At times, uncovering the cause of a patient's pain requires piecing together clues from their medical history. A woman, prominent in the St. Augustine community, was referred to my office after being released from the hospital a second time without a definite diagnosis as to the reason for her abdominal pain.

For years she had been suffering intermittent pains--some times worse than others--in the lower right quadrant of her abdomen, along with pain in the area of her right groin, as well as the right side of her genitalia.

Based on her description of the pain, different doctors, on two separate occasions, admitted her to the hospital. They were concerned, and rightfully so, that surgery might be required, but neither investigation warranted a surgical intervention.

Upon her release from the hospital, her case was referred to me. Her files were forwarded to my office and an appointment was scheduled at my office. During her first visit, I conducted a detailed interview aided by the documents, which she had filled out, including her medical history. Among the things that stood out in her history was an emergency appendectomy that had been performed several years earlier.

When I asked if she had had the abdominal and related pains before the appendectomy, she said that she hadn't. She explained that the pain definitely began sometime after the surgery. During the physical examination, I isolated a very tender point in the area of the old appendectomy scar.

Diagnosis: Piecing together the information gathered--from her files, her medical history, the interview with the patient, and the physical examination--revealed the most reasonable diagnosis: post-traumatic neuropathy with a possible neuroma formation at the site of the most intense pain.

Most likely, the pain had been caused by minute nerve fibers getting entrapped in the scar tissue during the normal healing process after her appendectomy.

Treatment: Treatment of her pain began with two weeks of conservative therapy, involving anti-inflammatory medication and Neurontin®, followed by a re-evaluation in my office. During the second visit, after determining that the treatment had given her some relief, I proceeded to inject the area of maximal tenderness with a local anesthetic and Kenalog.

Results: After the second treatment, the patient's abdominal and related pains vanished, and they have not returned. My patient is now pain-free, and happy that, after years of suffering and anxiety brought on by not knowing what was wrong, she can resume her normal active lifestyle.