How JustAnswer Works:

  • Ask an Expert
    Experts are full of valuable knowledge and are ready to help with any question. Credentials confirmed by a Fortune 500 verification firm.
  • Get a Professional Answer
    Via email, text message, or notification as you wait on our site.
    Ask follow up questions if you need to.
  • 100% Satisfaction Guarantee
    Rate the answer you receive.

Ask Dr. Natasha Your Own Question

Dr. Natasha
Dr. Natasha, Doctor
Category: Medical
Satisfied Customers: 11666
Experience:  American Board Certified in Emergency Medicine and Ivy League trained. Medical Review Officer trained in Drug Testing
Type Your Medical Question Here...
Dr. Natasha is online now
A new question is answered every 9 seconds

Please only answer if you know, thanks. XXXXX

Customer Question

Please only answer if you know, thanks. XXXXX Block injects a medicine to block nerve signaling for about 4 hours. Is there any evidence or medical principle that supports the notion that after this 4 hours, the pain/sensitivity of the corresponding region (rectum) will come back to a level less than the original pain? That a series of these blocks, done a week apart, will produce a significant lasting reduction in pain by incrementally wiping out "nerve memory"? Or is pain relief limited to ONLY the few hours during which the medication is active?
Submitted: 9 months ago.
Category: Medical
Expert:  Dr. Rick, MD replied 9 months ago.
Hi. My name isXXXXX and I am online and available to help you today. Thank you for your patience. I've not talked to you in a while.

I see that you still have over 50 questions that you received answers on, yet you did not give positive feedback. I hope you will not continue that trend with this thread....

To answer your question directly:

The pain relief is limited to the duration of time that the corresponding medication is active.

Is there anything else you would like to discuss at this point or have all your questions been answered to your satisfaction?

I hope this information was helpful for you. But I do work for tips so I want to make sure you are happy with me before rating me. If you have another question on this or a related issue feel free to fire away. You may also receive an email survey after our chat, if you don’t feel that I have earned a “10” rating in all areas, please let me know what I can do to meet your expectations.

Thanks in advance,

Dr. Rick MD FACS


Customer: replied 9 months ago.

You must be looking at the wrong account, because I give an excellent rating every time... in fact, JA has sent me two warnings that I'm giving out far too many excellent ratings.


 


Since you seem to be more worried about grubbing than actually addressing the user's question to earn that rating, I ask that you transfer this question to a different expert who actually wants to read and answer it. Thanks.

Expert:  Dr. Rick, MD replied 9 months ago.
Richard,

I'm not really worried about grubbing at all.....and we have talked before on issues such as this.

My day job as a surgeon pays the bills. I see JA as a service I can offer to those who can not afford or who can not access a physician directly.

I will opt out.

Have a good evening and best of luck to you.

Dr. Rick MD FACS
Expert:  Dr. Natasha replied 9 months ago.
Hi
I would like to help you if I can
The pain pathways are really complex as you have probably figured out.
But there is no evidence that sequential blocks wipe out any sort of memory - in fact they tested this notion of giving one injection followed by another in other regions of the body:
http://www.ncbi.nlm.nih.gov/pubmed/21270723
The actual blocking of the pain is limited to the duration of the medication- which is why the pain returns.
That being said, a lot of pain is more than the activation of the peripheral nerves. It is also related to the interpretation of the pain by the brain, which can produce endorphins which make it feel good and combat the feeling of pain- I am sure that you heard of the runner's high or working through the pain, etc.
So, after getting the injection, although the medication has worn off, the relief of the pain as perceived by the brain can actually cause enough relaxation of the muscles (for example in spasm) so that there is less triggering in the future. An already irritated area will hurt more. If the area is allowed to recover, the pain is felt less in the future.

I hope that this helped.

Please leave positive feedback if it did :-)
Dr. Natasha, Doctor
Category: Medical
Satisfied Customers: 11666
Experience: American Board Certified in Emergency Medicine and Ivy League trained. Medical Review Officer trained in Drug Testing
Dr. Natasha and 6 other Medical Specialists are ready to help you
Customer: replied 9 months ago.

Great info, I'm glad I found someone with knowledge in this specific area. My rectum is severely inflamed the past couple years due to Crohn's, resulting in a persistent sore/bruised type pain, and intense pain spikes when I use the toilet (~20/day) due to spasms and the rectum trying to push it'self out. I had one block done, which reduced the pain, but for only 3-4 hours, then came back, along with the added soreness from the injection, so it really didn't seem worth it.


Are we saying that getting 3 more blocks will simply be a repeat of this first injection experience, and will not produce any long-term benefits?

Expert:  Dr. Natasha replied 9 months ago.

Well, as mentioned before, it *might* help- because tissue that is in pain doesn't heal as well as tissue that is not- and inflammed tissue aggravates pain.
I imagine that you are working with a pain specialist.

Another option may be botox. - have you considered this?

http://www.lacolon.com/patient-education/anal-fissure


I hope that this helped.

Please leave positive feedback if it did :-)

Customer: replied 9 months ago.

So to wrap up this question... The first article you referenced does not explore if there is any long-term or cumulative benefit to doing blocks (beyond the duration of the injected medicine). Have any studies shown whether or not benefits exist, and to what extent?


 


You stated "An already irritated area will hurt more."... so the blocks will increase my pain? I will ask my surgeon about that botox option.

Expert:  Dr. Natasha replied 9 months ago.
I was not able to find any such studies over long term- this was divided by minutes. But I'll look again.And the blocks could help. It may allow the area to heal faster by decreasing pain-> better muscle relaxation-> less anal spams-> fewer fissure and Similar trauma
Customer: replied 9 months ago.

But if the medication only decreases pain for 3 hours out of a week, that's only 1% I'll be relaxing the muscles and thus free of the spasms... compared to 99% of the time I'll be having spasms. I don't see how a small moment of relaxation can be considered a patient's path of healing, when it's engulfed in a sea of spasms. Or am I missing something?

Expert:  Dr. Natasha replied 9 months ago.
it actually can, by decreasing lactic acid build up etc.
And it can help psychologically which is huge

JustAnswer in the News:

 
 
 
Ask-a-doc Web sites: If you've got a quick question, you can try to get an answer from sites that say they have various specialists on hand to give quick answers... Justanswer.com.
JustAnswer.com...has seen a spike since October in legal questions from readers about layoffs, unemployment and severance.
Web sites like justanswer.com/legal
...leave nothing to chance.
Traffic on JustAnswer rose 14 percent...and had nearly 400,000 page views in 30 days...inquiries related to stress, high blood pressure, drinking and heart pain jumped 33 percent.
Tory Johnson, GMA Workplace Contributor, discusses work-from-home jobs, such as JustAnswer in which verified Experts answer people’s questions.
I will tell you that...the things you have to go through to be an Expert are quite rigorous.
 
 
 

What Customers are Saying:

 
 
 
  • I feel so much better today, and upon further investigation believe that there is a chance that the responses I got saved me from a serious, even life threatening situation. I am very grateful to the experts who answered me. Susan O. USA
< Last | Next >
  • I feel so much better today, and upon further investigation believe that there is a chance that the responses I got saved me from a serious, even life threatening situation. I am very grateful to the experts who answered me. Susan O. USA
  • I can go as far as to say it could have resulted in saving my sons life and our entire family now knows what bipolar is and how to assist and understand my most wonderful son, brother and friend to all who loves him dearly. Thank you very much Corrie Moll Pretoria, South Africa
  • I thank-you so much! It really helped to have this information and confirmation. We will watch her carefully and get her in for the examination and US right away if things do not improve. God bless you as well! Claudia Albuquerque, NM
  • Outstanding response time less than 6 minutes. Answered the question professionally and with a great deal of compassion. Kevin Beaverton, OR
  • Suggested diagnosis was what I hoped and will take this info to my doctor's appointment next week.
    I feel better already! Thank you.
    Elanor Tracy, CA
  • Thank you to the Physician who answered my question today. The answer was far more informative than what I got from the Physicians I saw in person for my problem. Julie Lockesburg, AR
  • You have been more help than you know. I seriously don't know what my sisters situation would be today if you had not gone above and beyond just answering my questions. John and Stefanie Tucson, AZ
 
 
 

Meet The Experts:

 
 
 
  • Dr. Thomas, MD

    Board Certified Physician

    Satisfied Customers:

    46349
    Internal Medicine--practice all of internal medicine, all ages, family, also Integrative, CAM, etc
< Last | Next >
  • http://ww2.justanswer.com/uploads/DR/DrThomasMd/2012-7-25_134438_Imagess1.64x64.jpg Dr. Thomas, MD's Avatar

    Dr. Thomas, MD

    Board Certified Physician

    Satisfied Customers:

    46349
    Internal Medicine--practice all of internal medicine, all ages, family, also Integrative, CAM, etc
  • http://ww2.justanswer.com/uploads/MY/mysticdoc/2012-6-8_15615_mysticdoc3.64x64.jpg Dr. D.J.'s Avatar

    Dr. D.J.

    Board Certified Physician

    Satisfied Customers:

    14679
    MD
  • http://ww2.justanswer.com/uploads/agketch/2008-7-14_184046_drketchresized.jpg Dr. Ketch's Avatar

    Dr. Ketch

    Board Certified Physician

    Satisfied Customers:

    76
    Medical Degree, Former Assistant Professor at School of Medicine at Yale University
  • http://ww2.justanswer.com/uploads/FA/FamilyPhysician/2013-8-31_191624_JA550x500Photo.64x64.jpg Family Physician's Avatar

    Family Physician

    Doctor

    Satisfied Customers:

    2562
    Emergency Medicine and Family Practice for over 26 years
  • http://ww2.justanswer.com/uploads/DR/drappapo/2013-8-16_22576_drdavid.64x64.jpg Dr. David's Avatar

    Dr. David

    Board Certified Physician

    Satisfied Customers:

    224
    Treat children/young adults, former chief resident, multiple publications
  • http://ww2.justanswer.com/uploads/DrDLove/2009-08-12_141522_DrDLove.jpg Dr. D. Love's Avatar

    Dr. D. Love

    Doctor

    Satisfied Customers:

    11961
    Family Physician for 10 years; Hospital Medical Director for 10 years.
  • http://ww2.justanswer.com/uploads/CO/commissure/2011-4-15_192514_REISD20080926JR1090.64x64.jpg Dr. David's Avatar

    Dr. David

    Board Certified Physician

    Satisfied Customers:

    10667
    Experienced Physician trained in New York City. I'm ready to help.