My partner is suffering from pulmonary tuberculosis with involvement of the pleura. Her discharge medication from hospital is rifampicin - 900mg and isoniazid - 900mg intravenously 3 times weekly due to intolerance to oral medication. Unfortunately she suffers from constant chronic pain in her right (infected) lung that registers between severe to unbearable pain while she breaths (this varies between shallow to medium intakes of breath). She is taking 800mcg of buprenorphine nightly (sometimes with a top of up another 800mcg in the day), but even this only reduces the severity of the pain to a bearable level temporarily. After 4 weeks of medication the pain does not appear to be subsiding in any manner, if anything it appears to be progressively worsening. After numerous X-Ray's, Ultra-sound's, CT's, MRI's and bone scans, they have found an erosion / thinning of the 7th/8thrib. The consultants / specialists are at a loss as to what to suggest. We are at our wits end after months of sleepless nights (she recently went for 4days and nights with no sleep at all due to severity of the pain). Any guidance, help, suggestions would be greatly appreciated.
So sorry to hear of your partner's pain. It sounds dreadful and, thus far, beyond relief. It would be helpful to first determine the site of origin of the pain. Is it somewhat diffuse, classical pleuritic pain associated with pleurisy, or does the pain occur just in the nerve distribution of the intercostal nerves of the 7th and/or 8th ribs? The intercostal nerves that would have to be treated for pain relief could be identified by the distribution of the pain.
The pleura that covers the chest wall is innervated by the intercostal nerves. These nerves contain pain fibers and pain transmitted to the brain by these fibers can be relieved by medicinal blockage or by actual severence of the nerves, called a neurectomy. This is explained further in an article from the Division of Plastic and Reconstructive Surgery, Johns Hopkins University School of Medicine, and Dellon Institute for Peripheral Nerve Surgery, Baltimore, Maryland 21218, USA, ***@****. Neurectomy for Treatment of Intercostal Neuralgia by Eric H. Williams, Christopher G. Williams, Gedge D. Rosson, Richard F. Heitmiller, A Lee Dellon in Annals of Thoracic Surgery 2008 May, Volume 85, Number 5, pages 1766-1770.
I suggest that you consult with an anesthesiologist who specializes in pain relief and find out if interruption of these nerve pathways would be feasible and likely to provide pain relief. I hope so.
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