Chronic pain in the high-performance athlete is a serious concern since it can result in a career ending decision as we have seen with several athletes in the NFL recently. The most recent high-profile athlete was Luke Kuechley, a linebacker on the Carolina Panthers football team.
Athletes are a unique population when discussing chronic pain and understanding their need for a successful solution. While most athletes are playing through some level of pain, their performance may be affected; and if there is a significant drop in production, they might lose their starting position, cash bonuses, contract extensions, and even their spot on the team. This forces many to downplay their level of pain. However, if the pain is severe enough, it could mean the end of an athlete’s career in a sport that they have invested so much of their lives.
Chronic post-surgical pain is often overlooked and not well understood by most practitioners. Often an athlete may have a ligament, tendon, bone, or joint injury, which requires surgical repair. The ligament may have been repaired with a piece of a nearby tendon; the tendon reinforced with a suture; the fracture is repaired with a nail or has a plate and screws placed on it; or the joint has a scope placed inside to debride the frayed structures. Regardless of the repaired structed, the X-ray, MRI, or ultrasound will show that the repair was successful; however, the pain can persist or in some cases, be even worse. Most will improve with time, and the standard protocol is to reassure patients for the first several weeks after surgery. Unfortunately, some will remain in a high level of pain that is out of proportion to what would be expected after surgery, and they may end up in a pain management physician’s office for a variety of topical creams, nerve blocks, and other procedures.
However, the commonly overlooked source of pain is a peripheral nerve injury. There is a large network of nerves that run underneath the skin throughout the body, and any one of these branches can become damaged from a common sports injury or from surgery. If one of these nerves are damaged, severe pain in that nerve distribution is possible. Often patients will describe the pain as a lightning bolt or an electric shock that can take your breath away. Some of the signs to look for that might point to a nerve injury are:
1. Pinpoint pain over a scar.
2. Electrical/sharp/stabbing pain at a scar
3. Numbness surrounding a scar
An easy way to determine if surgery would be of benefit, requires a physician to inject a local anesthetic at the site of pain. I prefer to use 2% lidocaine since it is fast acting and can give confirmation within 5-10 minutes. If the nerve block is successful, most of the pain should have completely resolved. If not, this would confirm that a nerve injury is present and likely means that surgery can be performed to address the injured nerve. It is important to have a skilled peripheral nerve surgeon perform the surgery since these nerves can be quite small and require the surgeon to be skilled at microsurgery and to have a good understanding of the location of the peripheral nervous system.