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Why Are There So Few Peripheral Nerve Surgeons Focusing On Chronic Pain?

By June 8, 2021June 21st, 2021Educational Articles, FAQ, Videos

This FAQ video addresses the single biggest problem with chronic pain stemming from a peripheral nerve problem.

Why aren’t there more surgeons performing these life-changing surgeries? Dr. Tollestrup explains why this conundrum exists and how we can fix it in the future.

Oftentimes, patients will, once they find me and we’ve talked and whatnot, a lot of times a question that comes up is, why is there nobody in my home state or my home country that does this surgery? Why don’t doctors know about this? Why isn’t this readily available knowledge?

The first reason is that traditionally chronic pain has been viewed as a medical problem for which you take medicine in your mouth. And with the advent of more modern medical technology, a lot of times it can involve a spinal cord stimulator or a peripheral nerve stimulator as well.

The idea that you could really fix these problems surgically has just not crossed anybody’s radar screen. The system is just so ingrained that you broke your leg, that all healed up, the orthopedic surgeon did a great job. It’s now a year later and you’re having burning pain in your thigh. Well, that’s chronic pain. All the doctors just kind of shut their brain off and say, “You go to pain management.” That’s where people who have pain go.

The other problem is that this kind of knowledge is not taught to doctors at any level of their education. You can go to medical school, then a residency, then as many fellowships as you want to and you’re still not going to learn anything significant about peripheral nerves. There’s never any in-depth knowledge taught about peripheral nerve anatomy. It’s very complex anatomy. There’s lots and lots of nerves. And within each nerve, especially as they get smaller and smaller, there’s lots of variation that occurs. So from one person to another, you could be dealing with quite different anatomy.

And the other thing is nobody ever teaches the stories or the presentations of these kinds of nerve problems. Just about any doctor who’s gone to medical school can recognize the story that goes along with acute appendicitis or gallstones, or something like that, or a heart attack, but you never learn how pain presents and where it radiates to and et cetera, et cetera. I was fortunate enough to do a fellowship with really the father of the field, Dr. Dellon. He trained a certain number of fellows. Most of them, however, sort of went over to the dark side of cosmetic plastic surgery. And there’s only been just very few of us who’ve really dedicated ourselves to this field and to expanding it and pushing it on.