Post-Appendectomy: Intercostal Nerve Pain in New Moms

Can appendicitis surgery cause intercostal neuralgia?

Hello, doctor.
I am a new mother, and it has been over eight months since I gave birth.
The day after I completed my postpartum confinement, I underwent surgery for appendicitis.
Since the surgery, I have been experiencing pain in my upper left abdomen.
After about three months, the pain shifted to my ribs, where I feel a similar aching and sharp pain on both sides daily.
I also have persistent lower back pain.
However, the discomfort from the rib area is particularly bothersome.
If laparoscopic surgery can lead to neuropathic pain, I can understand the pain around the navel, but can neuropathic pain radiate to the intercostal area? It has been over six months since the surgery, and I am still troubled by neuropathic pain every day.
I have also consulted traditional Chinese medicine, but there has been little effect.
I am unsure how to proceed with treatment.
I would appreciate your assistance in addressing my concerns.
Thank you!

Ms. Zhang, 30~39 year old female. Ask Date: 2019/04/26

Dr. Chen Jiaming reply Surgery

Generally, laparoscopic surgery in the lower abdomen is unlikely to cause persistent pain (especially in the bilateral ribs).
You might want to reconsider the changes in daily postures and body mechanics related to postpartum childcare, which could contribute to the fatigue symptoms in the thoracolumbar region.
After all, many mothers experience various physical changes after childbirth, which is a more reasonable and scientifically supported inference.

Reply Date: 2019/04/26

More Info

Post-appendectomy pain, particularly intercostal nerve pain, can be a distressing experience for new mothers like yourself. After undergoing an appendectomy, it is not uncommon to experience various types of pain, including abdominal pain, referred pain to the ribs, and even back pain. Understanding the underlying mechanisms of this pain can help in managing it effectively.

The intercostal nerves, which run between the ribs, can become irritated or entrapped following abdominal surgeries, including appendectomies. This irritation can lead to a condition known as post-surgical neuropathic pain. The pain you are experiencing in your left upper abdomen and the subsequent transfer of pain to the rib area may be attributed to several factors:
1. Nerve Irritation or Damage: During surgery, the intercostal nerves may be stretched, compressed, or even cut. This can lead to neuropathic pain, which is characterized by sharp, burning, or tingling sensations. The pain can sometimes radiate to other areas, including the ribs and back.

2. Scar Tissue Formation: After surgery, scar tissue can form around the surgical site. This scar tissue can adhere to nerves and other tissues, leading to pain and discomfort. This phenomenon is known as adhesions, and they can cause pain that may feel like it is coming from different areas of the body.

3. Muscle Tension and Posture: As a new mother, you may be adopting certain postures while caring for your baby that could contribute to muscle tension in your back and abdomen. This tension can exacerbate pain in the rib area and may lead to discomfort that feels like nerve pain.

4. Visceral Pain: Sometimes, pain from internal organs can be perceived in areas that are not directly related to the organ itself. This is known as referred pain. The appendix is located in the lower right abdomen, but irritation or inflammation in the abdominal cavity can lead to discomfort in the upper abdomen and rib area.

Given that you have been experiencing this pain for over eight months, it is essential to seek further evaluation and treatment. Here are some recommendations:
- Consult a Pain Specialist: A pain management specialist can provide a comprehensive evaluation of your symptoms and may suggest treatments such as nerve blocks, physical therapy, or medications specifically aimed at neuropathic pain.

- Physical Therapy: Engaging in physical therapy can help strengthen the muscles around your abdomen and back, improve posture, and alleviate pain. A physical therapist can also provide exercises tailored to your needs as a new mother.

- Medication: If you haven't already, discuss with your healthcare provider the possibility of medications that target nerve pain, such as gabapentin or pregabalin. These medications can help manage neuropathic pain effectively.

- Alternative Therapies: Since you mentioned trying traditional Chinese medicine without much success, you might also consider other alternative therapies such as acupuncture, chiropractic care, or massage therapy, which may provide relief.

- Mind-Body Techniques: Stress and anxiety can exacerbate pain perception. Techniques such as mindfulness, meditation, or yoga may help manage stress and improve your overall well-being.

In conclusion, while it is not uncommon to experience intercostal nerve pain after an appendectomy, especially in the context of being a new mother, it is crucial to address these symptoms proactively. A multidisciplinary approach involving pain specialists, physical therapists, and possibly alternative medicine practitioners can help you find relief and improve your quality of life. Please consult with your healthcare provider to discuss the best course of action tailored to your specific situation.

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