surgery, particularly if the viscera was involved.…”

Diltiazem for the Management of Malignancy-Associated Perineal Pain and Tenesmus

“…2,3 The pain syndrome is frequently described as ''tight,'' ''aching,'' ''drilling,'' or ''pressing'' located deep within the rectum or pelvis 4 and often associated with rectal tenesmus and urgency. [3][4][5] Symptoms occur most commonly as a result of tumor recurrence, or postsurgical resection, or radiation injury. [3][4][5][6] In this population, pain and defecation issues often significantly impact quality of life.…”

“…[3][4][5] Symptoms occur most commonly as a result of tumor recurrence, or postsurgical resection, or radiation injury. [3][4][5][6] In this population, pain and defecation issues often significantly impact quality of life. 5,7 Such symptoms can be quite difficult to manage despite utilization of currently available therapies including oral analgesics, radiation and interventional techniques.…”

“…5,7 Such symptoms can be quite difficult to manage despite utilization of currently available therapies including oral analgesics, radiation and interventional techniques. 3,4,8 CCBs are a chemically diverse group of medications, most well known for their cardiovascular benefits. 9,10 They are also beneficial in the treatment of noncardiovascular diseases such as Raynaud's, migraine, pulmonary hypertension, and esophageal spasm.…”

Safety of opioid patch initiation in Australian residential aged care

“…Following amputation of a limb, and also breast, tongue, teeth, genitalia and even inner organs such as the rectum, or a deafferentiation injury such as brachial plexus avulsion (Bates & Stewart, 1991;Boas et al, 1993;Dijkstra et al, 2007), a number of phenomena can develop. These require differentiation.…”