Chronic Lower Back Pain After Gynecological Surgery: Possible Nerve Issues?

Long-term lower back pain after gynecological surgery?

Hello Doctor, I have undergone about five surgeries due to gynecological issues including chocolate cysts, fibroids, endometriosis, and uterine fibrosis.
The last surgery was approximately 5-6 years ago when I had a laparoscopy for a chocolate cyst.
After the anesthesia wore off post-surgery, I felt significant soreness in my lower back (near the hips), to the point where I needed to bend my knees to keep my back parallel to the bed.
At that time, the doctor mentioned that it was normal after surgery and that it would improve, but the soreness has persisted.
I experience daily lower back pain, which intensifies during my menstrual period, when I need to have a bowel movement, or when I am overly fatigued.
The pain is so severe that I cannot stand up straight and have to walk bent over.
During this time, I have consulted with specialists in obstetrics and gynecology, gastroenterology, neurosurgery, orthopedics, and neuromuscular rehabilitation, but none have identified the source of the problem.
I have undergone X-rays, bone density tests, ultrasounds, and MRIs, and the consensus has been that there are no issues found, and I have been advised to take pain medication.
I would like to ask the doctor if it is possible that the surgery caused nerve damage or compression, which could explain my daily back pain.
What tests could be performed to identify this? (I did not have this issue before the surgery, and the pain started immediately afterward, so I believe it may be related to that surgery.) Would it be appropriate to see a neurologist to investigate this further?

Ivy, 40~49 year old female. Ask Date: 2023/04/13

Dr. Peng Shiwei reply Neurology

Hello, while it may be related to the surgery, it is difficult to provide a definitive assessment based solely on the information provided.
I recommend that you consult with the physician who performed your examination for a detailed inquiry.
If you wish to seek assistance from a neurologist, you may also request an MRI to aid in the physician's evaluation.
Wishing you a speedy recovery, and thank you for your question.

Reply Date: 2023/04/13

More Info

Chronic lower back pain following gynecological surgery, particularly after multiple procedures such as those for chocolate cysts, fibroids, and endometriosis, can indeed be a complex issue. Your experience of persistent pain, especially after the last laparoscopic surgery, raises valid concerns about potential nerve damage or compression resulting from the surgical interventions.

Firstly, it is essential to understand that surgical procedures in the pelvic region can sometimes lead to complications, including nerve injury or irritation. The pelvic area is densely populated with nerves, and any manipulation during surgery can potentially affect these nerves. This could explain the onset of your lower back pain after the last surgery. The pain you describe, particularly the need to bend your knees to alleviate discomfort, suggests that there may be some underlying mechanical or neurological issue at play.

Given that you have undergone various imaging studies, including X-rays, MRIs, and ultrasounds, which have not revealed any significant abnormalities, it is understandable to feel frustrated. However, imaging studies may not always detect subtle nerve injuries or issues related to nerve entrapment. In your case, the persistent nature of your pain, which exacerbates during menstruation or physical exertion, could indicate a possible myofascial pain syndrome or nerve entrapment syndrome, where the nerves are compressed by surrounding tissues.

To address your concerns about nerve involvement, it would be prudent to consult with a neurologist or a pain specialist who can perform a thorough evaluation. They may recommend additional tests, such as electromyography (EMG) or nerve conduction studies, which can help assess the function of the nerves in the affected area. These tests can provide insights into whether there is any nerve damage or dysfunction that could be contributing to your chronic pain.

Moreover, considering the multifactorial nature of chronic pain, a multidisciplinary approach may be beneficial. This could include physical therapy focused on strengthening the core and pelvic muscles, which can help support the lower back and alleviate pain. Additionally, a pain management specialist could explore options such as nerve blocks or other interventional procedures that target pain relief.

It is also essential to consider the psychological aspect of chronic pain. Chronic pain can lead to emotional distress, anxiety, and depression, which can further exacerbate the perception of pain. Therefore, incorporating psychological support or cognitive-behavioral therapy may also be beneficial in managing your symptoms.

In summary, while it is possible that your chronic lower back pain is related to nerve issues stemming from your surgeries, a comprehensive evaluation by a neurologist or pain specialist is crucial. They can help determine the underlying cause of your pain and recommend appropriate treatment options. Additionally, exploring physical therapy and psychological support may provide further relief and improve your quality of life. Remember, you are not alone in this journey, and seeking help from specialists who understand chronic pain can lead to better management strategies.

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