General Anaesthesia

[skyblue]

I'm going in for an impacted wisdom tooth extraction on Tuesday that requires general anaesthetic. Right now, my pelvic floor muscles are incredibly tight, particularly the obturator internus and piriformis, thus causing a massive flare on the PN.

It is my understanding that general anaesthetics generally have a strong muscle-relaxant component, which is why a breathing tube is needed. It got me thinking that the GA itself might do a good job of loosening the pelvic muscles and thus giving the PN the break that it needs. If true, I wonder to what degree the GA involved in PN surgery has been a contributional factor to the success of any surgery? And by extension, could any failure with PN surgery have masked any GA successes? (i.e cases where surgery has caused flare-ups and masked the ability of the GA to allow the nerves to breath). Has anyone with PNE had any experience of a GA for non-pelvic surgery? It would be interesting to know if it has any kind of effect.

In any case, my GA is on Tuesday so I'll definitely be comparing pain levels before and after. I'll report back later this week!

[nyt]

Skyblue, we've had some discussions on this board around GA. I have always felt that when individuals are better for 4-12 weeks after surgery and the pain starts to slowly return and by 12 weeks they are back to square one that GA was what was responsible for the decreased pain. GA not only helps relax muscles but the medications work at the central nervous system level also quieting down the central mechanisms of pain. I'll be interested to see if you notice any difference.

Good luck with your dental procedure. Praying all goes well for you.

[helenlegs 11]

Hmm interesting. That sounds completely feasible nyt. I hope the GA has this calming effect for you skyblue, here's hoping that it lasts and lasts .

When I have had any extended shooting pain episodes, that I just CAN NOT get under control I do wonder whether gas and air or even cannabis would help. I'm sure it could, there's just never any around when needed .
I've tried 'breathing' techniques at this stage, hot baths. . . . but I've got to say that I'm just glad when they subside, and for no apparent reason. They usually occur in the middle of the night.
Has anyone else had the shooting (electric shock) pains every few minutes apart (2-5ish) that lasts for AGES! over an hour ?
3 and a 1/2 hrs was my worst one. I had put these episodes down to muscle contractions, as it is akin to childbirth, although admittedly, I feel no contraction, just the shooting pain.

Something that you said Violet about the nerves sending the signals to the muscles, has made me question my muscle 'theory' tho'. Now this GA discussion. . . . is it the calming of the central nervous system or muscle relaxant or a combo?? Even if, say gas and air or ganja did work on my 'episodes', I doubt that any conclusion could be drawn? was it because of the muscle relaxant properties or because of the quietening effects on the central nervous system.
Does it matter if it works .

[skyblue]

Good luck with your dental procedure. Praying all goes well for you.

Thanks nyt.

Has anyone else had the shooting (electric shock) pains every few minutes apart (2-5ish) that lasts for AGES! over an hour ?

That lightning pain is surely the worst thing in the world. Luckily for me I've only experienced it once, and was about two weeks after coming down with symptoms of PN in August 2008. I'm fairly certain it was a consequence of my GP fiddling around with his finger in a rectum examination. But yes, it lasted for about 24 to 48 hours with lightning blasts going down into my right testicle every 3-5 minutes or so. It was horrible. I couldn't sleep, couldn't walk, couldn't move - I was just lying there waiting for the next shock to come. That's actually been the only episode of it though, and I think represents my worst symptoms. And it was because of that episode that I immediately decided to enforcen a hyper-avoidance regime concerning sitting, and religiously followed a gradual re-introduction of sitting over the following three years, which I think is probably the reason I have never had as bad symptoms subsequently. I do wonder though: If I hadn't been so religious about the re-introduction of sitting gradually, might I have experienced that shooting pain again(?), or might I have realised that I could actually sit quite normally far sooner than when I actually eventually did? (in July 2011)

[helenlegs 11]

I couldn't even say that I was at my worst when I've had my 'lightening episodes', so who knows sky blue. It's all too crazy. Good luck with the dental work
Helen

[Laura]

Skyblue,

You've brought up a very interesting topics on general anesthesia and the part it plays on muscle relaxation and how that affects the nerve.
I've had pn for almost a year now, I'm not sure what brought it on. Very early on I practiced hyper-avoidance in requards to sitting, bending, heeding all the advice per pudendalhope forum .
I was also eventually put on 1200mg of Gabapentin and 25mg of Amitriptyine. As time went on I had all the musculoskeletal problems that accompany this lousy condition in my perineal area and hamstrings. I did have one nerve block done a couple of months into pn and had numbness for a two day period. Once the anesthetic wore off the pain returned. After about 7 days I had a flare with shooting pains that I hadn't had before. I was told I could have more blocks, but between the flare, and reading that nerve blocks were more a diagnostic tool, rather than a cure, I decided against it. In the meantime I started using a compounded amitriptyine creme which I applied about 3-4 times a day to my perineal area. In the meantime my flares came from bm's.
I had been diagnosed years before with irritable bowel syndrome, in fact prior to pn I was chronically constipated for about 3 years and who knows if that led to pn, even though I knew better than to strain, in order to produce a bm. Now that condition has totally turned around and instead of constipation, I now was having sometimes 7-8 loose bm's a day and that was causing the nerve to flare! That has been going on for quite a while now, but it has been flaring the nerve less and less. It does however cause my muscles to become more tight than on the days when I don't have 7-8 bm's. I also use a heating pad and self-massage to work on my tight muscles and trigger points. I forgot to mention that for about 2 months now I am off all medication except the creme and the 25mg of Amitriptyine I take at bedtime. The nerve pain is almost non-existant, the chronic muscles have become less, and I would say that has been helped by purchasing my own ultrasound and using it twice a day. I have tried to sit on a cushion for maybe 5-10 minutes maybe once or twice a week. It does not flare my nerve, but when I go to stand up I have a bad ache in my tailbone, like I was kicked by a horse or something. It only lasts a few seconds, which I assume is the result of chronically tight pelvic muscles and i have hope that will eventually resolve Itself one of these days! So going back to the general anesthesia discussion, of relaxing the muscles and having a positive affect on the nerve, I think it has some merit. First comes the irritated nerve and then the constant muscle tension which creates a vicious cycle. Of course I'm not saying this is true in every case, but with time maybe a lot more people would have better outcomes with hyper-avoidance and working on their muscle issues. All we can do is educate ourselves from this website, avoid whatever we possibly can that is harmful to our delicate nerves and have hope we can get better. That is my wish for all of us who deal with this painful condition!
Almost forgot to ask, in your signature it says you were cured, but then had a relapse. Do you know what caused you to relapse?

Helen.
So sorry to read about those shooting pains you had. They are the worst, I think, rather than constant pain. I wish you the best.

Laura

[HerMajesty]

Skyblue,

You actually just answered a question of mine that was puzzling me...I had surgery on 3/20 and for the week prior I was not allowed to take NSAIDS or Aspirin to prevent excessive bleeding...well, wouldn't you know it, I, the gal who never has any kind of musculoskeletal pain, managed to do something awful to my neck and shoulder exactly a week pre-op. I was in such pain, I spent all day and all night sitting or lying with a heating pad or hot neck wrap, and became totally useless. On the plane ride to get to the surgery, my neck pain started to turn into a migraine and I spent the last couple of pre op days totally miserable, lying on a heating pad and slathering menthol on my head. After I had the surgery all that was just GONE. I had other things on my mind but at some point I did stop and say, "Hey, what happened to all that awful neck and shoulder pain I had pre-op"? So now thanks to you I think it was the anesthesia. Weird. But a happy kind of weird.

[skyblue]

Hi everyone.

Well I survived the wisdom tooth op under GA. Next stop is the braces put on in two weeks from now, and then jaw surgery later this year around October/November time. So the first leg is out of the way and 'm taking it one step at a time.

So as for the GA - Just before they put me to sleep I spoke to the anaesthetist about the kind of anaesthetic they were using, and unfortunately, as the operation was relatively simple, so too was the anaesthetic. Apparently it didn't contain any muscle relaxant and only had the necessary elements to put me to sleep. I was a bit disappointed.

Weirdly though, the GA did have some kind of effect, even without the muscle relaxant. It wasn't a massive effect but certainly the whole pelvic region was calm for a good 24 hours, before finally going back to it's familiar irritable state.

Actually, the night before the operation I had gotten up in the middle of the night to get some water, and ended up pulling some kind of muscle, which set some muscle spasms going, which (typically) upset the nerve again. Perhaps if it wasn't for that then maybe the effects of the GA might have lasted longer.

In fact, I'm starting to now believe that the only thing that calms the nerve is time itself, and possibly if I were to have a GA at a point in time when the nerve was calm (but where only the muscles were irritable) then that might give more successful results.

[skyblue]

Almost forgot to ask, in your signature it says you were cured, but then had a relapse. Do you know what caused you to relapse?

Hi Laura. It's difficult to know for sure, but I think it's fair to say it was probably my own stupidity that did it. The trouble was that my journey back to normality was so long and slow - there never really was a single point where I suddenly woke up and was feeling better. After three slow years of gradual recovery, in time I forgot I even ever had PN in the first place, and thus, probably became complacent. Certainly, post July 2011, the nerve had proven itself to be strong and healthy: I could swim, cycle, do anything etc.

What I can say for sure is that the relapse started with just an innocent sneeze! I was sitting on the sofa, suddenly sneezed, and the shockwaves of the sneeze must have gone straight down the chassis of my torso because the next thing I know the nerve seems to let out a little electric yelp - not exactly painful - a bit like putting your tongue to a battery, but way down in the pudendal area. It was basically an "Uh-oh!" moment. From there, everything went downhill pretty quickly.

Obviously the relapse wasn't solely a consequence of the sneeze - more like a "straw that breaks the camels back" situation. There are a number of things I can think of in the weeks before that could have contributed specifically:-

Suddenly cycling after a winter of relative docility.
Suddenly swimming, after a winter of relative docility.
Working long hours in front of a computer terminal.
Pushing some heavy furniture up some stairs.

Any and all of these probably had some effect, and like I said, I guess it really comes down to my own stupidity and becoming complacent.